Nichole Faller

A Randomized Controlled Trial of an Online Psychoeducation Course for Improving Knowledge and Access to Mental Health Accommodations

Doctoral Dissertation, Nichole Faller, 2021

Background: Available research on mental health accommodations within the workplace  suggests that employees with mental health concerns require  accommodations to improve work functioning. Unfortunately, only a  fraction of employees requiring mental health accommodations will  receive the accommodations they have requested. Reported barriers to  receiving mental health accommodations include lack of knowledge about  appropriate accommodations, concerns regarding stigma, and financial  constraints of the employer. There is a paucity of research available on  interventions aimed at improving accommodation knowledge and usage for  mental health concerns.

Method: The primary goal of the current study was to assess the efficacy of a  four-lesson, online, psychoeducational course developed to provide  information on anxiety/depression symptoms in the workplace, appropriate  accommodations to help manage symptoms, considerations for disclosure  of a mental health concern and accommodation requests, and general tips  for symptom management. A total of 89 participants with  anxiety/depression symptoms that were negatively impacting work  functioning were randomly assigned to a treatment group that received  access to the Workplace Coping Strategies (WCS) course or an eight-week  waiting list group. All participants received questionnaires at four-  and eight-weeks post randomization. Primary outcomes of interest  included the impact of the WCS course on requesting/receiving  accommodations, employee knowledge of accommodations, self-stigmatizing  attitudes, and workplace relationships. Organizational inclusivity and  supervisory leadership were also examined to determine how these  variables impacted accommodation usage and disclosure rates. Secondary  outcomes assessed the efficacy of the WCS course on comfort levels  disclosing and rates of disclosure. Exploratory analyses examined the  impact of the WCS course on absenteeism/presenteeism scores,  self-efficacy, and symptomology. Finally, quantitative content analyses  were used to examine qualitative data on accommodations identified,  barriers/facilitators to requesting/receiving accommodations, and  participant feedback on the course.

Results: Results suggest that those who participated in the WCS course relative  to the waiting list group had large improvements in accommodations  knowledge, increased self-efficacy, and improved presenteeism scores.  Both groups reported reduced internalized mental health stereotypes and  increased disclosures of mental health concerns over time. Regression  analyses further demonstrated that partial disclosures were associated  with organizational inclusiveness and supervisory leadership. The  results suggest that the intervention did not have an impact on  accommodation usage, symptomology, workplace relationships, or comfort  level disclosing a mental health concern. Qualitative analyses showed  that participants most frequently identified accommodations related to  scheduling flexibility and job description modification with limited  mention of communication facilitations and/or modifications to physical  space. The most frequently cited barrier was poor relationships with  management, while supportive relationships were considered a facilitator  for requesting/receiving an accommodation. Participants reported liking  the clarity and conciseness of the course content the most and disliked  aspects of the  course structure, such as a lack of video options. Areas  for improvements included changes to questionnaires (e.g., less  frequent), addition of employer-centered material (e.g., tips for  discussing mental health), and the use of persuasive design to increase  engagement.

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.

Taylor Patterson

Transdiagnostic Internet-delivered therapy among post-secondary students: Are booster lessons beneficial?

Honours Thesis Results, Taylor Patterson, 2021

Background: Internet-delivered cognitive behaviour therapy (iCBT) has been found to be effective among post-secondary students. Booster lessons have been proposed as a strategy for maintaining and improving outcomes but have yet to be investigated among students.

Method: To inform future use of booster lessons with students completing iCBT, this study used a mixed-methods approach to identify student (n = 101) use of a booster lesson, predictors of completion, and student preferences regarding delivery of a booster lesson one month following a 5-week transdiagnostic iCBT course.

Results: Approximately one-third of clients utilized the booster lesson; among this group the booster lesson was perceived as worthwhile, client satisfaction was high, and every client who completed the booster indicated that the length was appropriate. Clients provided varied responses regarding the ideal timing of a booster lesson (1-2 weeks to 3-6 months) and whether therapist support is preferred while completing the lesson (50% of completers and 40% of non-completers expressed preference for therapist support). The only significant predictors of use of the booster lesson were the number of iCBT lessons completed and whether the client was currently receiving treatment for mental health concerns. School-related time constraints (27.0%) were identified as a large concern for non-completers.

Conclusions: Understanding client use and gaining feedback about their preferences provides direction for future research to maximize the likelihood a booster lesson would be beneficial. Future research incorporating a booster lesson in iCBT should consider student preferences and exhibit flexibility to elevate client engagement.

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.