Michael Edmonds

Can patient characteristics at intake predict patient response to therapist-assisted transdiagnostic internet-delivered cognitive behavioural therapy?

Masters Thesis Results, Michael Edmonds 2018

Background: The Wellbeing Course is a transdiagnostic  online program designed to treat anxiety and depression. The five lesson  course teaches patients skills for managing anxiety and depression  based on principals of cognitive behavioural therapy and includes weekly  therapist contact via telephone or secure message. The program has been  shown to reduce symptoms in patients overall and, on average, patients  report a high degree of satisfaction. Although the program is effective  overall, only 75% of patients complete the program and only 50% of  patients complete the program and report a reliable reduction in either  anxiety or depression. The aim of this research was therefore to examine  patient outcomes further and look for relationships with patient  characteristics that might allow us to predict which patients are most  likely to benefit from online therapy.

Method: Patient case records from 1201 patients who enrolled in the Wellbeing Course were compiled and analyzed to look for relationships between patient  characteristics at intake and patient outcomes. Autoregressive latent  trajectory modeling was used to look for relationships between patient  characteristics and patient symptom change over time. Classification  trees were created to predict treatment dropout and overall treatment  success.

Results: Younger people were found to be at greater risk of  dropping out from online therapy. Higher initial severity of anxiety or  depression was related to greater improvement over the course of  therapy. Age and relationship status were related to anxiety symptom  trajectories, while education and initial psychological distress and  disability scores were related to depressive symptom trajectories.

Conclusions: Although some groups were identified as being at  higher risk of dropout or not improving, none of these effects were  strong enough to suggest that exclusion criteria for the program should  be changed. Instead, future research should look at how the program can  be modified to improve outcomes for at-risk groups.