Victoria Suchan

Examining the acceptability and effectiveness of transdiagnostic, Internet-delivered cognitive behaviour therapy for symptoms of postpartum anxiety and depression: A randomized controlled trial

Doctoral Dissertation, Victoria Suchan, 2021

Background: Following childbirth, women experience significant biological, physical, social, and emotional changes, wherein 20% of new mothers experience clinically impairing symptoms of anxiety or depression. Although effective treatment options exist, such as cognitive behaviour therapy (CBT), new mothers report barriers to accessing such services. Importantly, many of these barriers can be overcome using Internet-delivered CBT (ICBT), which has been found to be effective in the treatment of various mental health concerns, including depression and anxiety. As postpartum anxiety and depression often co-occur, transdiagnostic ICBT that addresses both

Method: The current study explored the acceptability and effectiveness of a transdiagnostic ICBT program, the Wellbeing Course for New Moms, with a sample of Saskatchewan women who had an infant less than one year of age. Participants (= 60) endorsing symptoms of depression or anxiety were randomly assigned to the Wellbeing Course for New Moms or a waitlist control (WLC) group. Participants completed measures pre-treatment, post-treatment, and 1-month follow-up. Treatment satisfaction, therapeutic alliance, and open-ended questions assessing participant experiences with treatment were also explored.

Results: The analyses revealed that both treatment and WLC participants experienced significant reductions in anxiety, depression, and distress over time, as well as improvements in mother-infant bonding.  The treatment group reported significantly superior improvements in symptoms of anxiety and distress as compared to the WLC. For the treatment group large changes were seen on measures of anxiety and depression and symptom improvement was maintained at follow-up. On some measures of depression, however, differences between the WLC and the treatment group not statistically significant, although trends were observed.

Conclusions: Participants were satisfied with this treatment modality and were able to establish a strong working alliance with their online therapist. Results from the current study provide emerging evidence for transdiagnostic ICBT in the treatment of postpartum anxiety and depression.

Increasing favourable expectations of therapist-assisted Internet-delivered cognitive behaviour therapy: Importance of testimonial-based versus statistically-based information

Masters Thesis Results, Victoria Owens 2017

The current study explored whether transdiagnostic, Internet-delivered cognitive behaviour therapy (ICBT) is effective in the treatment of health anxiety, characterized by excessive worry about one’s health and fear that one will acquire an illness. Further, the level of therapist support, namely weekly therapist support or optional therapist support, was examined. Ninety-six clients participating in the Wellbeing Course, an 8-week transdiagnostic ICBT program, with elevated health anxiety symptomatology (≥15 on the Short Health Anxiety Inventory [SHAI]) were included in the current study. Results suggest that health anxiety symptoms significantly reduce following transdiagnostic ICBT. Additionally, clients receiving both weekly and optional therapist contact experienced symptom reduction to a similar extent; however, clients that received weekly therapist contact displayed more favourable treatment engagement (i.e., more lessons completed, more messages sent). Future research is warranted to disentangle the role of therapist contact on symptom reduction and treatment engagement. The results from the current study lend support for the use of transdiagnostic ICBT in the treatment of health anxiety.

Increasing favourable expectations of therapist-assisted Internet-delivered cognitive behaviour therapy: Importance of testimonial-based versus statistically-based information

Honours Thesis Results, Victoria Owens 2015

Background: Internet-delivered Cognitive Behaviour Therapy (ICBT) is an effective method of treating anxiety and depression. Nevertheless, many individuals have low expectations about this treatment given that it is novel. This presents a problem, as higher expectations of treatment have been linked to more favourable treatment outcomes.

Objective: The aim of the present study was to determine if an educational video about ICBT is an effective way to increase individuals’ views of this treatment.

Methods: Participants were assigned to view an educational video about ICBT containing testimonial-based (n = 44) or statistically-based information (n = 53). Questionnaires administered pre- and post-video were analyzed to assess for changes in attitudes towards ICBT, and to determine whether one video was more effective. Correlates between participant characteristics and views of ICBT were examined.

Results: Perceptions of ICBT significantly improved post-video; however, the difference between the two video conditions was not significant. While participant characteristics (e.g., age, sex) were not correlated with views of ICBT, how participants rated the video were.

Conclusion: Educational videos effectively increase expectations of ICBT, and the quality of information presented in the video is more important than the particular information presented.

Practice Implications: In order to facilitate the greatest therapeutic benefit from an ICBT treatment program, it may be beneficial for clients to watch an educational video prior to the onset of treatment.

Catherine Couture

Client correspondence in Internet-delivered cognitive behaviour therapy: An examination into client communication with therapists and symptom improvement

Honours Thesis Results, Catherine Couture 2017

Background: Internet-delivered cognitive behavioral therapy (ICBT) is an efficacious treatment for anxiety and depression. Most ICBT programs include therapist assistance in the form of secure online messaging; however, a high degree of variability has been found in the content of client and therapist correspondence. Recent research conducted by Svartvatten et al. (2015) found that client statements suggesting alliance bolstering and text expressing a positive change in mood after the implementation of a suggested skill or exercise appear to correlate with greater symptom improvement.

Purpose: The current study sought to examine: (1) if previously identified themes in client communication with their Internet therapist (Svartvatten et al., 2015) would replicate in a transdiagnostic ICBT program for depression and anxiety; and (2) if these themes correlated with symptom improvement and treatment completion. 

Method: The present study used data from 80 randomly selected patients from a previously published trial of ICBT for depression and or anxiety. Client emails (on average 5.69 per client) were examined for the presence of 10 themes reported by Svartvatten et al. (2015).

Results: Statistically significant differences were found in the frequency of all themes between the two studies. Further, in the current study, greater frequency of statements classified as maladaptive repetitive thinking and problems with treatment content correlated with smaller improvements in symptoms of anxiety from pre- to post-treatment.

Implications: This research provides a better understanding of the parameters of client communication and information for future therapists regarding the content of clients’ correspondence in ICBT.

Kristen Klassen

Analyzing therapist emails in Internet-delivered cognitive behavioural therapy

Honours Thesis Results, Kristen Klassen 2017

Background: Internet-delivered cognitive behaviour therapy (ICBT) arose as a response to barriers associated with face-to-face therapy and has shown to be efficacious especially when offered with therapist assistance.

Objective: Despite the importance of therapist-assistance to ICBT, there has been minimal research on this topic. No scales have been developed to specifically assess presence of therapist behaviours during ICBT. As such, the purpose of this study was to: 1) develop an ICBT rating scale that captures the main elements of the therapist/client interactions in secure email messages, and 2) evaluate a random selection of ICBT therapists using this scale to assess average ratings on therapist/client interactions during the course of ICBT.

Method: The initial scale was developed based on past content analysis of therapist behaviours during ICBT. Five therapists trialed this initial measure and provided feedback on their experiences during a focus group. The measure was then revised and inter-rater reliability was established between three student raters. The scale was used to examine emails that were sent to 50 patients who completed an 8-week transdiagnostic ICBT course for depression and anxiety (Wellbeing Course).

Results: Review of ratings suggested that most therapists were providing high quality emails. Multiple significant correlations were found which indicated that clients who sent more emails to their therapist were receiving better quality emails, that therapists who were solely focused on delivering ICBT, and therapists with a psychology background obtained higher ratings on the scale.

Practical Implications: Numerous directions for future research exist, such as exploring the applicability of the scale to other ICBT units.