Carly Chadwick

Pre-treatment change in Internet-delivered alcohol use disorder treatment

Honours Thesis Results, Carly Chadwick 2020

Background: Alcohol misuse is a common mental disorder that can have devastating effects on an individual’s physical and mental health. Although alcohol misuse is both prevalent and disabling, only 21% of individuals receive treatment. Internet-delivered cognitive behaviour therapy (ICBT) may serve as a promising solution for the treatment gap, as it minimizes concerns about the stigma surrounding seeking treatment. Previous studies in alcohol treatment literature address a phenomenon named Assessment Reactivity (AR) which suggests that assessment interviews are predictive of significant changes in pre-treatment drinking. This may be of clinical importance as early abstinence from alcohol has been significantly associated with longer periods of continuous abstinence.

Purpose: The primary objective of the current study was to explore pre-treatment change by experimentally manipulating assessment in an ICBT program for alcohol misuse.

Method: The present study used data from 87 clients who were randomly assigned to receive an assessment interview or no assessment interview prior to beginning treatment.

Results: Results indicated that there were no significant differences in drinking behaviours between groups at pre-treatment. However, significant reductions in alcohol consumption were observed amongst both groups, suggesting that factors other than an assessment interview may contribute to client’s willingness to improve their drinking behaviours. No significant differences in motivation to change or depressive symptoms were observed between groups, although, both groups experienced a significant increase in motivation and decrease in depressive symptoms over time. 

Hugh McCall

Does persuasive design predict efficacy in unguided ICBT? A meta-regression analysis

Masters thesis results, Hugh McCall 2020 

Background: Internet-delivered cognitive behavioural therapy (ICBT) is an innovative treatment for common mental health problems like depression and anxiety. It is similarly efficacious to face-to-face therapy when it is offered with therapist support by phone or secure email. It is not as efficacious when it is offered in a purely self-guided format, but it is easier to implement on a large scale. Various research groups have suggested that persuasive design—designing an intervention to be more engaging and stimulating for users—can help improve the efficacy of ICBT and other digital interventions for health and mental health problems. The objective of this study was to explore the relationship between persuasive design elements and efficacy among previously published trials of unguided ICBT for depression and anxiety.

Method: A systematic review of five databases was conducted to identify randomized controlled trials of unguided ICBT for depression and anxiety. Meta-analyses were conducted, and meta-regression was used to determine whether the effect size of each unguided ICBT program could be predicted by the number of persuasive design elements it included. Meta-regression was also used to explore changes in the efficacy and persuasive design of unguided ICBT over time.

Results: A total of 41 studies (= 10,301) were identified through the systematic search. Meta-analyses revealed a small to moderate weighted mean effect size (Hedges’ g = 0.29) for unguided ICBT for depression and a moderate effect size (Hedges’ g = 0.48) for unguided ICBT for anxiety. The results of the meta-regressions showed that the number of persuasive design elements identified in each intervention predicted the efficacy of ICBT for depression but not ICBT for anxiety. Additional meta-regressions showed that year of study did not predict the efficacy of each intervention or the number of persuasive design elements each intervention included.

Implications: The results suggest that more persuasively designed ICBT interventions are more efficacious, at least for treating symptoms of depression. There was no evidence that efficacy or persuasive design has increased over time in unguided ICBT for depression and anxiety. However, further research will be required to clarify the role of persuasive design in ICBT; in particular, experimental research comparing versions an ICBT intervention with and without specific persuasive design elements and qualitative research exploring how clients experience persuasive design elements would help advance this literature.

Joelle Soucy

Online motivational interviewing for enhancing internet-delivered cognitive behaviour therapy: A randomized controlled trial

Doctoral Dissertation Results, Joelle Soucy 2020

Background: Despite the fact that internet-delivered cognitive behaviour therapy (iCBT) can be used to effectively reduce symptoms of anxiety and depression, not all clients benefit from treatment. Opportunities exist to further enhance treatment outcomes in order to maximize the impact of iCBT. Motivational Interviewing (MI) is a clinical tool used by therapists to help facilitate clients’ motivation to change. Integrating MI and face-to-face therapy in the treatment of anxiety has been shown to result in better treatment response and completion relative to face-to-face therapy alone. Therefore, there is a possibility that combining iCBT with online MI can result in similar outcomes. This investigation sought to first develop a brief, interactive online MI pre-treatment that was designed to increase motivation to engage in iCBT for anxiety and depression. Once the protocol was developed and piloted, we examined the impact of the online MI pre-treatment on motivation levels, symptom change, and treatment engagement/completion.

Methods: A total of 480 clients applying to iCBT were randomly assigned to first receive the MI pre-treatment or no pre-treatment. The online MI pre-treatment consisted of a single lesson that comprised of videos, exercises, and feedback designed to increase intrinsic motivation to engage in iCBT. All clients then participated in an 8-week transdiagnostic iCBT program for anxiety and/or depression that consisted of 5 lessons aimed at providing psychoeducation and coping techniques for managing symptoms of anxiety and depression.    

Results: Contrary to prediction, little evidence of using online MI to further improve iCBT outcomes for anxiety and depression was found in the study. Engagement in iCBT was high across groups, with clients completing the same number of lessons and logging into the program a comparable number of times. Clients in both groups also reported high levels of motivation both prior to and following the MI period. Similarly, across groups, clients reported large reductions in anxiety and depression from pre- to post-treatment. During the 6-month follow-up, cliens in the iCBT only group continued to report small reductions in symptoms of anxiety, whereas clients in the MI plus iCBT group did not continue making improvements. The addition of MI to iCBT was also associated with minor increases in symptoms of depression during follow-up, wheras symptom improvements were maintained for clients in the iCBT only group.

Conclusions: Results from this study suggest that online MI may not enhance client outcomes when motivation at pre-treatment is high. In some instances, online MI may also prevent further treatment progress, especially among individuals with high motivation to engage in treatment. Moving forward, it will be important to determine if specific client populations benefit more from online MI.

Treatment acceptability and preference among primary care patients experiencing severe health anxiety: The role of internet-delivered cognitive behaviour therapy

Masters Thesis Results, Joelle Soucy 2016

Although cognitive behaviour therapy (CBT) is a helpful intervention for health anxiety, many individuals are unable to receive this treatment because of difficulties accessing it. Internet-delivered cognitive behaviour therapy (ICBT) is a new and accessible treatment that has been shown to successfully manage symptoms of health anxiety; however, it remains unclear whether ICBT would be used if in fact offered to individuals with health anxiety. The goal of this study was to see how patients perceive ICBT compared to other existing treatments for health anxiety. Primary care patients who were experiencing symptoms of health anxiety were presented with descriptions of three different treatments for health anxiety. The treatments were medication, CBT, and ICBT. Perceptions of the treatments were assessed following the presentation of each treatment description. Participants were also asked to rank the three treatments based on the likelihood wanting to receive that intervention for health anxiety. Results indicated that all three treatments were similarly rated as moderately acceptable. The highest preference ranks were for CBT and medication. That said, a small sample of participants ranked ICBT as the preferred intervention. While CBT and medication were the preferred treatments for health anxiety, the generally favourable perceptions of ICBT found in the study suggest that it would likely be considered a desirable treatment option by a number of potential users.