ORCID Profile
0000-0002-7092-9056
Current Organisation
University of Regina
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Publisher: Elsevier BV
Date: 09-2018
Publisher: MDPI AG
Date: 24-07-2023
DOI: 10.20944/PREPRINTS202307.1574.V1
Abstract: Depression and anxiety are the most common mental health disorders worldwide. Internet-Delivered Cogni-tive Behaviour Therapy (ICBT) can reduce barriers to care for broad cross sections of the population. How-ever, People of Diverse Ethnocultural Backgrounds (PDEGs) other than White/Caucasian underutilize mental health services and are underrepresented in clinical trials of psychological interventions. To address this research gap, we adapted an evidence-based ICBT program for PDEGs. The current pilot study explores the effectiveness, satisfaction, and engagement in the adapted ICBT by PDEGs (N=41) when benchmarked against a s le of PDEGs (N=134) drawn from a previous non-adapted version of the ICBT program. Inntent-to-treat analyses showed that the adapted ICBT program is effective in reducing anxiety and de-pression symptoms among PDEGs. Large within-group pre-to-post-treatment Cohen’s effect sizes of d = 1.23, 95% CI [0.68, 1.77] and d = 1.24, 95% CI [0.69, 1.79] were found for depression and anxiety, respectively. Further, 81.8% of the PDEGs who received the adapted ICBT program reported high overall satisfaction, 90.9 % reported increased confidence in managing symptoms, and 70.7% of participants completed the ma-jority of the psychoeducational lessons in the ICBT program. No statistically significant differences in clinical outcomes, engagement, and satisfaction were found between the pilot study and benchmark s le. Future directions for ICBT research with PDEGs are described.
Publisher: American Psychological Association (APA)
Date: 08-2019
DOI: 10.1037/REP0000276
Abstract: Many in iduals with a spinal cord injury (SCI) report significant symptoms of depression and/or anxiety post-SCI however, access to mental health services can be limited. The purpose of this study was to evaluate patient perspectives on the acceptability of an 8-week guided Internet-delivered cognitive behavior therapy (ICBT) course (Chronic Conditions Course) for people with SCI. In particular, we sought to understand patient perceptions of facilitators and barriers of engaging in ICBT and strengths and weaknesses of ICBT program content. Semistructured interviews were conducted with 8 SCI patients after completion of the ICBT course. The interviews were audio-recorded, transcribed verbatim, and examined by means of thematic analysis by 2 coders. Eight participants (mean age = 53.2 years males = 50% paraplegia = 67.5%) were interviewed. Four major themes emerged when examining facilitators to completing the program: accessibility, flexibility, motivation, and guided support. Barriers to completing the program included course timeframe and physical health. Strengths of the course included effective skill development and mental health prioritization. Suggested changes to the course included improved breadth of case stories, development of extra resources, adjusting the course timeframe to account for the SCI, and more support from the guide. ICBT was overall highlighted as an acceptable method of receiving care for people with SCI. The study provides direction for improving delivery of ICBT to ensure this method of treatment meets the needs of in iduals with SCI. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-12-2017
DOI: 10.1097/J.PAIN.0000000000000802
Abstract: Fibromyalgia (FM) is a common and often debilitating chronic pain condition. Research shows that symptoms of depression and anxiety are present in up to 3 quarters of in iduals with FM. Of concern, most adults with FM cannot access traditional face-to-face cognitive behavioural pain management programs, which are known to be beneficial. Given known difficulties with treatment access, the present study sought to explore the efficacy and acceptability of a previously developed Internet-delivered cognitive behavioural pain management course, the Pain Course , for adults with FM. The five-lesson course was delivered over 8 weeks and was provided with brief weekly contact, via telephone and secure email, with a guide throughout the course. Participants were randomized either to the Pain Course (n = 30) or to a waiting-list control group (n = 30). Symptoms were assessed at pre-treatment, post-treatment and 4-week follow-up. Completion rates (87%) and satisfaction ratings (86%) were high. Improvements were significantly greater in treatment group participants compared to waiting-list group participants on measures of FM (Cohen's d = 0.70 18% reduction), depression (Cohen's d = 0.63-0.72 20%-28% reduction), pain (Cohen's d = 0.87 11% improvement) and fear of pain (Cohen's d = 1.61 12% improvement). Smaller effects were also observed on measures of generalized anxiety and physical health. The changes were maintained at 4-week follow-up. The current findings add to existing literature and highlight the specific potential of Internet-delivered cognitive behavioural pain management programs for adults with FM, especially as a part of stepped-care models of care. Future research directions are described.
Publisher: Springer Science and Business Media LLC
Date: 15-09-2018
DOI: 10.1007/S00520-017-3872-8
Abstract: Although most cancer survivors adjust well, a subset experiences clinical levels of anxiety and depression following cancer treatment. Internet-delivered cognitive behavior therapy (iCBT) is a promising intervention for symptoms of anxiety and depression among survivors however, patient and provider perceptions of iCBT have not been examined. We employed an exploratory qualitative method and conducted semi-structured interviews with 13 cancer survivors and 10 providers to examine iCBT strengths and weaknesses, areas for improvement, and perceived barriers to program completion. A thematic content analysis approach was used to analyze the data. The majority of survivors liked the flexible, convenient, and private nature of the program. Many viewed the program as helping them feel less alone following cancer treatment. Areas of improvement included suggestions of additional information regarding cancer treatment side effects. Barriers to completing the program were identified by a minority of survivors and included finding time to complete the program and current symptoms. Providers liked the program's accessibility and its ability to provide support to patients after cancer treatment. All providers perceived the program as useful in their current work with survivors. Concerns around the fit of the program (e.g., for particular patients) were expressed by a minority of providers. Results provide additional evidence for the acceptability of an iCBT program among recent cancer survivors and providers in oncology settings. The current study highlights the value of research exploring iCBT for cancer survivors and provides insights for other groups considering Internet-delivered care for survivors.
Publisher: SAGE Publications
Date: 12-04-2022
DOI: 10.1177/07067437211006873
Abstract: There is strong evidence supporting internet-delivered cognitive behaviour therapy (iCBT) and consequently growing demand for iCBT in Canada. Transdiagnostic iCBT that addresses both depression and anxiety is particularly promising as it represents an efficient method of delivering iCBT in routine care. The Online Therapy Unit, funded by the Saskatchewan government, has been offering transdiagnostic iCBT for depression and anxiety since 2013. In this article, to broadly inform implementation efforts, we examined trends in utilization, patient characteristics, and longitudinal improvements for patients receiving transdiagnostic iCBT over 6 years. Patients who completed telephone screening between November 2013 and December 2019 were included in this observational study. Patients provided demographics and mental health history at screening and completed measures at pre-treatment, post-treatment and at 3- to 4-month follow-up. Treatment engagement and satisfaction were assessed. A total of 5,321 telephone screenings were completed and 4,283 of patients were accepted for treatment over the 6-year period (80.5% acceptance). The most common reason for referral to another service was high suicide risk/severe symptoms (47.1%). Examination of trends showed growing use of transdiagnostic iCBT over time (37% increase per year). There was remarkable stability in patient characteristics across years. Most patients were concurrently using medication (57.3%) with 11.9% reporting using iCBT while on a waiting list for face-to-face treatment highlighting the importance of integrating iCBT with other services. Consistent across years, large improvements in depression and anxiety symptoms were found and maintained at 3- to 4-month follow-up. There was strong patient engagement with iCBT and positive ratings of treatment experiences. As there is growing interest in iCBT in Canada, this large observational study provides valuable information for those implementing iCBT in terms of likely user characteristics, patterns of use, and improvements. This information has potential to assist with resource allocation and planning in Canada and elsewhere.
Publisher: Oxford University Press (OUP)
Date: 04-08-2023
DOI: 10.1093/PM/PNAD102
Abstract: Numerous randomized controlled trials have evaluated the outcomes of internet-delivered psychological pain management programs (PMPs) as a way of increasing access to care for people with chronic pain. However, there are few reports of the effectiveness of these PMPs when provided as part of routine care. The present study sought to report the clinical and demographic characteristics of users (n = 1367) and examine the effectiveness of an established internet-delivered psychological PMP program in improving several pain-related outcomes, when offered at a national digital mental health service over a 5-year period. It also sought to comprehensively explore predictors of treatment commencement, treatment completion, and clinical improvement. Evidence of clinical improvements (% improvement Hedges g) were found for all outcomes, including pain interference (18.9% 0.55), depression (26.1% 0.50), anxiety (23.9% 0.39), pain intensity (12.8% 0.41), pain self-efficacy (-23.8% -0.46) and pain-catastrophizing (26.3% 0.56). A small proportion of users enrolled but did not commence treatment (13%), however high levels of treatment completion (whole treatment = 63% majority of the treatment = 75%) and satisfaction (very satisfied = 45% satisfied = 37%) were observed among those who commenced treatment. There were a number of demographic and clinical factors associated with commencement, completion and improvement, but no decisive or dominant predictors were observed. These findings highlight the effectiveness and acceptability of internet-delivered psychological PMPs in routine care and point to the need to consider how best to integrate these interventions into the pathways of care for people with chronic pain.
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.JANXDIS.2019.02.002
Abstract: Emerging evidence from research trials suggests that Internet-delivered cognitive behaviour therapy (ICBT) produces similar symptom improvements whether patients receive weekly therapist support (standard support) or therapist support only when requested (optional support). It remains unknown, however, how many patients receiving ICBT as part of routine clinical care would prefer optional support compared to standard support and how outcomes compare when patients select their preferred treatment option. In this uncontrolled trial, we investigated patient preference and outcomes for standard versus optional support among patients with depression and or anxiety who were offered an 8-week transdiagnostic ICBT intervention in routine care. Of 401 patients accepted for ICBT, 22% selected optional support and 78% selected standard support. At assessment, patients who selected optional support had lower symptoms of anxiety and panic than patients who selected standard support. At post-treatment, both groups achieved similar large improvements in symptoms of anxiety and depression, with improvements sustained at 3-month follow-up. Patients receiving optional support sent and received fewer messages compared to patients receiving standard support. This study demonstrates the potential of optional therapist support to meet the needs and preferences of patients and to also reduce therapist costs in routine care.
Publisher: Springer Science and Business Media LLC
Date: 18-12-2020
DOI: 10.1007/S11764-019-00810-9
Abstract: To compare the effectiveness and acceptability of two low-intensity methods of offering a transdiagnostic Internet-delivered cognitive behaviour therapy (ICBT) intervention for treating symptoms of anxiety and depression among cancer survivors. Cancer survivors with symptoms of anxiety or depression (n = 86) were randomly assigned to receive a transdiagnostic ICBT programme (Wellbeing After Cancer) that was either guided by a technician (n = 42) or self-guided (n = 44). Measures of anxiety, depression, fear of cancer recurrence, and quality of life were completed at pre-treatment, post-treatment, and 4 weeks following treatment completion. Large within-group effect sizes were observed on measures of depression, anxiety, and mental health-related quality of life (d range, 0.98-1.86) at post-treatment. Medium effects were found for reductions in fear of cancer recurrence (d range, 0.65-0.78). Non-inferiority was established for the primary outcome measures of anxiety and depression. All participants reported high satisfaction ratings of the programme however, technician-guided participants were slightly more satisfied with their level of support (d = 0.57, p = .014). The Wellbeing After Cancer Course was associated with improved levels of anxiety, depression, fear of cancer recurrence, and quality of life, regardless of how ICBT was offered. ICBT is emerging as an accessible and effective treatment for depression, anxiety, and fear of cancer recurrence in cancer survivors. The success of non-therapist-guided options increases the potential scalability of ICBT, which is particularly valuable for cancer survivors from rural areas who have less access to mental health services.
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.JANXDIS.2017.09.006
Abstract: Internet-delivered cognitive behaviour therapy (ICBT) is effective for treating anxiety and depression. The relative benefits of offering standard weekly compared to optional weekly therapist support in conjunction with ICBT within routine care has not been examined. Patients seeking ICBT for depression and or anxiety in routine care were randomized to standard (n=92) or optional (n=88) weekly support. The optional approach resulted in therapists receiving half as many messages from (1.70 vs. 3.96) and sending half as many messages to patients (3.62 vs. 7.29). Optional Support was associated with lower completion rates (56.6% versus 82.4%), but, similar to Standard Support, resulted in large reductions on the GAD-7 (within Cohen's d≥1.08 avg. reduction ≥47%) and PHQ-9 (within Cohen's d≥0.82 avg. reduction ≥43%) at post-treatment and 3-month follow-up. Optional weekly support appears clinically effective and acceptable for many patients and may reduce costs, but safety requires monitoring given lower completion rates.
Publisher: Wiley
Date: 11-11-2017
DOI: 10.1002/PON.4032
Publisher: Springer Science and Business Media LLC
Date: 26-05-2018
Publisher: JMIR Publications Inc.
Date: 11-02-2022
Abstract: ostpartum depression (PPD) and postpartum anxiety (PPA) are often comorbid and associated with significant personal and economic costs. Fewer than half of mothers experiencing PPD or PPA receive face-to-face treatment, suggesting a need for alternative delivery formats such as internet-delivered cognitive behaviour therapy (ICBT). he goal of the pilot study was to examine the impact of a therapist-assisted, transdiagnostic ICBT program on PPD and PPA, as there is only one previous study on transdiagnostic ICBT with this population and the study did notinclude therapist assistance. lients endorsing symptoms of PPD/PPA (N = 63) were randomized to an 8-week transdiagnostic ICBT course (Wellbeing Course for New Moms) or to treatment-as-usual (TAU). Clients completed measures of depression, anxiety, stress, postnatal bonding, and relationship satisfaction at pre-treatment, post-treatment, and 1-month follow-up, as well as measures of treatment satisfaction and therapeutic alliance. Outcome measures were also completed at 6-month follow-up for clients who completed ICBT. oth the ICBT and TAU groups experienced statistically significant improvements over time. The ICBT group experienced larger improvements at post-treatment and 1-month follow-up on more measures than TAU, with medium between-group Cohen’s d effects on primary outcome measures for anxiety (Cohen’s d = 0.65, 95% CI: 0.13, 1.17), postpartum depression (Cohen’s d = 0.52, 95% CI: 0.01, 1.04), and depression (Cohen’s d = 0.56, 95% CI: 0.05, 1.08), and on secondary outcome measures of overall distress (Cohen’s d = 0.69, 95% CI: 0.17, 1.21), anxiety (Cohen’s d = 0.59, 95% CI: 0.07, 1.11), and stress (Cohen’s d = 0.76, 95% CI: 0.23, 1.28). Time-by-group interactions for proportional reductions between groups over time were only significant at post-treatment and 1-month follow-up for the primary anxiety measure (p = .006). The study was underpowered for detecting small or medium effects. Overall, clients perceived the treatment as credible and 95% of clients (21/22) were satisfied with treatment content and therapist support. indings from this pilot study provide preliminary support for transdiagnostic ICBT in treating PPD/PPA to improve access to psychological treatments. linicalTrials.gov NCT04012580
Publisher: American Psychological Association (APA)
Date: 12-2011
DOI: 10.1037/A0026176
Publisher: Elsevier BV
Date: 03-2022
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.JANXDIS.2016.05.006
Abstract: Effects of Internet-delivered cognitive behaviour therapy (ICBT) for anxiety and depression are not well understood when delivered in non-specialized as compared to specialized clinic settings. This open trial (n=458 patients) examined the benefits of transdiagnostic-ICBT when delivered in Canada by therapists (registered providers or graduate students) working in either a specialized online clinic or one of eight nonspecialized community clinics. Symptoms of depression and anxiety were assessed at pre-treatment, post-treatment and at 3-month follow-up. Completion rates and satisfaction were high. Significant and large reductions (effect sizes 1.17-1.31) were found on symptom measures. Completion rates, satisfaction levels and outcomes did not differ whether ICBT was delivered by therapists working in a specialized online clinic or nonspecialized community clinics. Differences were also not found between registered providers and graduate students, or therapists trained in psychology or another discipline. The findings support the public health potential of ICBT.
Publisher: Elsevier BV
Date: 09-2020
Publisher: Elsevier BV
Date: 11-2020
Publisher: MDPI AG
Date: 19-03-2022
DOI: 10.3390/MICROORGANISMS10030657
Abstract: The global scale of land salinization has always been a considerable concern for human livelihoods, mainly regarding the food-producing agricultural industries. The latest update suggested that the perpetual salinity problem claimed up to 900 million hectares of agricultural land worldwide, inducing salinity stress among salt-sensitive crops and ultimately reducing productivity and yield. Moreover, with the constant growth of the human population, sustainable solutions are vital to ensure food security and social welfare. Despite that, the current method of crop augmentations via selective breeding and genetic engineering only resulted in mild success. Therefore, using the biological approach of halotolerant plant growth-promoting bacteria (HT-PGPB) as bio-inoculants provides a promising crop enhancement strategy. HT-PGPB has been proven capable of forming a symbiotic relationship with the host plant by instilling induced salinity tolerance (IST) and multiple plant growth-promoting traits (PGP). Nevertheless, the mechanisms and prospects of HT-PGPB application of glycophytic rice crops remains incomprehensively reported. Thus, this review describes a plausible strategy of halophyte-associated HT-PGPB as the future catalyst for rice crop production in salt-dominated land and aims to meet the global Sustainable Development Goals (SDGs) of zero hunger.
Publisher: Elsevier BV
Date: 12-2019
Publisher: Elsevier BV
Date: 09-2021
Publisher: Wiley
Date: 12-10-2022
DOI: 10.1002/EJP.1866
Abstract: Internet‐delivered cognitive behavioural pain management programmes (PMPs) are effective, but less is known about their use outside of research trials. Five years of data from offering the Internet‐delivered cognitive behavioural PMP in an online therapy clinic was examined to assess effectiveness, acceptability and predictors of outcomes. Patients ( N = 293) were offered a previously validated 8‐week Internet‐delivered cognitive behavioural PMP and administered measures at pre‐treatment, post‐treatment and 3 months. There was growth in demand for an Internet‐delivered cognitive behavioural PMP over time ( n = 64 first year to n = 133 fifth year). Moderate‐to‐large improvements on depression (post‐treatment 35% reduction 3‐month 41% reduction) and anxiety (post‐treatment 37% reduction 3‐month 41% reduction), and small‐to‐moderate improvements on disability (post‐treatment 19% reduction 3‐month 20% reduction) were found. Lesson completion and satisfaction were high. Lower pain acceptance, lower pain self‐efficacy and higher pain intensity were associated with lower improvements on depression, anxiety and disability. This longitudinal observational study provides support for Internet‐delivered cognitive behavioural PMPs when offered as routine care by an online therapy clinic. This 5‐year observational study provides support for Internet‐delivered cognitive behavioural pain management programs (PMPs) offered as routine care in an online therapy clinic. Interest in the service grew over 5 years. Outcomes, engagement and satisfaction were strong. Higher pain acceptance, pain self‐efficacy and lower pain severity were associated with greater post‐treatment improvements on depression, anxiety and disability.
Publisher: Cambridge University Press (CUP)
Date: 18-06-2018
DOI: 10.1017/BEC.2018.14
Abstract: Translating existing internet-based cognitive-behavioural therapy (iCBT), along with the use of transdiagnostic and self-guided formats, may prove to be a cost-effective option of disseminating iCBT. Only recently have encouraging findings been reported for a self-guided delivery. This study assessed the feasibility of a French and self-guided version of an existing English iCBT course, called the Wellbeing Course, for the treatment of anxiety and depression. Existing ICBT programs have not yet been delivered in French, although this language is spoken worldwide. Thirty-one participants were included in a single group pre-post open trial with a 3-month follow-up. Feasibility outcomes were attrition, treatment adherence, acceptability, and preliminary efficacy. Primary outcome measures were the Patient Health Questionnaire 9-item (PHQ-9) and the Generalised Anxiety Disorder 7-item (GAD-7). Nearly 75% of the participants completed the program. Over 80% of the participants provided posttreatment and follow-up data. All study completers reported that they would recommend the Wellbeing Course to a friend having similar problems. Significant reductions in symptoms of anxiety and depression were found following treatment, consistent with earlier studies. These preliminary findings support the use of the assessed strategies to facilitate the cross-cultural dissemination of iCBT for a more universal access to quality psychological care.
Publisher: MDPI AG
Date: 17-08-2019
DOI: 10.3390/JCM8081239
Abstract: There is a large body of research showing that psychological treatment can be effectively delivered via the internet, and Digital Mental Health Services (DMHS) are now delivering those interventions in routine care. However, not all attempts to translate these research outcomes into routine care have been successful. This paper draws on the experience of successful DMHS in Australia and Canada to describe ten lessons learned while establishing and delivering internet-delivered cognitive behavioural therapy (ICBT) and other mental health services as part of routine care. These lessons include learnings at four levels of analysis, including lessons learned working with (1) consumers, (2) therapists, (3) when operating DMHS, and (4) working within healthcare systems. Key themes include recognising that DMHS should provide not only treatment but also information and assessment services, that DMHS require robust systems for training and supervising therapists, that specialist skills are required to operate DMHS, and that the outcome data from DMHS can inform future mental health policy. We also confirm that operating such clinics is particularly challenging in the evolving funding, policy, and regulatory context, as well as increasing expectations from consumers about DMHS. Notwithstanding the difficulties of delivering DMHS, we conclude that the benefits of such services for the broader community significantly outweigh the challenges.
Publisher: Elsevier BV
Date: 09-2020
Publisher: Elsevier BV
Date: 09-2022
Publisher: JMIR Publications Inc.
Date: 29-06-2022
Abstract: nternet-delivered cognitive behaviour therapy (ICBT) can improve access to mental healthcare for students, although high attrition rates are concerning, and little is known about long-term outcomes. Motivational interviewing (MI) exercises and booster lessons can improve engagement and outcomes in face-to-face CBT. he current study was designed to examine the use of pre-treatment MI exercises and booster lessons in ICBT for post-secondary students. n this factorial trial (factor 1: online MI pre-treatment factor 2: self-guided booster lesson 1-month post-treatment), 308 clients were randomized to one of four treatment conditions, with 277 (89.9%) clients starting treatment. All clients received a 5-week transdiagnostic ICBT course (the UniWellbeing Course). Primary outcomes included changes in depression, anxiety, and perceived academic functioning from pre-treatment to post-treatment and 1- and 3-month follow-up. verall, 54.0% (n=150) of students completed treatment and reported large improvements in symptoms of depression and anxiety, and small improvements in academic functioning at post-treatment, which were maintained at 1- and 3-month follow-up. Pre-treatment MI did not contribute to better treatment completion or engagement, but small between-group effects favoured MI for reductions in depression (Cohen’s d: 0.23) and anxiety (Cohen’s d: 0.25) at post-treatment. Only 30.9% (n=43) of students randomized to one of the booster conditions accessed the booster. No main effects were found for booster overall. Sub-analyses revealed that clients who accessed the booster had larger decreases in depressive symptoms (Cohen’s d: 0.31) at 3-month follow-up. No interactions were found between MI and booster. ather than offering MI at pre-treatment, clients may experience more benefit from MI exercises later in ICBT when motivation wanes. Low uptake of the self-guided booster limits our conclusions about its effectiveness. Future research should examine offering a booster at a longer duration after treatment, with therapist support, and with a longer follow-up period. linicalTrials.gov: (NCT04264585)
Publisher: Elsevier BV
Date: 03-2020
Publisher: JMIR Publications Inc.
Date: 05-05-2021
DOI: 10.2196/27610
Abstract: Canadian public safety personnel (PSP) experience high rates of mental health disorders and face many barriers to treatment. Internet-delivered cognitive behavioral therapy (ICBT) overcomes many such barriers, and is effective for treating depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms. This study was designed to fill a gap in the literature regarding the use of ICBT tailored specifically for PSP. We examined the effectiveness of a tailored ICBT program for treating depression, anxiety, and PTSD symptoms among PSP in the province of Saskatchewan. We employed a longitudinal single-group open-trial design (N=83) with outcome measures administered at screening and at 8 weeks posttreatment. Data were collected between December 5, 2019 and September 11, 2020. Primary outcomes included changes in depression, anxiety, and PTSD symptoms. Secondary outcomes included changes in functional impairment symptoms of panic, social anxiety, and anger as well as treatment satisfaction, working alliance, and program usage patterns. Clients reported large symptom reductions on measures of depression and anxiety, as well as moderate reductions on measures of PTSD and secondary symptoms, except for social anxiety. Most clients who reported symptoms above clinical cut-offs on measures of depression, anxiety, and PTSD during screening experienced clinically significant symptom reductions. Results suggested good engagement, treatment satisfaction, and working alliance. Tailored, transdiagnostic ICBT demonstrated promising outcomes as a treatment for depression, anxiety, and PTSD among Saskatchewan PSP and warrants further investigation. Clinicaltrials.gov NCT04127032 t2/show/NCT04127032
Publisher: American Psychological Association (APA)
Date: 02-2022
DOI: 10.1037/CCP0000775
Abstract: Assigning homework to patients to facilitate skill development is an essential part of internet-delivered cognitive behavior therapy (ICBT). This study examined if patients' self-ratings of homework engagement, including conceptual (e.g., understandability, difficulty, perceived usefulness) and practical (e.g., effort put into reviewing the lessons, practicing skills, continuity in use of the learned skills) engagement predicts ICBT outcomes for anxiety and depression using a subs le of data from a previously published randomized controlled trial. Three hundred and one adult patients (74.56% female 91.29% Caucasians Patient-rated homework engagement significantly predicted rate of change in depression and anxiety symptom severity but was not significantly associated with initial levels of either outcome. Patients who reported higher engagement with assigned homework activities achieved more symptom reduction over treatment and follow-up at 12 weeks. The findings provide evidence of the importance of patients' self-rated engagement with homework in ICBT as well psychometric evidence supporting use of homework ratings to assess engagement. Further studies are needed to replicate the association between homework engagement and reduction in anxiety and depression symptoms. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Publisher: Cambridge University Press (CUP)
Date: 16-08-2020
DOI: 10.1017/S135246581900047X
Abstract: Despite its established efficacy, access to internet-delivered CBT (iCBT) remains limited in a number of countries. Translating existing programs and using a minimally monitored model of delivery may facilitate its dissemination across countries. This randomized control trial aims to evaluate the efficacy of an iCBT transdiagnostic program translated from English to French and offered in Canada using a minimally monitored delivery model for the treatment of anxiety and depression. Sixty-three French speakers recruited in Canada were randomized to iCBT or a waiting-list. A French translation of an established program, the Wellbeing Course, was offered over 8 weeks using a minimally monitored delivery model. Primary outcome measures were the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), which were obtained pre-treatment, post-treatment and at 3-month follow-up. Mixed-effects models revealed that participants in the treatment group had significantly lower PHQ-9 and GAD-7 scores post-treatment than controls with small between-groups effect sizes (d = 0.34 and 0.37, respectively). Within-group effect sizes on primary outcome measures were larger in the treatment than control group. Clinical recovery rates on the PHQ-9 and GAD-7 were significantly higher among the treatment group (40 and 56%, respectively) than the controls (13 and 16%, respectively). The provision of a translated iCBT program using a minimally monitored delivery model may improve patients’ access to treatment of anxiety and depression across countries. This may be an optimal first step in improving access to iCBT before sufficient resources can be secured to implement a wider range of iCBT services.
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.JANXDIS.2014.09.018
Abstract: This dissemination study examined the effectiveness of therapist-assisted Internet-delivered Cognitive Behavior Therapy (ICBT) when offered in clinical practice. A centralized unit screened and coordinated ICBT delivered by newly trained therapists working in six geographically dispersed clinical settings. Using an open trial design, 221 patients were offered 12 modules of ICBT for symptoms of generalized anxiety (n=112), depression (n=83), or panic (n=26). At baseline, midpoint and post-treatment, patients completed self-report measures. On average, patients completed 8 of 12 modules. Latent growth curve modeling identified significant reductions in depression, anxiety, stress and impairment (d=.65-.78), and improvements in quality of life (d=.48-.66). Improvements in primary symptoms were large (d=.91-1.25). Overall, therapist-assisted ICBT was effective when coordinated across settings in clinical practice, but further attention should be given to strategies to improve completion of treatment modules.
Publisher: Elsevier BV
Date: 03-2019
Publisher: JMIR Publications Inc.
Date: 26-08-2019
Abstract: nxiety and depression are leading causes of disability, but are often undertreated. Internet-delivered cognitive behaviour therapy (ICBT) improves access to treatment by overcoming barriers to obtaining care, such as location, time, and privacy. ICBT has been found to be efficacious in research trials and routine care, but there has been limited study of ICBT when ICBT is recommended and funded by insurance companies for clients on or recently in receipt of disability benefits or accommodations. he goal of this study was to examine ICBT engagement, acceptability, and effectiveness among in iduals involved with two insurance companies. The two s les were benchmarked against previously published outcomes obtained in a publicly-funded ICBT clinic. n iduals who were on or recently in receipt of disability benefits and were either employees of an insurance company (n = 21) or plan members of an insurance company (n = 19) were referred to ICBT funded by the respective insurance companies. Outcomes from these two s les were benchmarked against outcomes of ICBT obtained in a publicly-funded ICBT clinic, with clients in the clinic ided into those who reported no involvement with insurance companies (n = 414) and those who self-reported being on short-term disability (n = 44). All clients received the same 8-week, therapist-assisted, transdiagnostic ICBT course targeting symptoms of anxiety and depression. Engagement was assessed by examining ICBT completion rates, and number of emails exchanged and log-ins. Acceptability was assessed using post-treatment satisfaction questions. Effectiveness was assessed using measures of depression, anxiety, and disability administered at pre-treatment, post-treatment and 3-month follow-up. ll s les showed high levels of ICBT engagement and acceptability. Insurance company employees experienced significant effects on outcome measures at post-treatment (depression d = 0.48 anxiety d = 0.81 disability d = 0.72) that were maintained at 3-month follow-up. Insurance company plan members, who notably had greater pre-treatment disability than the other s les, experienced significant moderate effects on outcome measures at post-treatment (depression d = 0.56, anxiety d = 0.53, disability d = 0.48), but gains were not maintained at 3-month follow-up. Effect sizes in both insurance company s les were significantly smaller than in the publicly-funded s le who reported no insurance benefits (depression d = 1.17-1.20 anxiety d = 1.31-1.36 disability d =.93-1.06 at post-treatment and 3-month follow-up) and the publicly-funded s le who reported having short-term disability benefits (depression d = .89-1.06 anxiety d = 1.01-1.18 disability d =.86-1.03 at post-treatment and 3-month follow-up). any clients referred and funded by insurance companies were engaged with ICBT and found it acceptable and effective. Results, however, were not maintained among those with very high levels of pre-treatment disability. Directions for future research related to ICBT funded by insurance companies are described.
Publisher: JMIR Publications Inc.
Date: 17-06-2019
Abstract: ransdiagnostic internet-delivered cognitive behavioral therapy (T-ICBT) is an effective treatment for anxiety and depression, and nowadays, there is interest in exploring ways to optimize T-ICBT in routine care. T-ICBT programs are designed to address the primary cognitive-affective and behavioral symptoms of anxiety and depression (eg, low mood, worry, anhedonia, and avoidance). Treatment also has the potential to resolve other symptom concerns (eg, sleep disruption, sexual dysfunction, lack of energy, and appetite or weight changes). Having additional information regarding the extent of these concerns and how concerns change over time could prove beneficial for further development of T-ICBT in routine care. his exploratory formative study aims to better understand sleep, sexual functioning, energy, and appetite concerns among T-ICBT clients seeking treatment for depression and anxiety. A qualitative analytic approach was used to identify themes in the symptom concerns reported by patients in the areas of sleep, sexual functioning, energy, and appetite at the time of enrollment. Patient responses to related items from screening measures for anxiety and depression were also examined pre- and posttreatment. atients in routine care who applied for a T-ICBT program for depression and anxiety over a 1-year period were included in this study. As part of the application and screening process, participants completed depression and anxiety symptom measures (ie, 9-item Patient Health Questionnaire and 7-item Generalized Anxiety Disorder scale). These same measures were administered posttreatment. Subsequently, they were asked if they were experiencing any problems with sleep, sexual activity, energy, or appetite (yes or no). If their response was yes, they were presented with an open-ended comment box that asked them to describe the problems they had experienced in those areas. total of 462 patients were admitted to T-ICBT during the study period, of which 438 endorsed having some problems with sleep, sexual activity, energy, or appetite. The analysis of open-ended responses indicated that 73.4% (339/462) of patients reported sleep problems (eg, difficulty initiating or maintaining sleep), 69.3% (320/462) of patients reported problems with energy or motivation (eg, tiredness and low motivation), 57.4% (265/462) of patients reported appetite or body weight concerns (eg, changes in appetite and weight loss or gain), and 30.1% (139/462) of patients described concerns with sexual functioning (eg, loss of interest in sex and difficulty with arousal). Item analysis of symptom measures demonstrated that T-ICBT produced improvements in sleep, energy, and appetite in 8 weeks. Sexual dysfunction and weight changes were not represented in the screening measures, so it remains unclear what effect T-ICBT has on these symptoms. leep disruption, lack of energy, appetite or weight changes, and sexual dysfunction are common concerns reported by clients enrolled in T-ICBT in routine practice and may deserve greater attention in T-ICBT program development and administration.
Publisher: Elsevier BV
Date: 12-2021
Publisher: Elsevier BV
Date: 03-2018
Publisher: JMIR Publications Inc.
Date: 06-09-2022
DOI: 10.2196/37216
Abstract: Postpartum depression (PPD) and postpartum anxiety (PPA) are often comorbid and are associated with significant personal and economic costs. Fewer than half of the mothers experiencing PPD or PPA symptoms receive face-to-face treatment, suggesting a need for alternative delivery formats such as internet-delivered cognitive behavioral therapy (ICBT). This pilot study aimed to examine the impact of a therapist-assisted, transdiagnostic ICBT program on symptoms of PPD and PPA, as there is only one previous study on transdiagnostic ICBT with this population, which did not include therapist assistance. Clients endorsing the symptoms of PPD or PPA (N=63) were randomized to an 8-week transdiagnostic ICBT course (Wellbeing Course for New Moms) or to treatment as usual (TAU). Clients completed measures of depression, anxiety, stress, postnatal bonding, and relationship satisfaction, as well as measures of treatment satisfaction and therapeutic alliance, before treatment, after treatment, and at the 1-month follow-up. Outcome measures were also completed at the 6-month follow-up for clients who completed the ICBT course. Both the ICBT and TAU groups experienced statistically significant improvements over time. The ICBT group experienced larger improvements after treatment and at the 1-month follow-up on more measures than the TAU group, with medium between-group Cohen d effects on primary outcome measures for anxiety (Cohen d=0.65, 95% CI 0.13-1.17), PPD (Cohen d=0.52, 95% CI 0.01-1.04), and depression (Cohen d=0.56, 95% CI 0.05-1.08), and on secondary outcome measures of overall distress (Cohen d=0.69, 95% CI 0.17-1.21), anxiety (Cohen d=0.59, 95% CI 0.07-1.11), and stress (Cohen d=0.76, 95% CI 0.23-1.28). Time-by-group interactions for proportional reductions between groups over time were only significant after treatment and at the 1-month follow-up for the primary anxiety measure (P=.006). This study was underpowered for detecting small or medium effects. Overall, clients perceived the treatment as credible, and 95% (21/22) of the clients were satisfied with the treatment content and therapist support. Findings from this pilot study provide preliminary support for transdiagnostic ICBT in treating PPD and PPA symptoms to improve access to psychological treatments. ClinicalTrials.gov NCT04012580 t2/show/NCT04012580
Publisher: MDPI AG
Date: 11-10-2022
DOI: 10.3390/JCM11206001
Abstract: Adaptive actions, including healthy thinking and meaningful activities, have been associated with emotional wellbeing. The Things You Do Questionnaire—21 item (TYDQ-21) has recently been created to measure the frequency of such actions. A study using the TYDQ-21 found that adaptive actions increased across Internet-delivered therapy for symptoms of depression and anxiety, and higher TYDQ-21 scores were associated with lower psychological distress at post-treatment. The current study examined the relationships between adaptive actions and psychological distress among adults (n = 1114) receiving Internet-delivered therapy as part of routine care in Canada, and explored whether adaptive actions mediated reductions in depression and anxiety. As hypothesised, adaptive actions increased alongside reductions in depression and anxiety symptoms from baseline to post-treatment. Treatment effects were consistent when the intervention was provided with regular weekly therapist support or with optional weekly therapist support, and some (but not all) types of adaptive actions had a mediating effect on change in depressive symptoms. The present findings support further work examining adaptive actions as a mechanism of change in psychotherapy, as well as the utility and scalability of Internet-delivered treatments to target and increase adaptive actions with the aim of improving mental health.
Publisher: Elsevier BV
Date: 12-2020
Publisher: JMIR Publications Inc.
Date: 30-01-2021
Abstract: anadian public safety personnel (PSP) experience high rates of mental health disorders and face many barriers to treatment. Internet-delivered cognitive behavioral therapy (ICBT) overcomes many such barriers, and is effective for treating depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms. his study was designed to fill a gap in the literature regarding the use of ICBT tailored specifically for PSP. We examined the effectiveness of a tailored ICBT program for treating depression, anxiety, and PTSD symptoms among PSP in the province of Saskatchewan. e employed a longitudinal single-group open-trial design (N=83) with outcome measures administered at screening and at 8 weeks posttreatment. Data were collected between December 5, 2019 and September 11, 2020. Primary outcomes included changes in depression, anxiety, and PTSD symptoms. Secondary outcomes included changes in functional impairment symptoms of panic, social anxiety, and anger as well as treatment satisfaction, working alliance, and program usage patterns. lients reported large symptom reductions on measures of depression and anxiety, as well as moderate reductions on measures of PTSD and secondary symptoms, except for social anxiety. Most clients who reported symptoms above clinical cut-offs on measures of depression, anxiety, and PTSD during screening experienced clinically significant symptom reductions. Results suggested good engagement, treatment satisfaction, and working alliance. ailored, transdiagnostic ICBT demonstrated promising outcomes as a treatment for depression, anxiety, and PTSD among Saskatchewan PSP and warrants further investigation. linicaltrials.gov NCT04127032 t2/show/NCT04127032
Publisher: JMIR Publications Inc.
Date: 07-09-2022
DOI: 10.2196/40637
Abstract: Internet-delivered cognitive behavioral therapy (ICBT) can improve access to mental health care for students, although high attrition rates are concerning and little is known about long-term outcomes. Motivational interviewing (MI) exercises and booster lessons can improve engagement and outcomes in face-to-face cognitive behavioral therapy. This study aimed to examine the use of pretreatment MI exercises and booster lessons in ICBT for postsecondary students. In this factorial trial (factor 1: web-based MI before treatment factor 2: self-guided booster lesson 1 month after treatment), 308 clients were randomized to 1 of 4 treatment conditions, with 277 (89.9%) clients starting treatment. All clients received a 5-week transdiagnostic ICBT course (the UniWellbeing course). Primary outcomes included changes in depression, anxiety, and perceived academic functioning from before treatment to after treatment and at the 1-month and 3-month follow-ups. Overall, 54% (150/277) of students completed treatment and reported large improvements in symptoms of depression and anxiety and small improvements in academic functioning after treatment, which were maintained at the 1-month and 3-month follow-ups. Pretreatment MI did not contribute to better treatment completion or engagement, although small between-group effects favored MI for reductions in depression (Cohen d=0.23) and anxiety (Cohen d=0.25) after treatment. Only 30.9% (43/139) of students randomized to one of the booster conditions accessed the booster. Overall, no main effects were found for the booster. Subanalyses revealed that clients who accessed the booster had larger decreases in depressive symptoms (Cohen d=0.31) at the 3-month follow-up. No interactions were found between MI and the booster. Rather than offering MI before treatment, clients may experience more benefits from MI exercises later in ICBT when motivation wanes. The low uptake of the self-guided booster limited our conclusions regarding its effectiveness. Future research should examine offering a booster for a longer duration after treatment, with therapist support and a longer follow-up period. ClinicalTrials.gov NCT04264585 t2/show/NCT04264585
Publisher: MDPI AG
Date: 30-07-2022
Abstract: Patients seeking transdiagnostic internet-delivered cognitive behavior therapy (T-ICBT) for anxiety or depression often have sleep difficulties. A brief resource that includes sleep psychoeducation and strategies for improving sleep (e.g., stimulus control and sleep restriction) may address comorbid insomnia without the need for an insomnia-specific ICBT course. This observational study explored patient use and feedback of a brief sleep resource available to all patients (n = 763) enrolled in an 8-week T-ICBT course. Overall, 30.1% of patients (n = 230) reviewed the resource and were older, more engaged with the ICBT course (i.e., more likely to complete the program, more logins, and greater number of days enrolled in the course) and had higher pretreatment insomnia symptoms than those who did not review the resource. Resource reviewers did not report larger improvements in symptoms of insomnia than non-reviewers, even among patients with clinical levels of insomnia, and average insomnia levels remained above the clinical cutoff at posttreatment. While patients were satisfied with the resource and it was beneficial to some patients, more research is needed to further explore how it may be integrated into T-ICBT and how therapists can encourage the use of the resource among patients who may benefit from the resource.
Publisher: Elsevier BV
Date: 03-2022
Publisher: SAGE Publications
Date: 2019
Abstract: A body of literature suggests that the provision of human support improves both adherence to and clinical outcomes for digital mental health interventions. While multiple models of providing human support, or coaching, to support digital mental health interventions have been introduced, specific guidance on how to develop coaching protocols has been lacking. In this Education Piece, we provide guidance on developing coaching protocols for text-based communication in digital mental health interventions. Researchers and practitioners who are tasked with developing coaching protocols are prompted to consider the scope of coaching for the intervention, the selection and training of coaches, specific coaching techniques, how to structure communication with clients and how to monitor adherence to guidelines, and quality of coaching. Our goal is to advance thinking about the provision of human support in digital mental health interventions to inform stronger, more engaging, and effective intervention designs.
Publisher: Cambridge University Press (CUP)
Date: 26-01-2019
DOI: 10.1017/S1352465818000668
Abstract: Background: Although internet-delivered cognitive behaviour therapy (ICBT) yields large clinical outcomes when accompanied by therapeutic support, a portion of clients do not benefit from treatment. In ICBT, clients review treatment materials online typically on a weekly basis. A key component of therapist-assistance involves answering questions as clients review and work on assignments related to the treatment materials. Aims: The goal of this study was to enhance understanding of the nature of client questions posed during ICBT and examine potential associations between the number of questions asked and treatment outcomes in order to provide insight into how to improve ICBT for future users. Method: Content analysis was used to qualitatively analyse and identify questions that 80 clients asked their designated therapist over the course of an 8-week ICBT programme for anxiety and depression. Results: On average, clients sent six emails during the course of treatment, of which less than two questions were asked. Of the 137 questions posed by clients, 46.72% reflected questions designed to enhance understanding and apply the material and techniques reviewed in the programme. Additional questions were categorized as clarifying the therapeutic process (22.62%), addressing technical challenges (18.25%), and seeking assistance with problems outside the scope of ICBT (12.41%). Number of client questions asked was not significantly correlated with the number of lessons completed, symptom change, or perceptions of therapeutic alliance. Conclusions: Findings can inform future practitioners who deliver ICBT of what to expect with this treatment approach and also assist in the development of future ICBT programmes.
Publisher: Springer Science and Business Media LLC
Date: 09-01-2020
DOI: 10.1038/S41393-019-0398-6
Abstract: Observational pre-post study. Guided internet-delivered CBT (ICBT) offers an alternative approach for mental health service delivery in the community for those with spinal cord injury (SCI). The feasibility and acceptability of guided ICBT programme is available for various chronic health conditions however, the evidence related to SCI is limited. The primary aim of the current study was to examine feasibility and acceptability of a guided transdiagnostic ICBT programme for persons with SCI. Community. In this single-group pre-post study, persons with SCI (n = 20) living in the community were provided with a guided 8-week transdiagnostic ICBT programme for overall well-being. Study feasibility was examined by the following outcomes: patient recruitment, engagement, and attrition. Acceptability of the programme was evaluated post-treatment. Reductions in symptoms of depression and anxiety were assessed at baseline, post-intervention, and at 3-month follow-up. Approximately 60% of eligible participants were recruited. The study found high rates of programme completion (90%) and outcome data were obtained from 90% of participants. Improvement in symptoms of depression (and anxiety) were seen after treatment. Gains were maintained at 3-month follow-up. Guided transdiagnostic ICBT programme is a feasible and acceptable treatment option for those with psychological needs following SCI.
Publisher: Elsevier BV
Date: 02-2014
Publisher: Informa UK Limited
Date: 2018
Publisher: Elsevier BV
Date: 12-2019
Publisher: Informa UK Limited
Date: 25-04-2018
DOI: 10.1080/16506073.2018.1457079
Abstract: Internet-delivered cognitive behaviour therapy (ICBT) is often accompanied by therapist emails, but there is limited research on the quality of this therapist-assistance. In this study, an ICBT Therapist Rating Scale (ICBT-TRS) was developed and evaluated to assess whether therapist emails showed fidelity to specific therapist behaviours. Using data from a previous ICBT trial for depression and anxiety, the ICBT-TRS was used to rate 706 emails sent by 39 therapists to 91 randomly selected patients. Emails were rated for adherence (absent resent) and quality (inadequate/competent) on the following behaviours: Builds Rapport, Seeks Feedback, Provides Symptom Feedback, Provides Psychoeducation, Facilitates Understanding, Praises Effort, Encourages Practice, Clarifies Administrative Procedures, and Communicates Effectively. Inter-rater reliability was high. Most behaviours were identified as present in 72-100% of emails, with the exception of Provides Symptom Feedback and Facilitating Understanding which were only present in 54 and 61% of emails. The majority of emails were rated as high quality (88-98% of messages). While not related to symptom improvement, ICBT-TRS ratings were higher when patients were more engaged in ICBT (e.g. log-ins) and among therapists who specialized in ICBT or had a background in Psychology. The ICBT-TRS has potential to facilitate ICBT research and clinical training.
Publisher: JMIR Publications Inc.
Date: 04-02-2020
DOI: 10.2196/16005
Abstract: Anxiety and depression are leading causes of disability but are often undertreated. Internet-delivered cognitive behavioral therapy (ICBT) improves access to treatment by overcoming barriers to obtaining care. ICBT has been found to be efficacious in research trials and routine care, but there is limited research of ICBT when it is recommended and funded by insurance companies for clients on or recently in receipt of disability benefits or accommodations. The aim of this study was to examine ICBT engagement, treatment satisfaction, and effectiveness among in iduals involved with 2 insurance companies. The 2 s les were benchmarked against published outcomes from a publicly funded (PF) ICBT clinic. In iduals who were on or recently in receipt of disability benefits and were either insurance company (IC) employees (n=21) or IC plan members (n=19) were referred to ICBT funded by the respective insurance companies. Outcomes were benchmarked against outcomes of ICBT obtained in a PF ICBT clinic, with clients in the clinic ided into those who reported no involvement with insurance companies (n=414) and those who were on short-term disability (n=44). All clients received the same 8-week, therapist-assisted, transdiagnostic ICBT course targeting anxiety and depression. Engagement was assessed using completion rates, log-ins, and emails exchanged. Treatment satisfaction was assessed posttreatment. Depression, anxiety, and disability measures were administered pretreatment, posttreatment, and at 3 months. All s les showed high levels of ICBT engagement and treatment satisfaction. IC employees experienced significant improvement at posttreatment (depression d=0.77 anxiety d=1.13 and disability d=0.91) with outcomes maintained at 3 months. IC plan members, who notably had greater pretreatment disability than the other s les, experienced significant moderate effects at posttreatment (depression d=0.58 anxiety d=0.54 and disability d=0.60), but gains were not maintained at 3 months. Effect sizes at posttreatment in both IC s les were significantly smaller than in the PF s le who reported no insurance benefits (depression d=1.14 and anxiety d=1.30) and the PF s le who reported having short-term disability benefits (depression d=0.95 and anxiety d=1.07). No difference was seen in effect sizes among IC employees and the PF s les on disability. However, IC plan members experienced significantly smaller effects on disability d=0.60) compared with the PF s le with no disability benefits d=0.90) and those on short-term disability benefits d=0.94). Many clients referred and funded by insurance companies were engaged with ICBT and found it acceptable and effective. Results, however, were not maintained among those with very high levels of pretreatment disability. Small s le sizes in the IC groups are a limitation. Directions for research related to ICBT funded by insurance companies have been described.
Publisher: JMIR Publications Inc.
Date: 13-10-2020
DOI: 10.2196/15037
Abstract: Transdiagnostic internet-delivered cognitive behavioral therapy (T-ICBT) is an effective treatment for anxiety and depression, and nowadays, there is interest in exploring ways to optimize T-ICBT in routine care. T-ICBT programs are designed to address the primary cognitive-affective and behavioral symptoms of anxiety and depression (eg, low mood, worry, anhedonia, and avoidance). Treatment also has the potential to resolve other symptom concerns (eg, sleep disruption, sexual dysfunction, lack of energy, and appetite or weight changes). Having additional information regarding the extent of these concerns and how concerns change over time could prove beneficial for further development of T-ICBT in routine care. This exploratory formative study aims to better understand sleep, sexual functioning, energy, and appetite concerns among T-ICBT clients seeking treatment for depression and anxiety. A qualitative analytic approach was used to identify themes in the symptom concerns reported by patients in the areas of sleep, sexual functioning, energy, and appetite at the time of enrollment. Patient responses to related items from screening measures for anxiety and depression were also examined pre- and posttreatment. Patients in routine care who applied for a T-ICBT program for depression and anxiety over a 1-year period were included in this study. As part of the application and screening process, participants completed depression and anxiety symptom measures (ie, 9-item Patient Health Questionnaire and 7-item Generalized Anxiety Disorder scale). These same measures were administered posttreatment. Subsequently, they were asked if they were experiencing any problems with sleep, sexual activity, energy, or appetite (yes or no). If their response was yes, they were presented with an open-ended comment box that asked them to describe the problems they had experienced in those areas. A total of 462 patients were admitted to T-ICBT during the study period, of which 438 endorsed having some problems with sleep, sexual activity, energy, or appetite. The analysis of open-ended responses indicated that 73.4% (339/462) of patients reported sleep problems (eg, difficulty initiating or maintaining sleep), 69.3% (320/462) of patients reported problems with energy or motivation (eg, tiredness and low motivation), 57.4% (265/462) of patients reported appetite or body weight concerns (eg, changes in appetite and weight loss or gain), and 30.1% (139/462) of patients described concerns with sexual functioning (eg, loss of interest in sex and difficulty with arousal). Item analysis of symptom measures demonstrated that T-ICBT produced improvements in sleep, energy, and appetite in 8 weeks. Sexual dysfunction and weight changes were not represented in the screening measures, so it remains unclear what effect T-ICBT has on these symptoms. Sleep disruption, lack of energy, appetite or weight changes, and sexual dysfunction are common concerns reported by clients enrolled in T-ICBT in routine practice and may deserve greater attention in T-ICBT program development and administration.
Publisher: Cambridge University Press (CUP)
Date: 2022
DOI: 10.1017/S1754470X22000423
Abstract: Digital CBT refers to the use of digital tools, platforms or devices to deliver or enhance cognitive behavioural therapy assessment, formulation, treatment, training and supervision. The ‘Advances in Digital CBT’ special issue aimed to document ex les of innovative digital CBT practice in this rapidly developing field. In this paper, we have briefly summarised and synthesised the advances demonstrated in this group of articles. These include developments in our understanding of mental health apps, the use of digital tools as an adjunct to therapy, the effectiveness of remotely delivered CBT in routine clinical practice, our understanding of user experiences and involvement, and in digital CBT research methods. We consider the extent of current knowledge in these areas and identify where gaps in evidence lie and how the field could be taken forward to address these. Lastly, we reflect on the broader digital CBT picture and offer our suggestions of six key directions for future research: using robust study designs to evaluate and optimise digital tools translating and culturally adapting digital tools and practices understanding and addressing digital exclusion exploring, reporting and addressing possible negative effects improving user involvement in design and evaluation and addressing the implementation gap for digital tools. We suggest that further advances in these areas would be of particular benefit to the digital CBT field. (1) To gain an overview of the articles in the special issue and an understanding of the advances in digital CBT they represent. (2) To understand how the advances suggested by the present studies could be taken forward and extended. (3) To consider key future directions for further advances in digital CBT.
Publisher: Elsevier BV
Date: 12-2020
Publisher: JMIR Publications Inc.
Date: 12-2022
Abstract: roblematic alcohol use is common among clients seeking transdiagnostic internet-delivered cognitive behavioral therapy (ICBT) for depression or anxiety but is not often addressed in these treatment programs. The benefits of offering clients a psychoeducational resource focused on alcohol use during ICBT for depression or anxiety are unknown. his observational study aimed to elucidate the impacts of addressing comorbid alcohol use in ICBT for depression and anxiety. ll patients (N=1333) who started an 8-week transdiagnostic ICBT course for depression and anxiety received access to a resource containing information, worksheets, and strategies for reducing alcohol use, including psychoeducation, reasons for change, identifying risk situations, goal setting, replacing drinking with positive activities, and information on relapse prevention. We assessed clients’ use and perceptions of the resource client characteristics associated with reviewing the resource and whether reviewing the resource was associated with decreases in clients’ alcohol use, depression, and anxiety at posttreatment and 3-month follow-up among clients dichotomized into i low-risk /i and i hazardous /i drinking categories based on pretreatment Alcohol Use Disorders Identification Test (AUDIT) scores. uring the 8-week course, 10.8% (144/1333) of clients reviewed the resource, and those who reviewed the resource provided positive feedback (eg, 127/144, 88.2% of resource reviewers found it worth their time). Furthermore, 18.15% (242/1333) of clients exhibited hazardous drinking, with 14.9% (36/242) of these clients reviewing the resources. Compared with nonreviewers, resource reviewers were typically older ( i P /i =.004) and separated, orced, or widowed ( i P /i & .001). Reviewers also consumed more weekly drinks ( i P /i & .001), scored higher on the AUDIT ( i P /i & .001), and were more likely to exhibit hazardous drinking ( i P /i & .001). Regardless of their drinking level (ie, low risk vs hazardous), all clients showed a reduction in AUDIT-Consumption scores ( i P /i =.004), depression ( i P /i & .001), and anxiety ( i P /i & .001) over time in contrast, there was no change in clients’ drinks per week over time ( i P /i =.81). Reviewing alcohol resources did not predict changes in AUDIT-Consumption scores or drinks per week. verall, ICBT appeared to be associated with a reduction in alcohol consumption scores, but this reduction was not greater among alcohol resource reviewers. Although there was some evidence that the resource was more likely to be used by clients with greater alcohol-related difficulties, the results suggest that further attention should be given to ensuring that those who could benefit from the resource review it to adequately assess the benefits of the resource.
Publisher: JMIR Publications Inc.
Date: 18-04-2023
DOI: 10.2196/44722
Abstract: Problematic alcohol use is common among clients seeking transdiagnostic internet-delivered cognitive behavioral therapy (ICBT) for depression or anxiety but is not often addressed in these treatment programs. The benefits of offering clients a psychoeducational resource focused on alcohol use during ICBT for depression or anxiety are unknown. This observational study aimed to elucidate the impacts of addressing comorbid alcohol use in ICBT for depression and anxiety. All patients (N=1333) who started an 8-week transdiagnostic ICBT course for depression and anxiety received access to a resource containing information, worksheets, and strategies for reducing alcohol use, including psychoeducation, reasons for change, identifying risk situations, goal setting, replacing drinking with positive activities, and information on relapse prevention. We assessed clients’ use and perceptions of the resource client characteristics associated with reviewing the resource and whether reviewing the resource was associated with decreases in clients’ alcohol use, depression, and anxiety at posttreatment and 3-month follow-up among clients dichotomized into low-risk and hazardous drinking categories based on pretreatment Alcohol Use Disorders Identification Test (AUDIT) scores. During the 8-week course, 10.8% (144/1333) of clients reviewed the resource, and those who reviewed the resource provided positive feedback (eg, 127/144, 88.2% of resource reviewers found it worth their time). Furthermore, 18.15% (242/1333) of clients exhibited hazardous drinking, with 14.9% (36/242) of these clients reviewing the resources. Compared with nonreviewers, resource reviewers were typically older (P=.004) and separated, orced, or widowed (P .001). Reviewers also consumed more weekly drinks (P .001), scored higher on the AUDIT (P .001), and were more likely to exhibit hazardous drinking (P .001). Regardless of their drinking level (ie, low risk vs hazardous), all clients showed a reduction in AUDIT-Consumption scores (P=.004), depression (P .001), and anxiety (P .001) over time in contrast, there was no change in clients’ drinks per week over time (P=.81). Reviewing alcohol resources did not predict changes in AUDIT-Consumption scores or drinks per week. Overall, ICBT appeared to be associated with a reduction in alcohol consumption scores, but this reduction was not greater among alcohol resource reviewers. Although there was some evidence that the resource was more likely to be used by clients with greater alcohol-related difficulties, the results suggest that further attention should be given to ensuring that those who could benefit from the resource review it to adequately assess the benefits of the resource.
Publisher: Springer Science and Business Media LLC
Date: 03-08-2022
DOI: 10.1007/S10865-022-00346-X
Abstract: There is growing interest in offering Internet-delivered cognitive behaviour therapy (ICBT) to in iduals with chronic health conditions, with this process often being guided by a single clinician. Due to lack of full time personnel, it is sometimes necessary to have multiple clinicians offer guidance or for no guidance to be offered. In this randomized trial, we compared team-guided ICBT ( n = 90) to self-guided ICBT ( n = 88). Participants completed measures at pre-, post-, and 3-months post-ICBT. Both groups showed similar rates of treatment completion and large improvements on depression and anxiety at post-treatment and follow-up. Unexpectedly, more participants in the self-guided versus team-guided condition showed clinically significant improvement on depression at post-treatment (76.5% vs 49.2%) and follow-up (70% vs 45.6%). Thus, team-guided ICBT may not provide significant benefits compared to self-guided ICBT. However, it may be an alternative approach to consider among a population of high risk in iduals that wants or requires closer monitoring of symptoms. Trail registration TRN: NCT03500237 Date: April 18, 2018.
Publisher: Elsevier BV
Date: 06-2021
Publisher: Elsevier BV
Date: 04-2020
No related grants have been discovered for Heather Hadjistavropoulos.