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

Abstract

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

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

“…These manipulated various aspects of the treatment format reported mostly null results with small effect sizes. In single trials, small moderating effects were reported for therapist guidance, app recommendations and pretreatment motivational interviewing 70 96. In other trials, null results were, however, also reported for guidance and motivational interviewing 51 80…”

“…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.…”

Outcomes of Best-Practice Guided Digital Mental Health Interventions for Youth and Young Adults with Emerging Symptoms: Part II. A Systematic Review of User Experience Outcomes

“…Web-delivery was the most frequent delivery method for asynchronous interventions ( n = 9) followed by app-based interventions ( n = 1; Ravaccia et al, 2022 ), and combination-delivered interventions ( n = 1; Hennemann et al, 2022 ). Solely asynchronously guided support was provided through email ( n = 1; Juniar et al, 2022 ), SMS/text messages ( n = 1; Peynenburg et al, 2022 ), and other messaging functions built in to the intervention platform, such as chat functions ( n = 7). Partially asynchronous guided support ( n = 10) was provided through a mix of messaging (within platform or SMS) and phone calls ( n = 6), emails and phone calls/text ( n = 1; Stapinski et al, 2021 ), phone calls only (Radomski et al, 2020 ), emails (O’Connor et al, 2020 ), and other channels such as online support and community newsfeeds ( n = 1; van Doorn et al, 2022 ).…”

“…Use NR NR Mean intervention length 89.64 days ( SD = 67.87; range = 4–475) for SC-ONLY, 96.09 days ( SD = 133.44; range 3–1036) for SC + TX. On average, SC-ONLY and SC + TX participants used 15% of DHMI or viewed an average of 16.27 pages ( SD = 17.72; Range 0–101) and used an average of 3.88 tools ( SD = 4.98; Range 0–41) Efficacy = Yes Efficient = NR Peynenburg et al ( 2022 ) To examine effects of including pretreatment MI and a self-guided booster (UniWellbeing) offered 1-month after transdiagnostic iCBT for postsecondary students 1. Satisfaction (TSQ) NR High satisfaction (82.3% (158/193) with participants reporting they were ‘satisfied’ or ‘very satisfied’ with treatment.…”

Exploring reasons for usage discontinuation in an internet-delivered stress recovery intervention: A qualitative study

“…Motivational interviews before ICBT program may encourage participants to use the program for more days ( Soucy et al, 2021 ; Titov et al, 2010 ). On the other hand, motivational interviewing may not benefit all individuals equally ( Peynenburg et al, 2022 ). It is therefore important to restrict motivational interviews only to those who would benefit from them, in order to avoid an additional treatment burden.…”