A randomized factorial trial of internet-delivered cognitive behavioural therapy: An 8-week program with or without extended support and booster lesson

Hadjistavropoulos, Heather D.; Peynenburg, Vanessa; Thiessen, David; Nugent, Marcie; Karin, Eyal; Dear, Blake F.; Titov, Nickolai

doi:10.1016/j.invent.2022.100499

Cited by 17 publications

(16 citation statements)

References 55 publications

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“…Booster use in this study was lower (43/134, 31.9%) than that in previous trials of boosters in ICBT (32/47, 68% in the study by Andersson et al [ 23 ] and 114/223, 51.5% in the study by Hadjistavropoulos et al [ 24 ]), although both these trials included therapist support during the booster, which may have been more favorable to clients than a self-guided booster lesson. There was evidence for lower symptoms of depression at the 3-month follow-up among clients who accessed the booster than among those who did not access the booster, which was in contrast with the findings of a recent trial of a therapist-assisted booster following ICBT [ 24 ]. It is possible that clients who felt that they were managing their academic studies well were more likely to believe that they had the time to review the booster lesson.…”

Section: Discussioncontrasting

confidence: 68%

“…In the case of ICBT, there is some evidence showing that booster sessions after ICBT contribute to greater levels of overall functioning and delay the onset of relapse in clients with obsessive-compulsive disorder [ 23 ]. However, in another recent study of booster lessons with ICBT, the benefits of a booster session could not be adequately explored as uptake of the therapist-assisted booster lesson was low [ 24 ]. Overall, given the need to improve the engagement and outcomes of ICBT among postsecondary students, the benefits of booster lessons after ICBT are worthy of exploration.…”

Section: Introductionmentioning

confidence: 99%

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Internet-Delivered Cognitive Behavioral Therapy for Postsecondary Students: Randomized Factorial Trial for Examining Motivational Interviewing and Booster Lessons

Peynenburg¹,

Hadjistavropoulos²,

Thiessen³

et al. 2022

J Med Internet Res

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Background 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. Objective This study aimed to examine the use of pretreatment MI exercises and booster lessons in ICBT for postsecondary students. Methods 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. Results 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. Conclusions 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. Trial Registration ClinicalTrials.gov NCT04264585; https://clinicaltrials.gov/ct2/show/NCT04264585

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Section: Discussioncontrasting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Internet-Delivered Cognitive Behavioral Therapy for Postsecondary Students: Randomized Factorial Trial for Examining Motivational Interviewing and Booster Lessons

Peynenburg¹,

Hadjistavropoulos²,

Thiessen³

et al. 2022

J Med Internet Res

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“…In transdiagnostic ICBT, the focus is typically on depression and anxiety and includes content that mirrors traditional CBT (e.g., cognitive restructuring, breathing or relaxation strategies, behavioral activation, graded exposure, and relapse prevention; see Reference [ 5 ]). During a T-ICBT intervention, patients also often access extra materials that include psychoeducational content and skills for specific issues and difficulties that are expected to be relevant for some, but not all, patients [ 6 ]. Sleep represents one such problem area that is relevant for many patients and is likely important to address in T-ICBT.…”

Section: Introductionmentioning

confidence: 99%

Examining the Utility of a Sleep Resource in Transdiagnostic Internet-Delivered Cognitive Behavior Therapy: An Observational Study

Peynenburg

Ababei

Wilhelms

et al. 2022

IJERPH

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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.

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“…In the 57 included trials, 21 795 participants were randomised 46–102. Arms were as follows: 83 internet-delivered transdiagnostic psychological treatments, 36 rudimentary controls, 8 attention/engagement controls and three other bona-fide treatments.…”

Section: Resultsmentioning

confidence: 99%

Internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety or both: a systematic review with meta-analysis of randomised controlled trials

Kolaas,

Berman,

Hedman-Lagerlöf

et al. 2024

BMJ Open

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ObjectiveDepression and anxiety are major public health problems. This study evaluated the effects of internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety, or both.DesignSystematic review with meta-analysis.Data sourcesMedline (Ovid), Cochrane Library (Wiley), the Web of Science Core Collection (Clarivate), and PsycInfo (EBSCO) were searched on 24 May 2021, with an update on 6 February 2023.Eligibility criteriaRandomised controlled trials of internet-delivered transdiagnostic psychological treatments, open to both participants with primary depression and participants with primary anxiety. This review concerned all treatment frameworks, both guided and unguided formats and all age groups.Data extraction and synthesisIn random-effects meta-analysis, we estimated pooled effects on depression symptoms and anxiety in terms of Hedges’gwith 95% CIs. Absolute and relative heterogeneity was quantified as the τ2andI2.ResultsWe included 57 trials with 21 795 participants. Nine trials (16%) recruited exclusively from routine care, and three (5%) delivered treatment via video. For adults, large within-group reductions were seen in depression (g=0.90; 95% CI 0.81 to 0.99) and anxiety (g=0.87; 95% CI 0.78 to 0.96). Compared with rudimentary passive controls, the added effects were moderate (depression:g=0.52; 95% CI 0.42 to 0.63; anxiety:g=0.45; 95% CI 0.34 to 0.56) and larger in trials that required all participants to meet full diagnostic criteria for depression or an anxiety disorder. Compared with attention/engagement controls, the added effects were small (depression:g=0.30; 95% CI 0.07 to 0.53; anxiety:g=0.21; 95% CI 0.01 to 0.42). Heterogeneity was substantial, and the certainty of the evidence was very low. Two trials concerned adolescents and reported mixed results. One trial concerned older adults and reported promising results.ConclusionInternet-delivered transdiagnostic treatments for depression and anxiety show small-to-moderate added effects, varying by control condition. Research is needed regarding routine care, the video format, children and adolescents and older adults.PROSPERO registration numberCRD42021243172.

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A randomized factorial trial of internet-delivered cognitive behavioural therapy: An 8-week program with or without extended support and booster lesson

Cited by 17 publications

References 55 publications

Internet-Delivered Cognitive Behavioral Therapy for Postsecondary Students: Randomized Factorial Trial for Examining Motivational Interviewing and Booster Lessons

Internet-Delivered Cognitive Behavioral Therapy for Postsecondary Students: Randomized Factorial Trial for Examining Motivational Interviewing and Booster Lessons

Examining the Utility of a Sleep Resource in Transdiagnostic Internet-Delivered Cognitive Behavior Therapy: An Observational Study

Internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety or both: a systematic review with meta-analysis of randomised controlled trials

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