Tag: 2018

A randomized trial of technician-guided and self-guided ICBT: Wellbeing After Cancer

Doctoral Dissertation Results, Dale Dirkse 2018

Internet-delivered  cognitive behviour therapy (ICBT) has only recently been used to treat  anxiety and depression within a cancer population but has demonstrated  promising results. The focus of this study was to assess the  effectiveness of two forms of non-therapist assisted ICBT for cancer  survivors with symptoms of depression and anxiety in a larger sample.  The Wellbeing After Cancer course was offered to Canadians from August 2016 to May 2017. In this study we were interested in the impact of Wellbeing After Cancer on symptoms of depression, anxiety, fear of cancer recurrence, and overall quality of life after the course.

Wellbeing After Cancer included education about depression and anxiety, strategies to identify  and modify unhelpful thoughts, manage physical symptoms of anxiety and  depression, overcome avoidance, cope with uncertainty, and maintain  improvements after treatment. The course was administered to a  randomized group of cancer survivors; 42 individuals who were guided by a  technician and 44 individuals who independently progressed through the  course.

The findings were very encouraging. The results of this  study showed that participants’ symptoms of anxiety and depression  improved significantly from pre to post treatment. Participants also  reported strong satisfaction ratings with the program.  Furthermore,  there was no difference in anxiety or depression symptom improvement or  overall satisfaction between those who were guided by a technician or  those who independently progressed through the course. Participants also  improved on secondary measures of fear of cancer recurrence and quality  of life.

Results from this study demonstrate the ability to  provide effective treatment to Canadian cancer survivors with symptoms  of anxiety and depression from one centralized site.  Providing ICBT has  the potential to change the mental health care landscape for cancer  survivors across Canada. Future research should focus on best practices  for implementation of ICBT. 

Linguistic analysis of communication in a therapist-assisted Internet-based cognitive behaviour therapy program for individuals with generalized anxiety disorder

Masters Thesis Results, Dale Dirkse 2014

Background: Therapist-assisted Internet-based Cognitive Behaviour Therapy (TAICBT) is an effective method of treating generalized anxiety disorder (GAD). In addition to the cognitive and behavioural elements found within face-to-face Cognitive Behaviour Therapy (CBT), TAICBT includes elements of expressive writing, through email communication with a therapist. Expressive writing has been associated with positive outcomes; furthermore, certain linguistic dimensions have been associated with psychological and physical health benefits.

Objective: The purpose of the present study was to understand how clients with symptoms of GAD are communicating with their online therapists, and explore whether their communication style was related to successful participation.

Method: Written communication submitted to therapists by 107 adult clients with symptoms of GAD during the course of a 12 module TAICBT program was analyzed along with symptom measures of anxiety, worry, and adjustment. Clients’ written communication was analyzed by a linguistic software (Linguistic Inquiry and Word Count Software) which categories words into several categories (e.g., negative emotion words, insight words).

Results: Negative emotion words, anxiety words, insight words, and past tense words were associated with symptom measures of anxiety and worry and they changed over time. A higher number of negative emotion and anxiety words differentiated clients that dropped out of the program earlier versus those that dropped later, and were associated with reduced therapeutic alliance and treatment satisfaction.

Discussion: Results suggest it may be useful to pay attention to linguistic categories as they can be used as indicators of client progress and well-being. Findings improve our understanding of the client experience of participating in TAICBT, with some linguistic trends being consistent with what clinicians would expect to see from a client’s successful participation in therapy. Other findings offer new insight into communication that may be particularly relevant to clients with symptoms of GAD. Findings confirm that clients are engaging with the program and opening up to their therapists.

Treating comorbid insomnia in patient enrolled in therapist-assisted transdiagnostic internet-delivered cognitive behaviour therapy for anxiety and depression: A randomized controlled trial

Doctoral Dissertation Results, Michael Edmonds 2023

Background: Transdiagnostic Internet-delivered cognitive behaviour therapy (ICBT) for patients experiencing anxiety and depression can produce large improvements in symptoms. Comorbid insomnia is common among individuals seeking treatment for anxiety and depression, yet transdiagnostic ICBT rarely targets insomnia and many ICBT patients report that symptoms of insomnia remain after treatment. This trial explored the impact of including a brief intervention for insomnia alongside an existing transdiagnostic ICBT course that included brief weekly therapist assistance.

Method: The current study used a two-group randomized controlled trial design. Patients were randomly assigned to receive one of two 8-week interventions: a Standard transdiagnostic course or a Sleep-Enhanced course, which included information on sleep restriction and stimulus control. Primary outcomes were assessed at pre-treatment, weekly during treatment, post-treatment, and three-month follow-up. Primary outcomes included symptoms of insomnia, depression, and anxiety.

Results: Patients reported significant, large reductions in all primary outcomes from pre-treatment to post-treatment, with changes maintained at 3-months. Patients assigned to the Sleep-Enhanced course reported larger reductions in insomnia than patients in the Standard transdiagnostic course at post-treatment but no significant group differences in any of the primary outcomes were found at follow-up. Patient-reported adherence to sleep restriction guidelines was associated with greater reductions in insomnia symptoms during the course.

Conclusions: Overall, patients who received the Sleep-Enhanced course were satisfied with the materials and most patients reported making sleep behaviour changes. The trial results demonstrate that including a brief intervention targeting insomnia can be beneficial for many patients who enroll in ICBT primarily for symptoms related to anxiety and depression.

Can patient characteristics at intake predict patient response to therapist-assisted transdiagnostic internet-delivered cognitive behavioural therapy?

Masters Thesis Results, Michael Edmonds 2018

Background: The Wellbeing Course is a transdiagnostic  online program designed to treat anxiety and depression. The five lesson  course teaches patients skills for managing anxiety and depression  based on principals of cognitive behavioural therapy and includes weekly  therapist contact via telephone or secure message. The program has been  shown to reduce symptoms in patients overall and, on average, patients  report a high degree of satisfaction. Although the program is effective  overall, only 75% of patients complete the program and only 50% of  patients complete the program and report a reliable reduction in either  anxiety or depression. The aim of this research was therefore to examine  patient outcomes further and look for relationships with patient  characteristics that might allow us to predict which patients are most  likely to benefit from online therapy.

Method: Patient case records from 1201 patients who enrolled in the Wellbeing Course were compiled and analyzed to look for relationships between patient  characteristics at intake and patient outcomes. Autoregressive latent  trajectory modeling was used to look for relationships between patient  characteristics and patient symptom change over time. Classification  trees were created to predict treatment dropout and overall treatment  success.

Results: Younger people were found to be at greater risk of  dropping out from online therapy. Higher initial severity of anxiety or  depression was related to greater improvement over the course of  therapy. Age and relationship status were related to anxiety symptom  trajectories, while education and initial psychological distress and  disability scores were related to depressive symptom trajectories.

Conclusions: Although some groups were identified as being at  higher risk of dropout or not improving, none of these effects were  strong enough to suggest that exclusion criteria for the program should  be changed. Instead, future research should look at how the program can  be modified to improve outcomes for at-risk groups.