Internet-delivered Treatment Research Articles

Implementation trial II: Clinical outcomes and acceptability of an internet-delivered intervention for anxiety and depression delivered as part of routine care for university students in Australia

BackgroundUniversity students report high levels of psychological distress, which is a contributor to poorer academic, social and health outcomes. There is increasing interest in the use of internet-delivered psychological treatments in student counselling services as a strategy improving access to psychological care at scale. However, to date, few large-scale prospective effectiveness trials of internet-delivered psychological treatment have been conducted in “real world” settings with university student populations. AimTo investigate the effectiveness and acceptability of a brief transdiagnostic internet-delivered cognitive behavioural therapy (iCBT) intervention for anxiety and depression when delivered as part of routine care by the counselling service of an Australian university. DesignA large, prospective, single-group Phase IV clinical trial. MethodStudents engaging with the university counselling service between 2018 and 2023 (N = 845; 8.5% of those presenting to the service) were given the option to receive the intervention based on their clinical needs and preferences. Students completed standardised measures of depression and anxiety severity at pre-treatment, each week of the intervention, and post-treatment. A subsample (n = 426) also completed the measures at 3-month follow-up. ResultsOver a 5-year period, 700 students participated in the intervention and 489 provided data at post-treatment. Significant reductions in depression symptoms (% reduction = 27%, Hedges' g = 0.35) and anxiety (% reduction = 37%, Hedges' g = 0.61) were observed, alongside high levels of satisfaction (>70%) and adherence (68%). Over 50% of students had clinically significant improvements in symptom severity, and symptom deterioration was observed in <15% of students. ConclusionThe results of the current trial provide support for the effectiveness and acceptability of internet-delivered psychological interventions provided as part of routine care to university students with symptoms of anxiety and depression.

Single-blinded, randomised, parallel-group, controlled trial comparing the efficacy and cost-effectiveness of therapist- and self-guided internet-delivered behavioural activation versus treatment as usual for adolescents with mild to moderate depression: study protocol

IntroductionThe number of adolescents seeking professional help for depression is increasing and, despite advances in treatment, large unmet treatment needs remain. In the current protocol, we describe the design and...

Investigating non-inferiority of internet-delivered versus face-to-face cognitive behavioural therapy for insomnia (CBT-I): a randomised controlled trial (iSleep well)

BackgroundInsomnia is a highly prevalent disorder associated with numerous adverse health outcomes. Cognitive behavioural therapy for insomnia (CBT-I) is recommended as first-line treatment by clinical guidelines but is accessible to only a minority of patients suffering from insomnia. Internet-delivered CBT-I (iCBT-I) could contribute to the widespread dissemination of this first-line treatment. As there is insufficient evidence regarding non-inferiority, this study directly aims to compare therapist-guided internet-delivered versus face-to-face CBT-I in terms of insomnia severity post-treatment. Furthermore, a health-economic evaluation will be conducted, and potential benefits and disadvantages of therapist-guided iCBT-I will be examined.MethodsThis study protocol describes a randomised controlled two-arm parallel-group non-inferiority trial comparing therapist-guided iCBT-I with face-to-face CBT-I in routine clinical care. A total of 422 patients with insomnia disorder will be randomised and treated at 16 study centres throughout Germany. Outcomes will be assessed at baseline, 10 weeks after randomisation (post), and 6 months after randomisation (follow-up). The primary outcome is insomnia severity measured using the Insomnia Severity Index. Secondary outcomes include depression-related symptoms, quality of life, fatigue, physical activity, daylight exposure, adverse events related to treatment, and a health-economic evaluation. Finally, potential moderator variables and several descriptive and exploratory outcomes will be assessed (e.g. benefits and disadvantages of internet-delivered treatment).DiscussionThe widespread implementation of CBT-I is a significant healthcare challenge. The non-inferiority of therapist-guided iCBT-I versus face-to-face CBT-I will be investigated in an adequately powered sample in routine clinical care, with the same therapeutic content and same level of therapist qualifications provided with both interventions. If this trial demonstrates the non-inferiority of therapist-guided iCBT-I, healthcare providers may be more confident recommending this treatment to their patients, contributing to the wider dissemination of CBT-I.Trial registrationTrial registration number in the German Clinical Trials Register: DRKS00028153 (https://drks.de/search/de/trial/DRKS00028153). Registered on 16th May 2023.

Caregiver Distress and Child Behavior Problems in Children with Developmental Delay from Predominantly Minoritized Backgrounds

ABSTRACT Importance Child behavior problems have been shown to contribute to caregiver distress and vice versa among youth with developmental delay (DD). However, studies have not examined these associations among children and caregivers from underrepresented ethnic/racial backgrounds. Furthermore, research has not explored how associations function differently following internet-delivered treatment or based on the level of acculturation and enculturation. Objective We examined bidirectional associations between caregiver distress (i.e. symptoms of depression, anxiety, and stress) and externalizing and internalizing behavior problems in 3- to 5-year-old children with DD from underrepresented ethnic/racial backgrounds. We also examined the impact of internet-delivered Parent–Child Interaction Therapy (iPCIT) and the moderating role of acculturation and enculturation on these bidirectional associations. Method Children aging out of early intervention services (n = 150) and their primary caregiver were randomized to receive iPCIT or referrals as usual (RAU) in the community. Results Findings provide support for bidirectional associations between child internalizing behavior problems and caregiver depressive symptoms, although there were fewer significant associations among families randomized to iPCIT compared to RAU. Weaker associations were observed among families with higher levels of enculturation, whereas stronger associations were observed among families with higher levels of acculturation. Conclusions Results highlight a sensitive period from age 3.5 to 4 years old for bidirectional associations between caregiver distress and child behavior problems and highlight the importance of addressing family cultural values during treatment. Findings also suggest the utility of internet-delivered behavioral parenting interventions in weakening the effect of child behavior problems on caregiver distress and vice versa.

Mediation of social anxiety and depression during internet-delivered treatment for social anxiety disorder

ABSTRACT Many individuals with social anxiety disorder (SAD) have depressive symptoms that meet criteria for major depressive disorder (MDD). In our study, we examined the temporal relationship between symptoms of social anxiety and symptoms of depression during the course of an 11-week internet-delivered cognitive behavioral treatment (ICBT) for SAD (n = 170). Specifically, we investigated whether weekly changes in social anxiety mediated changes in depression, changes in depression mediated changes in anxiety, both or neither. In addition, we compared individuals with SAD and MDD (n = 50) and individuals with SAD and no MDD (n = 120) to examine the role of MDD as a moderator of the social anxiety—depression relationship. Lower-level mediational modeling revealed that changes in social anxiety symptoms mediated changes in depression symptoms to a greater extent than vice versa. In addition, mediation among individuals with SAD and MDD was significantly greater compared to individuals with SAD and no MDD. Our findings suggest that ICBT is effective in treating individuals with SAD regardless of comorbid depression, and that focusing ICBT interventions on social anxiety can lead to significant reductions in depression among individuals with SAD.

The role of significant others in the process of internet-delivered intervention for tinnitus: a qualitative study

Internet-delivered interventions for tinnitus have been found to be efficacious in reducing tinnitus distress. Additionally, various client, therapist, and intervention factors related to good outcomes in internet-delivered interventions have been studied. However, the role that other people play in the processes of internet-delivered treatments has received less attention. The aim of this study was to investigate how participants receiving an internet-delivered psychological treatment for tinnitus perceived the role of significant others in the process of their treatment.In total, 14 participants of an internet-delivered CBT and mindfulness-based psychological interventions for tinnitus were interviewed using a semi-structured interview after the completion of treatment. They were asked a series of questions, including if they told anyone about their participation in the intervention. Interviews were recorded, transcribed, and then coded using the method of thematic analysis.Two main themes with three and four sub-themes for each main theme were derived from the data. A) Other people know: 1. Support; 2. Neutrality; 3. Autonomy; 4. Misunderstood. B) Other people do not know: 1. Underappreciated; 2. Hiding; 3. Stigma. Results show that other people played various roles in the participants’ efforts to complete the internet-delivered intervention. Some themes were found to be closely related to tinnitus, whereas others were more general.Other people may play a significant role in the treatment process when engaging in internet-delivered interventions, whether actively or passively, as reported by the participants. Stigma and previous negative experiences of not being understood after sharing information about tinnitus were among the few of the reasons for not involving others. In contrast, participants also talked about the positive impact of surrounding people who encouraged and supported their participation in the intervention. Further studies should examine how significant others may impact the engagement with the intervention and possibly the overall effects on treatment outcome. Social support has been shown to be an important factor in treatment success in previous studies. The present study demonstrated participants’ experiences with involving significant others with their tinnitus treatment. Strategies for how to meaningfully include surrounding people in internet-delivered treatments need to be investigated as this could increase treatment efficacy.

From research to routine care: A historical review of internet-based cognitive behavioral therapy for adult mental health problems in Sweden.

This narrative historical review examines the development of internet-based cognitive behavioral therapy (ICBT) in Sweden, describing its progression within both academic and routine care settings. The review encompasses key publications, significant scientific findings, and contextual factors in real-world settings. Over 25 years ago, Sweden emerged as a pioneering force in internet-delivered treatment research for mental health. Since then, Swedish universities, in collaboration with research partners, have produced substantial research demonstrating the efficacy of ICBT across various psychological problems, including social anxiety disorder, panic disorder, generalized anxiety disorder, and depression. Although research conducted in clinical settings has been less frequent than in academic contexts, it has confirmed the effectiveness of therapist-supported ICBT programs for mild-to-moderate mental health problems in routine care. Early on, ICBT was provided as an option for patients at both the primary care level and in specialized clinics, using treatment programs developed by both public and private providers. The development of a national platform for delivering internet-based treatment and the use of procurement in selecting ICBT programs and providers are factors that have shaped the current routine care landscape. However, gaps persist in understanding how to optimize the integration of digital treatment in routine care, warranting further research and the use of specific implementation frameworks and outcomes. This historical perspective on the research and delivery of ICBT in Sweden over two decades offers insights for the international community into the development and broad dissemination of a specific digital mental health intervention within a national context.

Treating child anxiety using family-based internet delivered cognitive behavior therapy with brief therapist guidance: A randomized controlled trial

Online treatment delivery has the potential to increase access to evidence-based mental health care for children with anxiety disorders. Using a randomized controlled trial design, we evaluated the efficacy of Cool Kids Online, a family-based and therapist supported internet-delivered cognitive behavioral treatment (CBT) designed to target anxiety disorders in children. Ninety-five children aged 7–12 years with a DSM-5 anxiety disorder were randomly allocated to Cool Kids Online or a waitlist control. Children were assessed at baseline, week 11, and 6-months following treatment. Children in waitlist received treatment after week 11 and also completed assessments immediately and six months after treatment, allowing treatment maintenance to be evaluated for all children. Compared to waitlist, Cool Kids Online led to significantly greater remission of anxiety disorders (primary and all anxiety diagnoses) and greater reduction of caregiver-reported anxiety symptoms and interference at week 11. Child-reported anxiety symptoms and interference and child- and caregiver-reported depressive or externalizing symptoms did not differ significantly between conditions. Medium to large within-treatment effects were observed for all children from pre to post treatment with post treatment effects maintained until follow-up. Overall, the findings provide support for the efficacy of the program in treating anxiety. Cool Kids Online compared to waitlist for the remission of anxiety disorders in clinically anxious children; anzctr.org.au; ACTRN12615000947505.

Decision-making about uptake and engagement with digital mental health services: a qualitative exploration of service user perspectives

ABSTRACT Objective Digital mental health services (DMHS) overcome many barriers to help-seeking. Yet, people’s use and uptake of treatment with DMHSs varies considerably. This study explored service user perspectives on deciding to take up online assessment and treatment for anxiety and/or depression within a large national DMHS. Method Participants were 20 adults who had self-referred or were referred by a GP to an Australia-wide DMHS for psychological assessment (group 1), plus follow-up discussion of treatment/other service options with a therapist (group 2), plus enrolment into internet-delivered treatment with optional therapist guidance (group 3). Participants took part in one-to-one semi-structured interviews, with parallel question guides tailored to their group status. Interviews were transcribed verbatim and analysed thematically using framework methods. Results Analyses yielded three interlinking themes. Theme 1 highlighted the “importance of the broader treatment context, and its interaction with DHMS”; Theme 2 drew attention to “how the internal service structure shapes decision-making”; Theme 3 focussed on “the scope and limitations of DMHS”. Conclusion Findings provide in-depth insights into service user decision-making around engagement with DMHS and can inform the development of interventions to support users to take up DMHS offerings that are best suited to their needs, preferences, and current circumstances.

Internet-Delivered Cognitive Behavioral Treatment for Chronic Pain in Adolescent Survivors of Childhood Cancer: Protocol for a Single-Group Feasibility Trial.

There are over 500,000 survivors of childhood cancer in North America alone. One in 4 survivors experiences chronic pain after treatment has been completed. Youths with chronic pain report increased anxiety, depression, activity limitations, and sleep disturbances. An 8-week web-based cognitive behavioral treatment for chronic pain (Web-Based Management of Adolescent Pain [WebMAP]) has demonstrated a reduction in pain in youths but has not yet been explored in survivors. The objectives of this study are to (1) test the feasibility and acceptability of WebMAP for a sample of survivors with chronic pain and their parents; (2) assess the acceptability of WebMAP using qualitative interviews; (3) assess WebMAP's effect on activity limitations, pain intensity, depression and anxiety symptoms, and sleep disturbances; and (4) assess WebMAP's effect on parent pain catastrophizing and parental response to their child's pain. A single-arm mixed methods pre-post intervention study design will be used. Participants will be 34 survivors and at least one of their parents or caregivers. Inclusion criteria are (1) a cancer history, (2) current age of 10-17 years, (3) >2 years post treatment or >5 years post diagnosis, (4) pain present over prior 3 months impairing >1 area of daily life and occurring >1 time per month, and (5) computer access with broadband internet. Survivors will complete a pretreatment questionnaire, which will include the following: the Child Activity Limitations Interview, the pain intensity Numerical Rating Scale, Patient-Reported Outcomes Measurement Information System (PROMIS)-Pain Interference, Anxiety, Depression, Insomnia Severity Index, and Adolescent Sleep Wake Scale. Parents will complete the Pain Catastrophizing Scale-Parent Version and the Adult Responses to Child Symptoms. Upon completion of pretreatment questionnaires (T0), survivors will begin WebMAP. After the 8-week intervention, survivors will complete the same measures (T1), and at 3-month follow-up (T2). Posttreatment interviews will be conducted to determine acceptability. Feasibility will be assessed via recruitment and retention rates. Treatment engagement will be measured by number of modules completed. Pre-post outcome data will be assessed using linear mixed models. Qualitative data will be analyzed using thematic analysis. Patient partners will be involved in study design, recruitment, interpretation of results, and knowledge translation. This study has been funded in January 2022. Data collection started in May 2022 and is projected to end in August 2023. We have enrolled 10 participants as of December 2022. Investigating whether WebMAP is useful to survivors will be an important step in improving pain management in this population. ClinicalTrials.gov NCT05241717; https://clinicaltrials.gov/ct2/show/NCT05241717. DERR1-10.2196/45804.

Therapists' experiences with providing guided internet-delivered cognitive behavioral therapy for patients with mild and moderate depression: a thematic analysis.

Guided internet-delivered therapy has shown promising results for patients with mild and moderate depressive disorder, but several challenges with the format have been reported. The aim of this qualitative study was to investigate therapists' experiences providing guided internet-delivered cognitive behavioral therapy for patients with mild and moderate depression. Twelve therapists were interviewed, and the interviews were analyzed using reflexive thematic analysis. Three themes were created: (1) For the right person, at the right time. This theme is about therapists' experiences appointing patients to the program. It is challenging to predict which patients will benefit from it, and it is not the right option for all patients. (2) It is not like chatting on Facebook. The second theme was about the experiences with demands on clinics, therapists and patients that must be considered. The internet-delivered treatment should not be viewed as a simple treatment option, and the value of having contact with the patients during treatment was emphasized. (3) It is like a railroad, but without the switches. This theme was about the experiences with how the treatment content was conveyed to the patients, how the therapists expressed concerns with the usability of the program and the reported need for more possibilities in tailoring treatment for each patient.

Commentary on Hyland et al.: Digital treatment for alcohol use disorders - challenges and opportunities.

Hyland and colleagues found no significant effects of an internet-delivered cognitive behavioral therapy intervention (iCBT) as addendum to treatment as usual in individuals with moderate alcohol use disorders. While findings can be attributed partially to methodological issues, future studies should focus upon patient preferences and include potential side effects of internet-based interventions. In the field of problematic alcohol consumption, digital interventions have shown promise in non-clinical populations [1]; however, little is known about their efficacy in clinical populations fulfilling criteria for alcohol use disorders (AUDs). Internet-delivered treatment has rapidly evolved as an option for various mental disorders. First meta-analyses show positive effects when compared to non-active controls in disorders such as depression and agoraphobia [2-4], but also for addictive disorders, especially behavioural addictions [5] and tobacco smoking [6]. Given that disorders due to alcohol and/or drugs are highly stigmatized, internet-delivered interventions might be a relevant tool for narrowing the treatment gap in the field. In their excellently conducted randomized controlled trial (RCT), Hyland and colleagues [7] found only weak evidence for an internet-delivered cognitive behavioral therapy (iCBT) intervention as addendum to treatment as usual (TAU) in individuals with AUDs compared to TAU. However, it has to be taken into account that, as comparator in this study, TAU included far more evidence-based components than would usually be expected in most treatment systems world-wide. The high rate of participants willing to take (and receiving) medication is particularly impressive: data from the United States show that only 16.3% of all speciality treatment programmes for alcohol use disorders offered any single medication for AUD treatment [8]. Furthermore, as all participants in the Hyland et al. study were self-selected, the initial motivation to change already might have produced strong effects, especially if we consider the high rates of unassisted recovery that are common in alcohol use disorders [9]. Another encouraging finding is that overall treatment initiation and completion rates are relatively high compared to digital self-help interventions in the field of affective and anxiety disorders [10], where efficacy of these interventions has already been demonstrated. There is no evidence that guided or unguided internet-delivered interventions for AUDs are associated with lower rates of treatment uptake compared to face-to-face delivery. A prior study from the research group of Hyland et al. on a therapist-guided iCBT intervention compared to therapist-delivered CBT showed no differences in uptake numbers between the two conditions, and both interventions did not differ on outcomes [11]. Another RCT on iCBT as a stand-alone intervention for individuals with AUDs [12] even showed that retention rates were better in the iCBT condition compared to therapist-delivered CBT, and that both conditions were superior compared to TAU (which included lower doses of treatment compared to the Hyland et al. study). Given that internet-delivered treatment requires a high level of patient engagement, future studies should take into account the interaction between type of treatment and patient preferences. Internet-delivered interventions might be a good option for some, but certainly not for all, patients suffering from AUDs. A systematic review on effects of matching patient preferences to treatment in the field of substance use disorders suggests that treatment effects might be improved, although findings were inconsistent [13]. Patient preferences have become increasingly important for the development of clinical interventions, and they could play an important role for improving treatment uptake and outcomes by affected individuals [14]. Finally, only recently have studies on the efficacy of treatment assessed potential side effects. A potential risk of digital interventions is that these interventions might incorrectly be viewed as sufficient by some individuals who otherwise would be willing to engage in other evidence-based treatments. The significant difference between the conditions in the Hyland et al. study regarding receipt of medication shows the need for further rigorous, well-conducted studies. For a more detailed understanding on processes of change in newly developed interventions, mixed-methods studies that include the experiences of patients are warranted. GB conceptualized and wrote the manuscript. None.

An open trial of the Things You Do Questionnaire: Changes in daily actions during internet-delivered treatment for depressive and anxiety symptoms

Many psychological treatments aim to reduce symptoms of depression and anxiety by modifying maladaptive patterns of cognitions, behavior, and other actions. The Things You Do Questionnaire (TYDQ) was developed to measure the frequency of actions that are associated with psychological health in a reliable and valid manner. The present study examined treatment-related change in the frequency of actions measured by the TYDQ. Using an uncontrolled single-group design, 409 participants with self-reported symptoms of depression, anxiety, or both received access to an 8-week internet-delivered treatment course based on cognitive behavior therapy. Most (77 %) participants completed the treatment, completed questionnaires at post-treatment (83 %), and obtained significant reductions in symptoms of depression (d = 0.88) and anxiety at post-treatment (d = 0.97), as well as improvement in a measure of satisfaction with life (d = 0.36). Factor analyses supported the five-factor structure of the TYDQ, including Realistic Thinking, Meaningful Activities, Goals and Plans, Healthy Habits, and Social Connections. Those participants who, on average, engaged in the identified actions on the TYDQ at least half the days of the week reported lower symptoms of depression and anxiety at post-treatment. The psychometric properties of both a longer 60-item (TYDQ-60) and shorter 21-item (TYDQ-21) version were acceptable. These findings provide further evidence that there are modifiable activities that are strongly associated with psychological health. Future studies will test the replicability to these results in in a broader range of samples, including those seeking psychological treatment.

Deep Hierarchical Attention Active Learning for Mental Disorder Unlabeled Data in AIoMT

In the Artificial Intelligence of Medical Things (AIoMT), Internet-Delivered Psychological Treatment (IDPT) effectively improves the quality of mental health treatments. With the advent of COVID-19, psychological tasks have become overloaded and complicated for medical professionals due to the overlap of sentimental values. The development of an AIoMT tool requires labeling of data to achieve clinical-level performance. Text data requires an appropriate set of linguistic features for vector latent representation and segmentation. Emotional biases could lead to incorrect segmentation of patient-authorized texts, and labeling emotional data is time-consuming. In this article, we propose an assistant tool for psychologists to assist them in mental health treatment and note-taking. We first extend the word and emotion lexicon and then apply a hierarchical attention method to support data labeling. The learned latent representation uses word position prediction and sentence-level attention to create a semantic framework. The augmented vector representation helps in highlighting words and classifying nine different symptoms from the text written by the patient. Our experimental results show that the emotion lexicon helps to increase the accuracy by 5% without affecting the overall results, and that the hierarchical attention method achieves an F1 score of 0.89.

The timing and magnitude of symptom improvements during an Internet-delivered transdiagnostic treatment program for anxiety and depression.

In face-to-face treatments, mental health symptoms improve rapidly across the first few treatment sessions, and the pace of improvement slows with additional sessions. Some individuals also report clinically meaningful symptom improvements after only two or three treatment sessions. As the rate of symptom change has been given limited attention within digital treatments, the present study investigated the timing and magnitude of symptom change during an 8-week online treatment for anxiety and depression. Three adult samples were derived from previous randomized controlled trials: generalized anxiety disorder (n = 165), major depression (n = 149), and mixed anxiety/depression (n = 262). Symptom scores were compared between consecutive weeks of treatment, and we examined the proportion of individuals who achieved a ≥ 25% or ≥ 50% improvement in symptoms each week. Across all three samples, symptoms improved more rapidly during the first half of treatment compared to the second half of treatment. Within the first 4 weeks, over half of the participants had experienced a ≥ 25% improvement in symptoms, and approximately a third of participants had experienced a ≥ 50% improvement in symptoms. This pattern of change was found irrespective of diagnostic status or outcome measure. A substantial number of people who receive internet-delivered treatments appear to experience rapid, large, and clinically significant symptom improvement early in treatment. These findings add to our theoretical understanding of symptom improvements during psychotherapy, and further research investigating the mechanisms of such change will inform the development of more effective treatments. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Hyper-Graph Attention Based Federated Learning Method For Mental Health Detection.

Internet-Delivered Psychological Treatment (IDPT) has become necessary in the medical field. Deep neural networks (DNNs) require large, diverse patient populations to train models that achieve clinician-level performance. However, DNN models trained on limited datasets have poor clinical performance when used in a new location with different data. Thus, increasing the availability of diverse as well as distinct training data is vital. This study proposes a structural hypergraph as well as an emotional lexicon for word representation. An embedding model based on federated learning was developed for mental health symptom detection. The model treats text data as a collection of consecutive words. The model then learns a low-dimensional continuous vector while maintaining contextual linkage. The generated models with attention-based mechanisms as well as federated learning are then tested experimentally. Our strategy is suitable for vocabulary diversification, grammatical word representation, as well as dynamic lexicon analysis. The goal is to create semantic word representations using an attention network model. Later, clinical processes are used to mark the text by embedding it. Experimental results show the encoding of emotional words using the structural hypergraph. The 0.86 ROC was achieved using the bidirectional LSTM architecture with an attention mechanism.

Internet-delivered treatment for patients suffering from severe functional somatic disorders: Protocol for a randomized controlled trial

BackgroundFunctional somatic disorders (FSDs) with symptoms from multiple organs, i.e., multi-system type, are common in the general population and may lead to disability and reduced quality of life. Evidence for efficient treatment programs has been established, however, there is a need for making treatments accessible to a larger group of patients. Internet-delivered therapy has become prevalent and has proven as effective as face-to-face therapy, while providing a flexible and easily accessible treatment alternative. The aim of the current study is to compare the efficacy of the therapist-assisted internet-delivered treatment program One step at a time (OneStep) with the internet-delivered self-help program Get started (GetStarted). MethodsA total of 166 participants aged 18–60 years diagnosed with multi-system FSD will be assessed and randomized to either 1) OneStep: a 14-week program consisting of 11 treatment modules based on principles from cognitive behavioural therapy or 2) GetStarted consisting of 1 module on psychoeducation. The primary outcome is physical health, assessed by a Short Form Health Survey (SF-36) aggregate score of the subscales vitality, physical functioning, and bodily pain 3 months after end-of-treatment and self-reported improvement assessed by the Clinical Global Improvement Scale. Secondary outcomes include symptom load, depression, anxiety, and illness worry. Process measures include emotional distress, illness perception, illness behaviour, and symptom interference. ConclusionsThis study is the first study to test an internet-delivered treatment program for FSD, multi-system type and has the potential to show the importance of making evidence-based internet-delivered treatment for FSD more accessible.

Supplemental Material for Internet-Delivered Cognitive Behavior Therapy Versus Treatment as Usual for Anxiety and Depression Among Latin American University Students: A Randomized Clinical Trial

Supplemental Material for Internet-Delivered Cognitive Behavior Therapy Versus Treatment as Usual for Anxiety and Depression Among Latin American University Students: A Randomized Clinical Trial

Transdiagnostic internet-delivered cognitive behaviour therapy: Feasibility of a motivational interviewing resource

BackgroundDespite growing evidence for the effectiveness of internet-delivered cognitive behaviour therapy (ICBT), engagement and treatment outcomes are lower for some clients. Online motivational interviewing (MI) has been investigated prior to offering ICBT to facilitate engagement and outcomes, but only appears to improve engagement. PurposeThis feasibility study investigated the potential use of a brief MI resource offered during ICBT rather than before, by examining: (1) use of the resource; (2) client and treatment variables associated with use; (3) whether use of the resource was associated with improved engagement and outcomes; and (4) how those who used the resource evaluated it. MethodThis study used data collected from 763 clients enrolled in an ICBT course. Symptoms related to depression, anxiety and disability were assessed at pre- and post-treatment. The website tracked treatment engagement. Clients completed an MI resource evaluation measure at post-treatment. ResultsApproximately 15% of clients used the resource. Clients who were older, had higher education, scored in the clinical range on depression, and scored lower on anxiety at pre-treatment were more likely to use the resource. Those who reported using the resource had higher engagement (i.e., more lessons and messages) in ICBT, but lower improvement in disability post-treatment. Positive feedback on the MI resource outweighed negative feedback, with 94 % of clients identifying a positive aspect of the resource and 66 % of clients reporting making changes in response to the resource. Overall, the MI resource appears to be used by and perceived as beneficial by a small portion of clients who complete ICBT. The study provides insight into use of the resource and directions for future research related to MI and ICBT.

Supplemental Material for The Timing and Magnitude of Symptom Improvements During an Internet-Delivered Transdiagnostic Treatment Program for Anxiety and Depression

Supplemental Material for The Timing and Magnitude of Symptom Improvements During an Internet-Delivered Transdiagnostic Treatment Program for Anxiety and Depression