Author: RITS Admin
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 (N = 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.
Exploring weekly reflections and twice-weekly support
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 (N = 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.
Comparing types of therapist support
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.