Cynthia Beck

A Usability Study of Internet-Delivered Cognitive Behaviour Therapy and Resource Tailored to Agriculture Producers

Masters Thesis Results, Cynthia Beck 2022

Background: Agriculture producers experience high rates of mental health challenges and are less likely to seek or to receive help for mental health concerns than the general population. Internet-delivered cognitive behaviour therapy (ICBT) is demonstrated to be effective for reducing symptoms of anxiety and depression and overcomes many barriers to receiving mental health care. This study assessed the usability of ICBT for Saskatchewan agricultural residents and its impact on symptoms of anxiety/depression, perceived stress, and resiliency.

Method: Saskatchewan residents involved in agriculture (n = 34) participated in the Agricultural Wellbeing Course (AWC), which is an online, five-lesson course providing strategies for dealing with symptoms of anxiety/depression with therapist-assistance. A mixed methods approach was used with measures completed at pre- and post-treatment and a follow-up interview. This study included developing an agriculturally tailored resource and exploring participant perceptions of ICBT post-treatment.

Results: 100% of participants reported that doing the course was worth their time and recommended it to other producers. Overall, their symptoms of anxiety, depression, and perceived stress largely improved, as did their reported resiliency. The agricultural participants had higher rates of engagement and completion than the general population in the Wellbeing Course. Participants spoke to strengths of the course, which included high therapist credibility, cultural appropriateness, and course content. All participants commented on how ICBT overcame barriers for them to access mental health care, including the ease of accessibility, convenience, flexibility, and reduced stigma. Areas for improvement included providing alternative delivery formats and therapist contact options. Challenges to participating included internal barriers (i.e., lack of motivation) and external barriers (i.e., time constraints, priorities). Course impact included improved skills, positive client impact on others and information sharing, improved view of mental health support, and words of advice to others.

Conclusion: Results suggest that ICBT is a usable and effective mental health treatment for the agriculture population and overcomes the many barriers that producers face in accessing mental health care.

Mixed-method Evaluation of an Online Motivational Interviewing Intervention as a Potential Adjunct to Internet-delivered Cognitive Behaviour Therapy

Honours Thesis Results, Cynthia Beck 2019

Background: While Internet-delivered cognitive behaviour therapy (ICBT) can effectively reduce anxiety and depression, not all clients benefit equally from treatment. Motivational Interviewing (MI) can result in behaviour change and, coupled with face-to-face therapy, can lead to enhanced outcomes; however, little research has examined MI as an adjunct to ICBT.

Purpose: The aim of the current study was to evaluate user feedback on a newly developed online MI intervention and to explore the immediate impact of the MI lesson on motivation for change.

Method: Two samples of participants, one with ICBT experience (n = 21) and one without ICBT experience (n = 20), worked through the exercises and watched the videos in the online MI intervention. Pre and post lesson participants reviewed and evaluated the online MI intervention.

Results: Following MI, both samples of participants reported a statistically significant increase in ability to reduce symptoms (p < .0001) and an increase that approached statistical significance in perceived importance of reducing symptoms (p < .052). Furthermore, after completing the MI intervention, participants reported increased confidence in recommending the lesson to a friend (p < .002) and increased belief that the lesson would be successful in helping someone to prepare for ICBT (p < .0001). Examination of ratings of the MI intervention and open-ended comments were positive, with participants recommending to expand the exercises and content to assist with self-reflection.

Conclusion: The current research provides evidence for the face validity of the MI intervention and sets the foundation for research on MI as a potential adjunct to ICBT for improving motivation prior to active treatment.

Sasheen Horse

Transdiagnostic Internet-delivered Cognitive Behaviour Therapy: Utility of a Motivational Interviewing Resource

Honours Thesis Results, Sasheen Horse 2022

Background: There is strong evidence for the effectiveness of internet-delivered cognitive behaviour therapy (ICBT) but clients can struggle with motivation during treatment. Online motivational interviewing (MI) has not yet been investigated during ICBT as a method of facilitating engagement and outcomes.

Purpose: This feasibility study investigated the potential use of an MI resource offered during ICBT by examining: (1) use of the resource; (2) patient and treatment variables associated with using the resource; (3) whether use of the resource was associated with improved engagement and outcomes; and (4) how those who used the resource evaluated it.

Method: This study used data collected from 763 clients enrolled in an ICBT course. Clients completed an MI resource evaluation measure at post-treatment. Symptoms were assessed at pre- and post-treatment. The website tracked treatment engagement.

Results: Approximately 15% of clients used the resource. Clients who were older, had higher education, higher depression, and lower anxiety at pre-treatment were more likely to use the resource. Those who reported using the resource had higher engagement (i.e., more lessons and more messages) in ICBT, but lower improvement in disability, which may have been a trigger for using the resource. Positive feedback on the MI resource outweighed the negative feedback, with 94% of clients identifying a positive aspect of the resource and 68% of clients reporting changes made in response to the resource.

Conclusion: Overall, the MI resource appears to have utility for a small portion of clients who complete ICBT and this study provides insight to who will use the resource. The resource will be available longer term for patient use in the Online Therapy Unit.

Vanessa Peynenburg

Examining motivational interviewing and booster sessions in Internet-delivered cognitive behaviour therapy for post-secondary students: An implementation trial

PhD Thesis Results, Vanessa Peynenburg 2022

Background: Nearly one-third of post-secondary students meet criteria for a mental disorder within any given year, with many students not receiving treatment. Internet-delivered cognitive behaviour therapy (ICBT) is an alternative to face-to-face services that is effective in general adult populations, but has been associated with high attrition rates and smaller effect sizes in student populations. Motivational interviewing (MI) is used by therapists in face-to-face settings and can help improve treatment completion and outcomes. Booster sessions are often used in face-to-face therapy to maintain long-term changes. To date, the use of online MI and booster sessions in ICBT for students has not been examined. In this implementation trial, the role of MI and booster sessions on treatment completion and outcomes was examined in Saskatchewan.

Methods: In this factorial trial (factor 1: presence of pre-treatment online MI); factor 2: presence of a booster lesson), a total of 308 clients were randomized to one of four groups: standard care, MI, booster, and MI + booster. All clients received a 5-week transdiagnostic ICBT course (the UniWellbeing Course) for symptoms of depression and anxiety. Primary outcomes included symptoms of depression, anxiety, and perceived academic functioning. All primary measures were administered at pre-treatment, post-treatment, and 1- and 3-month follow-up, Implementation outcomes (i.e., acceptability, adoption, and fidelity) were also examined.

Results:  Across all four groups, clients experienced large reductions in symptoms of depression and anxiety, as well as small improvements in perceived academic functioning. Changes were maintained at 1-month and 3-month follow-up. No benefit was found for the inclusion of MI on treatment completion, although clients who were assigned to MI had slightly larger improvements in symptoms of depression and anxiety at post-treatment. 30.9% of client assigned to one of the booster groups accessed the booster. When examining the booster groups as a whole, no benefits were found for improvements in depression, anxiety, or perceived academic functioning at 3-month follow-up. However, a sub-analysis of clients who accessed the booster found a small advantage in favour of the booster for depression. Overall, clients were satisfied with ICBT, although treatment completion remained low. Uptake of the ICBT course was highest at the two largest post-secondary institutions in Saskatchewan.

Conclusions: There is some evidence to suggest that including MI at pre-treatment results in greater symptom reduction, although these benefits do not persist to 1-month and 3-month follow-up. The inclusion of a self-guided booster lesson may also help with continued symptom management up to 3-month follow-up, but low uptake is a barrier to clients experiencing these benefits. Findings from this trial contribute to the literature on improving ICBT outcomes for post-secondary students.

Perceptions of and preferences for Internet-delivered cognitive behaviour therapy for anxiety and depression in post-secondary students

Masters Thesis Results, Vanessa Peynenburg 2019

Background: Anxiety and depression are prevalent mental health concerns experienced by post-secondary students. Rates of help-seeking are often low in this population, and students face several barriers to accessing psychological treatment. Internet-delivered cognitive behaviour therapy (ICBT) is an effective alternative to face-to-face therapy that addresses these barriers in adult populations with some evidence showing ICBT can also be effective with students. Additional research is necessary to identify students perceptions of and preferences for ICBT to assist with future implementation efforts in student populations. 

Methods: 314 Canadian post-secondary students completed an online survey and completed questionnaires about their symptoms of depression, anxiety, alcohol and drug use, and medical service utilization over the last 12 months. Students rated the acceptability and credibility of three treatment options (ICBT, face-to-face therapy, and medication) for the treatment of anxiety and depression. They also rated the utility of different kinds of content to be included in an ICBT course. 

Results: The three treatment options were rated as moderately acceptable and credible. Students expressed a preference for face-to-face services (44.6%), followed by medication (31.9%), and finally ICBT (23.5%). ICBT became more preferable once students would have to wait to receive face-to-face therapy. Students who were female and had less severe symptoms of depression had more positive perceptions of the use of ICBT in the treatment of anxiety and depression.

Conclusions: While many students expressed a preference for face-to-face therapy or medication over ICBT, a substantial number preferred ICBT. Students often have to wait to receive face-to-face therapy, so ICBT may also be more desirable in these circumstances. Implementation trials in student populations are necessary to identify barriers to implementation efforts.

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.

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.

Giuliano La Posta

Internet-delivered Cognitive Behaviour Therapy for Chronic Health Conditions With and Without Guidance: Exploring Changes in Benefit Finding

Honours Thesis Results, Giuliano La Posta 2019

Background: Internet-delivered cognitive-behaviour therapy (ICBT) is effective in reducing symptoms of anxiety and depression when targeted to specific groups with chronic health conditions (e.g., pain, cancer, cardiac, spinal cord injury). Nevertheless, there are some gaps in the literature regarding:

  •  the efficacy of ICBT programs that are transdiagnostic and address multiple chronic health conditions;
  • whether outcomes are improved when offered with support of team of providers compared to when ICBT is self-directed; and
  • whether ICBT is associated with improvements in benefit finding.

Purpose: To examine the efficacy of self-directed versus team-directed transdiagnostic ICBT Chronic Health Conditions course in improving benefit finding, as well as anxiety and depression among individuals with diverse chronic health conditions.

Method: Participants were divided into self-directed (n=15) and team-directed (n=16) groups and were measured for changes in benefit finding scores, as well as in anxiety and depression symptoms, at both pre-treatment and post treatment.

Results: There were no between group differences or interactions. For both self-directed and team-directed groups, significant time effects were present for anxiety (Cohen’s d=0.83), depression (Cohen’s d=0.69), distress (Cohen’s d=0.65) and disability (Cohen’s d=0.18). Benefit finding did not change significantly over time, although a small effect was seen when examining Cohen’s d=.30.

Conclusion: The transdiagnostic ICBT Chronic Conditions course when either self-directed or team-directed shows promise in reducing symptoms of anxiety and depression, distress, and disability over time.