iCBT Intervention Research Articles

Internet-Based Cognitive Behavioral Therapy for Depression and Anxiety Symptoms in Cancer: A Meta-Analysis

Background: Depression and anxiety affect up to 20% of patients with cancer. Physical treatment and side effects are usually the only factors given attention to during treatment and recovery. Psychological distress can have deleterious effects in their quality of life, and may even affect healing. Treatment options for depression and anxiety are limited. One well-studied treatment is cognitive behavioral therapy (CBT). However, face-to-face treatment has been a challenge for the oncology team during this pandemic. Internet-based cognitive behavioral therapy (iCBT) can be a new means of dealing with cancer patients’ psychological health. Objective: To evaluate iCBT in alleviating depression and anxiety symptoms in patients with cancer. Methods: A systematic search of Pubmed, Embase, Cochrane, Clinical trials databases and hand search were utilized to identify randomized controlled trials (RCTs) investigating the role of iCBT in addressing psychological distress in cancer patients. Meta-analysis was conducted on 4 randomized controlled trials (N=548). All 4 studies were included for analysis. Psychological distress was measured as depression and anxiety based on the Hospital Anxiety and Depression Scale (HADS) total scores. Results: There was a trend in improvement of anxiety and depression in the iCBT treatment group, however, it was not significant (p = 0.06). Due to substantial heterogeneity, subgroup analyses was done and showed improvement of anxiety and depression in patients with different cancer types and baseline psychological distress (p < 0.00001). Conclusion: The results indicate that iCBT can be a potential treatment option in cancer patients who exhibit baseline depression and anxiety, especially during this pandemic. More studies are needed to determine the efficacy of iCBT in cancer patients who are not clinically diagnosed with psychological disorders.

Internet-Delivered Cognitive Behavioural Therapy for the Management of Chronic Non-Cancer Pain


 This Health Technology Assessment (HTA) was conducted to inform decision-makers about whether internet-delivered cognitive behavioural therapy (iCBT) should be offered as a treatment option for chronic non-cancer pain as part of a multidisciplinary approach when in-person cognitive behavioural therapy (CBT) would otherwise be offered. This HTA consists of a systematic review of clinical effectiveness and safety, an interview study, and an Environmental Scan.
 In this HTA, iCBT is defined as psychotherapy based on CBT principles delivered through the internet, including self-directed app-based programs (with or without therapist support) and CBT delivered through the internet in real time by a therapist (e.g., videoconference).
 The Clinical Review found there was little to no difference between iCBT and in-person CBT for most outcomes, but the evidence was very uncertain because of risk of bias, inconsistency, indirectness, and imprecision. The uncertain clinical evidence prevents a strong conclusion about the safety and effectiveness of iCBT as a treatment option when in-person CBT would otherwise be offered for chronic non-cancer pain.
 Five women living with chronic non-cancer pain were interviewed regarding their experiences with, or perspectives on, the use of iCBT for chronic pain. All the women interviewed felt iCBT has the potential to be a supportive treatment option if offered as part of comprehensive, multidisciplinary pain care. Based on their experiences, the women interviewed reported that multidisciplinary pain care does not always happen in practice, and they described potential concerns of offering iCBT in the absence of other treatments. They also indicated that determining a patient’s readiness for iCBT is important. If iCBT is determined to be appropriate, the women emphasized that a tailored treatment approach and a strong therapeutic relationship between the patient and iCBT provider might improve the success of iCBT treatment for chronic pain.
 The Environmental Scan identified 16 iCBT programs for chronic pain that are available in Canada. Many potential facilitators (e.g., improving access, improving treatment experience, efficiency, and convenience) and barriers (preference for in-person treatment, privacy concerns, technology issues, and no access to a device or internet connection) for iCBT programs in Canada were identified.
 If decision-makers decide to implement an iCBT program for chronic pain as part of their multidisciplinary pain care approach, they may wish to consider offering programs that:
 
 are guided by therapists specifically trained in chronic pain
 foster strong therapeutic relationships, encourage shared decision-making practices, and can be tailored to the needs of the person living with chronic pain
 consider the readiness and suitability of the person living with chronic pain before offering iCBT
 consider privacy and technological concerns or challenges.
 
 

Internet-based cognitive therapy for women with antenatal depressive symptoms during the COVID-19 pandemic: protocol for a multi-center randomized controlled trial across China

BackgroundDepression and anxiety are common among pregnant women. Internet-delivered psychological therapies such as cognitive behavioral therapy (iCBT) have been developed to increase accessibility and address common help-seeking barriers, especially during pandemic period. The objective of this trial is to evaluate the short-term and long-term effects of iCBT on reducing depressive symptoms among pregnant women during the COVID-19 pandemic with the overall goal of preventing depression recurrence in the first 12 months postpartum.MethodsA multi-site randomized controlled trial will be conducted where 300 pregnant women early in their third trimester will be screened for depression symptoms using the Edinburgh Postnatal Depression Scale (EPDS) during a routine obstetrical visit. Eligible and consenting women with a score greater than 9 will be randomly allocated (1:1) to either intervention group or control group. ICBT involving the completion of 7 weekly online modules will be delivered via a well-designed perinatal mental healthcare app. The primary objective is to evaluate the effect of iCBT on reducing depression symptoms among pregnant Chinese women starting from their third trimester. The secondary objectives are to examine the effect of iCBT on anxiety, sleep quality, social support, parenting stress, co-parenting relationship, and infant development.DiscussionThis multi-center randomized controlled trial has been planned in accordance with best practices in behavioral trial design. The internet-based intervention addressed the needs of pregnant women during a major pandemic where face-to-face therapy is not preferable. The trial has a relatively large sample size with sufficient power to evaluate the efficacy of iCBT intervention for the primary and secondary outcomes. One year follow-up evaluation in the study is designed to determine the longer-term effect of the intervention on both maternal and infant outcomes. Although a limitation is the assessment of depression and anxiety using self-report measures, these easily incorporated and maternal-preferred assessments allow for real-life scalability if the intervention is proven to be effective.Ethics and disseminationEthics was approved by the institutional review board of International Peace Maternity and Child Health Hospital (GKLW2020-25). Dissemination of results will be published in peer-reviewed academic journals and presented at scientific conferences.Trial statusThe first patient was enrolled on 19 August 2020. To date, 203 participants have met eligibility requirements and been randomized to either the intervention group or control group. Data collection aims to be complete in September 2022. Date and version identifier: 2020715-version1.0.Trial registrationChiCTR2000033433. Registered 31 May 2020, http://www.chictr.org.cn/showproj.aspx?proj=54482.

Online psychological interventions to improve symptoms in multiple sclerosis: A systematic review: Online psychological interventions in Multiple Sclerosis.

The aim of this systematic review was to assess the effectiveness of Internet-based psychological interventions in the treatment of physical, socio-affective and cognitive symptoms and quality of life (QoL) in people with multiple sclerosis (pwMS) to provide currently available evidence. Systematic searches for eligible studies were carried out in four databases (August 2021) using key words. Studies were screened, data extracted, quality appraised and analysed by three independent reviewers, using predefined criteria and following the PRISMA rules. Study quality was assessed using Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields QUALSYST tool. Physical, socio-affective and cognitive symptoms and QoL were the primary outcomes. Thirteen studies were included. Two principal approaches were reported: Cognitive behavioural therapy (CBT) and mindfulness-based interventions (MBI). Interventions varied from tailored versions to videoconference by a clinician, duration mean 8 weeks, delivered via individually and groups, all online. The review found that iCBT interventions were effective for improve depression, anxiety, fatigue and QoL, and slightly in cognitive functioning in pwMS, whereas MBI interventions reported benefits in depression, anxiety, stress and QoL, and less evidence in fatigue. Generally, study quality was acceptable in most studies; eleven of the studies scored a low risk of bias on all items in the Qualsyst Tool, whereas only two studies were considered unacceptable. Psychological online interventions may improve physical, socio-affective and cognitive symptoms as well as QoL in pwMS, overcoming the face-to-face barriers (i.e. disability). Contact with the therapist and groups sessions have been identified as enablers of the online interventions. Nevertheless, the limited number of studies and the heterogeneity of health outcomes reported made difficult to afford robust conclusions on psychological intervention effects in pwMS.

Cost-effectiveness of Internet-delivered cognitive behavioural therapy in patients with cardiovascular disease and depressive symptoms

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): The Swedish Research Council and the Medical Research of Southeast Sweden Introduction Cost-effectiveness evaluations of psychological interventions, such as Internet-delivered cognitive behavioural therapy (iCBT) programs, in patients with cardiovascular disease (CVD) are rare. In a recent study we reported that a 9-week iCBT program (n=72) compared to an online discussion forum (ODF) (n=72) had moderate to large effect on depression in CVD outpatients. Purpose To evaluate the cost-effectiveness of this intervention. Methods Cost-effectiveness analysis of a RCT, using an incremental cost-effectiveness ratio (ICER). The costs and effects included in the ICER are from baseline to one year post intervention, but also costs for guidance and support to patients in iCBT and ODF groups. Data on healthcare costs were retrieved from healthcare registries, and the EQ-5D-3L was used to calculate the quality-adjusted life years (QALYs). The ICER can be seen as the additional costs needed to gain an additional QALY by the iCBT compared to ODF. Results At 12-month follow-up, the QALY was significantly higher in iCBT compared to the ODF group (0.713 vs.0.598, p=.007). The mean difference of 0.115 corresponds with 42 extra days in best imaginable health status in favour of the iCBT group over the course of one year. The ICER for iCBT versus ODF was €18,865 per QALY saved. The cost-effectiveness plane indicated that iCBT is a cheaper and more effective intervention in 24.5% of the cases, and in 75% a costlier and more effective intervention than ODF. Only in about 0.5% of the cases, there was an indication of a costlier, but less effective intervention compared to ODF. Conclusions The ICER of €18,865 was lower than the cost-effectiveness threshold range of €23,400-€35,100 as proposed by the NICE guidelines, suggesting that the iCBT treatment of depressive symptoms in patients with CVD is cost-effective.

Internet-delivered psychological treatment of functional gastrointestinal disorders in youth: Study protocol for exploration of cognitive biases

Introduction Functional gastrointestinal disorders (FGID) are common in children and adolescents (CA), cause functional disability and high health care use. Internet based cognitive behavioral therapy (i-CBT) have shown promising effect in Sweden. The treatment is exposure based and target avoidance behavior. Cognitive biases regarding bodily symptoms are suggested to be part of development and maintenance of functional disorders in adults, and could therefore be an important treatment target. Little is known about cognitive biases in CA with FGID, and hence the potential importance, it is crucial to explore more in depth. This study is embedded in The Danish FGID Treatment Study which aims to test Swedish i-CBT treatment in a Danish context.Objectives1) Examine cognitive biases in CA with FGID, compared with healthy controls. 2) Asses these biases before and after treatment for FGID to investigate changes and impact on treatment effect.MethodsWe developed a novel experimental approach to examine possible cognitive biases in CA. It consists of a picture task and a FGID-specific version of the Health Norms Sorting Task. We will examine 60 CA with FGID, who are included in The Danish FGID Treatment Study before and after treatment. In addition we will perform the test on 100 healthy controls.ResultsThe results are expected to improve our understanding of maintaining cognitive factors in CA with FGID, and how these may affect outcome and change during treatment, and how they differ from the general population.ConclusionsThis study can provide new targets for treatment approaches.DisclosureNo significant relationships.

Effect of an internet-based intervention for adjustment disorder on meaning in life and enjoyment

IntroductionPositive psychological variables, such as meaning in life and the capacity for enjoyment, are important resilience factors against negative behaviors and symptoms. These constructs are related to better emotional regulation strategies, a greater perception of control over one’s life, and better mental health in general. Adjustment disorder (AjD) is a prevalent condition defined as the failure to adapt to a stressful event.ObjectiveThis study presents secondary analysis data on the effect of an Internet-delivered cognitive-behavioral therapy intervention (iCBT) for AjD on meaning in life and capacity for enjoyment, compared to a control group.MethodThe sample consisted of 68 participants with AjD. 34 in the iCBT condition and 34 in the control group). Meaning in life was assessed by the Purpose-in-Life Test-10, and the Environmental Rewards Observation Scale was used to assess the capacity for enjoyment. The iCBT intervention focused on acceptance and processing of the stressful event. Intent-to-treat mixed-model analyses without any ad hoc imputations and using Cohen’s d effect comparisons were conducted.ResultsThe results revealed a significant main effect of time and a significant group x time interaction in all the measures. Significantly higher pre-post score differences were found in the treatment condition.DiscussionMeaning in life and capacity for enjoyment can change after an iCBT intervention for AjD. Therapeutic implications of the results and future lines of research about the role of meaning in life in AjD are discussed.

PO-1337 Adaptive 3-D ICBT Treatment Plans for cervical cancer: Target Volume vs. High Central Dose Profiles

PO-1337 Adaptive 3-D ICBT Treatment Plans for cervical cancer: Target Volume vs. High Central Dose Profiles

Single-Session, Internet-Based Cognitive Behavioral Therapy to Improve Parenting Skills to Help Children Cope With Anxiety During the COVID-19 Pandemic: Feasibility Study.

BackgroundThe COVID-19 pandemic has had a major impact on families’ daily routines and psychosocial well-being, and technology has played a key role in providing socially distanced health care services.ObjectiveThe first objective of this paper was to describe the content and delivery of a single-session, internet-based cognitive behavioral therapy (iCBT) intervention, which has been developed to help parents cope with children’s anxiety and manage daily situations with their children. The second objective was to report user adherence and satisfaction among the first participants who completed the intervention.MethodsThe Let’s Cope Together intervention has been developed by our research group. It combines evidence-based CBT elements, such as psychoeducation and skills to manage anxiety, with parent training programs that strengthen how parents interact with their child and handle daily situations. A pre-post design was used to examine user satisfaction and the skills the parents learned. Participants were recruited using advertisements, media activity, day care centers, and schools and asked about background characteristics, emotional symptoms, and parenting practices before they underwent the iCBT. After they completed the 7 themes, they were asked what new parenting skills they had learned from the iCBT and how satisfied they were with the program.ResultsOf the 602 participants who filled in the baseline survey, 196 (32.6%) completed the program’s 7 themes, and 189 (31.4%) completed the postintervention survey. Most (138/189, 73.0%) of the participants who completed the postintervention survey were satisfied with the program and had learned skills that eased both their anxiety (141/189, 74.6%) and their children’s anxiety (157/189, 83.1%). The majority (157/189, 83.1%) reported that they learned how to organize their daily routines better, and just over one-half (100/189, 53.0%) reported that the program improved how they planned each day with their children.ConclusionsThe single-session iCBT helped parents to face the psychological demands of the COVID-19 pandemic. Future studies should determine how the participation rate and adherence can be optimized in digital, universal interventions. This will help to determine what kinds of programs should be developed, including their content and delivery.

Cost-effectiveness of internet-delivered cognitive behavioural therapy in patients with cardiovascular disease and depressive symptoms: secondary analysis of an RCT

IntroductionCost-effectiveness evaluations of psychological interventions, such as internet-delivered cognitive behavioural therapy (iCBT) programmes, in patients with cardiovascular disease (CVD) are rare. We recently reported moderate to large effect sizes on...

Lessons learned from two feasibility trials of a translated and minimally monitored iCBT program for young adults among community and university samples

Young adults are less likely to use traditional mental health services than adults. iCBT may be more youth friendly, but its access remains limited in several countries. This study aims to evaluate the feasibility of a minimally monitored transdiagnostic iCBT program translated from English to French and offered in Canada for the treatment of anxiety and depression among young adults. The impact of the program on resilience was also assessed. Twenty-five participants from community and university samples were included in the analyses in two separate single-group feasibility trials with a 3-month follow-up. Feasibility outcomes were attrition, adherence, treatment acceptability and treatment gains. Outcome measures included the Patient Health Questionnaire 9-item (PHQ-9), Generalized Anxiety Disorder 7-item (GAD-7) and Connor-Davidson Resilience Scale (CD-RISC). In Trial 1 (N = 10), recruiting among the general population proved to be challenging. Low adherence (20%) and high attrition (80%) rates were observed. Methodological changes to recruitment were made and a second trial was conducted among university students using incentives (N = 15). About half of the participants completed treatment (55%, n = 8/15), 12/15 provided post-treatment data and 8/15 provided 3-month follow-up data. All study completers (100%; n = 14) reported they would recommend the program. Mixed effects model analyses revealed significant and large pre-post treatment reductions on the PHQ-9 and GAD-7 (Cohen's d = 1.09 and 1.64 respectively) with treatment gains maintained at follow-up. Moderate improvements were found on the CD-RISC post-treatment with further gains at follow-up (ds = 0.55 and 1.10 respectively). These finding suggest that future research on this French-Canadian version of the Mood Mechanic Course is feasible with appropriate attention to recruitment. Translating existing iCBT interventions and using minimal monitoring may be an optimal first step to initiate the cross-cultural dissemination of iCBT while increasing access to treatments among young adults. Lessons learned are discussed.

Implementing Internet-Based Cognitive Behavioral Therapy in Routine Care: Healthcare Practitioners\u2019 Attitude and Perceived Level of Normalization After a Single Information Event

Understanding implementation-related factors and processes is key to ensuring that Internet-based interventions are embedded in practice and provide added value to the delivery of evidence-based care. The aim of this study was to evaluate the attitudes towards an Internet-based cognitive behavioural therapy (iCBT) intervention for the treatment of depression as well as its level of normalization and early implementation success (operationalized as intention to use the intervention) among German health care professionals (HCP). Data were collected following onetime information sessions on an iCBT tool using the Evidence-Based Practice Attitude Scale (EBPAS) and the Normalization Process Theory Measure (NoMAD). Influences of attitudes on normalization as well as influences of attitude and normalization on intention to use were analysed. Most participants (n = 78; 86.3% clinical psychologists, 9.6% general practitioners) intended to use the intervention in the future (82.1%) and had a moderately positive attitude towards iCBT interventions. The perceived level of normalization (i.e., the level of how well iCBT is integrated in practice) was moderate in the overall sample. High appeal, openness towards iCBT, low requirement to use it, and low perceived divergence (perceived difference between current and new practices) had a significant positive effect on normalization. This study indicates that iCBT can be implemented in German routine mental healthcare. However, implementation processes might benefit from tailored information campaigns that clearly highlight the effectiveness and benefits of iCBT interventions to foster openness towards iCBT interventions among HCPs.

Internet-Based Psychotherapy Intervention for Depression Among Older Adults Receiving Home Care: Qualitative Study of Participants’ Experiences

BackgroundDepression is common among homebound older adults. Internet-based cognitive behavioral therapy (iCBT) is a promising but understudied approach for treating depression among older adults with disabilities.ObjectiveThis study aims to understand the experiences of homebound older adults who participated in a pilot feasibility trial of an iCBT for depression.MethodsThe participants included 21 homebound older adults who participated in a generic iCBT program that was not specifically designed for older adults and 8 home care workers who assisted in the iCBT program. Informants completed semistructured individual interviews, which were transcribed verbatim and analyzed using methods informed by grounded theory. A hierarchical code structure of themes and subthemes was developed after an iterative process of constant comparisons and questionings of the initial codes. The data analysis was conducted by using dedoose, a web app for mixed methods research.ResultsThree themes and various subthemes emerged related to participants’ experience of the iCBT intervention, as follows: intervention impact, which involved subthemes related to participants’ perceived impact of the intervention; challenges and difficulties, which involved subthemes on the challenges and difficulties that participants experienced in the intervention; and facilitators, which involved subthemes on the factors that facilitated intervention use and engagement.ConclusionsiCBT is a promising intervention for homebound older adults experiencing depression. Home care workers reported improved relationships with their clients and that the program did not add a burden to their duties. Future programs should involve accessible technical features and age-adapted content to improve user experience, uptake, and adherence.Trial RegistrationClinicalTrials.gov NCT04267289; https://clinicaltrials.gov/ct2/show/NCT04267289

Dropout From an Internet-Delivered Cognitive Behavioral Therapy Intervention for Adults With Depression and Anxiety: Qualitative Study.

BackgroundTreatment dropout continues to be reported from internet-delivered cognitive behavioral therapy (iCBT) interventions, and lower completion rates are generally associated with lower treatment effect sizes. However, evidence is emerging to suggest that completion of a predefined number of modules is not always necessary for clinical benefit or consideration of the needs of each individual patient. ObjectiveThe aim of this study is to perform a qualitative analysis of patients’ experiences with an iCBT intervention in a routine care setting to achieve a deeper insight into the phenomenon of dropout. MethodsA total of 15 purposively sampled participants (female: 8/15, 53%) from a larger parent randomized controlled trial were interviewed via telephone using a semistructured interview schedule that was developed based on the existing literature and research on dropout in iCBT. Data were analyzed using a descriptive-interpretive approach. ResultsThe experience of treatment leading to dropout can be understood in terms of 10 domains: relationship to technology, motivation to start, background knowledge and attitudes toward iCBT, perceived change in motivation, usage of the program, changes due to the intervention, engagement with content, experience interacting with the supporter, experience of web-based communication, and termination of the supported period. ConclusionsPatients who drop out of treatment can be distinguished in terms of their change in motivation: those who felt ready to leave treatment early and those who had negative reasons for dropping out. These 2 groups of participants have different treatment experiences, revealing the potential attributes and nonattributes of dropout. The reported between-group differences should be examined further to consider those attributes that are strongly descriptive of the experience and regarded less important than those that have become loosely affiliated.

The uptake and outcomes of Internet-based cognitive behavioural therapy for health anxiety symptoms during the COVID-19 pandemic

BackgroundInternet cognitive behavioural therapy (iCBT) for health anxiety has demonstrated efficacy but has not been evaluated during the COVID-19 pandemic. This study presents the first evaluation of the uptake and outcomes of iCBT for health anxiety during the COVID-19 pandemic. MethodsTHIS WAY UP is an Australian digital mental health service which delivers iCBT interventions to community members. We compared the uptake of THIS WAY UP’s iCBT course for health anxiety in an Australian adult sample who started the course before the pandemic (12th September 2019–11 th March 2020) to during the pandemic (12th March to 11th June 2020). The course was accessible to Australian adults over 18 years old, with no inclusion criteria. Outcomes included course registrations and commencements, lesson and course completion, and self-reported health anxiety (Short Health Anxiety Inventory), depression (Patient Health Questionnaire 9-item) and distress (Kessler-10). ResultsFrom March to June 2020, we observed significant increases in course registrations (N = 238 vs N = 1057); and course commencements (N = 126 vs. N = 778). Large, significant improvements in health anxiety (g = 0.89), and distress (K10: g = 0.91), and medium improvements in depression (g = 0.55) were found. Course completion during COVID was 30.5%. ConclusionsiCBT improved health anxiety during the COVID-19 pandemic, and provides scalable intervention that can address increased demands for mental health services in the community.

Clients' and therapists' experiences of five general change mechanisms during an Internet-based cognitive behavioralintervention for family caregivers.

Despite its efficacy, little is known about what makes Internet-based cognitive behavioral therapy (iCBT) effective. We, therefore, analyze participants' and therapists' experiences of Grawe's five general change mechanisms (alliance, resource activation, clarification, problem actuation, mastery) during an iCBT intervention for family dementia caregivers, and how their experiences were related to treatment outcomes. Participants (N = 30) exchanged eight weekly messages with a therapist via an Internet platform. We used the Bern Post Session Report to assess participants' and therapists' experiences of the general change mechanisms after each session. Treatment outcomes were associated with therapists' overall experiences of alliance, clarification, and mastery. Participants experienced more problem actuation than therapists. Only participants' and therapists' experiences of clarification over time differed. Grawe's general change mechanisms are also relevant for iCBT. We recommend considering Grawe's framework when designing Internet-based therapeutic interventions and when training therapists to deliver such interventions.

A qualitative study of university students' experience of Internet‐based CBT for depression

AbstractInternet‐based treatments for depression have the potential to promote the mental health of university students. Yet, little is known about students' experiences of Internet‐based mental health interventions (also known as e‐interventions) and the acceptability of this mode of treatment in low‐resource settings. Our aims were to investigate South African university students' experiences of using a brief semi‐guided Internet‐based cognitive behavioural therapy (iCBT) for depression and document the acceptability of this mode of psychotherapy. Data were collected via in‐depth semi‐structured interviews with students (n = 9) who had moderate to moderately severe symptoms of depression (as assessed by the PHQ‐9) and had used a 7 session guided skills‐based iCBT intervention. Data were analysed inductively using thematic analysis, with the aid of Atlas‐ti software. Participants found the anonymity, privacy and accessibility of iCBT appealing, believing this facilitated use of the intervention and overcame stigma associated with accessing traditional campus counselling services. The intervention was helpful and facilitated self‐disclosure, emotional expression, self‐awareness and skill acquisition. However, students also reported disappointment with the lack of human contact and immediate responsiveness, articulating an expectation that the e‐intervention would mimic face‐to‐face psychotherapy. Moves to incorporate iCBT into student counselling should take account of and manage students' expectations about the ability of e‐interventions to mimic traditional therapy and/or incorporate more opportunities for human interaction.

Effectiveness of an Individual Cognitive-Behavioral Intervention for Serious, Young Male Violent Offenders: Randomized Controlled Study With Twenty-Four-Month Follow-Up.

Background: Psychological recidivism-reducing interventions with serious, young violent offenders in residential care have unsatisfactory effects. We tested if a complementary individual cognitive behavioral therapy (iCBT) intervention focusing problem-solving, cognitive self-control, and relapse prevention reduces criminal recidivism beyond usual institutional care encompassing interventions such as social skills training and prosocial modeling (treatment-as-usual; TAU).Method: We consecutively approached 115 eligible serious, male violent crime offenders in five residential treatment homes run by the Swedish National Board of Institutional Care. Eighty-one (70%) 16 to 21-year-old youth at medium-high violent recidivism risk were included and randomized to an individualized 15 to 20-session CBT intervention plus TAU (n = 38) or to TAU-only (n = 43), 4–6 months before release to the community. Participants were assessed pre- and post-treatment, at 12 months (self-reported aggressive behavior, reconvictions) and 24 months (reconvictions) after release. Intent-to-treat analyses were applied.Results: The violent reconviction rate was slightly higher for iCBT+TAU vs. TAU-only youth at 12 months (34 vs. 23%, d = 0.30, 95% CI: −0.24 to 0.84) and 24 months following release (50 vs. 40%, d = 0.23, 95% CI: −0.25 to 0.72), but neither of these differences were significant. Cox regression modeling also suggested non-significantly, negligibly to slightly more violent, and any criminal recidivism in iCBT+TAU vs. TAU-only youth during the entire follow-up. Further, we found no significant between-group differences in conduct problems, aggression, and antisocial cognitions, although both iCBT+TAU and TAU-only participants reported small to large within-group reductions across outcome measures at post-treatment. Finally, the 12-month follow-up suggested marginally more DSM-5 Conduct Disorder (CD) symptoms of “aggression to people and animals” in iCBT+TAU vs. TAU-only youth (d = 0.10, 95% CI: −0.40 to 0.60) although this difference was not significant.Conclusion: We found no additive effect of individual CBT beyond group-based TAU in residential psychological treatment for serious, young male violent offenders. Limited sample size and substantial treatment dropout reduced the robustness of intent-to-treat effect estimates. We discuss the possible impact of treatment dose and integrity, participant retention, and TAU quality.

Following up internet-delivered cognitive behaviour therapy (CBT): A longitudinal qualitative investigation of clients' usage of CBT skills.

While the acquisition and application of Cognitive Behaviour Therapy (CBT) skills is a core component and likely mechanism of effect maintenance in all CBT-based treatments, the extent of post-therapeutic CBT skills usage among internet-delivered CBT (iCBT) clients remains under-researched. Nested within a pragmatic randomized controlled trial, 241 participants received an 8-week supported iCBT intervention for anxiety and/or depression and answered open-ended questions about their use and experience of CBT skills at 3-, 6-, 9-, and 12-month follow-up. Recurrent, cross-sectional qualitative analysis following the descriptive and interpretive approach was used to create a taxonomy, through which all qualitative data was coded. In total, 479 qualitative responses across 181 participants were analysed. Participants reported using a wide range of CBT skills and associated helpful and hindering experiences and impacts. The reasons for discontinued CBT skills usage were diverse, ranging from rare adverse effects to healthy adaptation. The study shows how clients receiving iCBT in routine care learn CBT skills during treatment and utilize them in productive ways post-treatment. Findings coincide with similar research in face-to-face CBT and may inform future research to drive innovation and iCBT intervention development.

Dismantling internet-based cognitive behavioral therapy for tinnitus. The contribution of applied relaxation: A randomized controlled trial

BackgroundInternet-based cognitive behavioral therapy (ICBT) for tinnitus is an evidence-based intervention. The components of ICBT for tinnitus have, however, not been dismantled and thus the effectiveness of the different therapeutic components is unknown. It is, furthermore, not known if heterogeneous tinnitus subgroups respond differently to ICBT. AimsThis dismantling study aimed to explore the contribution of applied relaxation within ICBT for reducing tinnitus distress and comorbidities associated with tinnitus. A secondary aim was to assess whether outcomes varied for three tinnitus subgroups, namely those with significant tinnitus severity, those with low tinnitus severity, and those with significant depression. MethodsA parallel randomized controlled trial design (n = 126) was used to compare audiologist-guided applied relaxation with the full ICBT intervention. Recruitment was online and via the intervention platform. Assessments were completed at four-time points including a 2-month follow-up period. The primary outcome was tinnitus severity as measured by the Tinnitus Functional Index. Secondary outcomes were included for anxiety, depression, insomnia, negative tinnitus cognitions, health-related quality of life, hearing disability, and hyperacusis. Treatment engagement variables including the number of logins, number of modules opened, and the number of messages sent. Both an intention-to-treat analysis and completer's only analysis were undertaken. ResultsEngagement was low which compromised results as the full intervention was undertaken by few participants. Both the ICBT and applied relaxation resulted in large reduction of tinnitus severity (within-group effect sizes d = 0.87 and 0.68, respectively for completers only analysis), which were maintained, or further improved at follow-up. These reductions in tinnitus distress were greater for the ICBT group, with a small effect size differences (between-group d = 0.15 in favor of ICBT for completers only analysis). Tinnitus distress decreased the most at post-intervention for those with significant depression at baseline. Both ICBT and applied relaxation contributed to significant reductions on most secondary outcome measures, with no group differences, except for a greater reduction of hyperacusis in the ICBT group. ConclusionDue to poor compliance partly attributed to the COVID-19 pandemic results were compromised. Further studies employing strategies to improve compliance and engagement are required. The intervention's effectiveness increased with initial level of tinnitus distress; those with the highest scores at intake experienced the most substantial changes on the outcome measures. This may suggest tailoring of interventions according to tinnitus severity. Larger samples are needed to confirm this.