Transdiagnostic Internet-delivered cognitive behaviour therapy with therapist support offered once-weekly or once-weekly supplemented with therapist support within one-business-day: Pragmatic randomized controlled trial
Open accessAbstract
In routine care, internet-delivered cognitive behaviour therapy (iCBT) regularly includes therapist support delivered via secure email, but the optimal response time to emails is unknown. In this study, we compared the benefits of therapists providing support once-weekly versus therapists providing support once-weekly supplemented with a one-business-day response to all patient emails. This pragmatic randomized controlled trial included therapists employed by a specialized iCBT clinic or community mental health clinics, where providing iCBT is a secondary service. Patients with depression and/or anxiety who enrolled in transdiagnostic iCBT (5 core lessons over 8 weeks) were randomized to: 1) once-weekly support supplemented with a one-business-day response to patient emails by specialized therapists (n = 233); 2) once-weekly support also offered by specialized therapists (n = 216); or 3) once-weekly support offered by community clinic therapists (n = 226). Outcomes were measured at 8, 12, 24, and 52-weeks post-enrollment. Patient engagement and treatment experiences (e.g., treatment satisfaction, therapist alliance) were also assessed and a focus group was conducted with therapists. Supplementing once-weekly therapist support with a one-business-day response to patient emails resulted in therapists sending more emails to patients (M: 13 versus 9) and required more therapist time over treatment (M: 155 versus 109 min), but was not associated with improved outcomes, patient engagement or treatment experiences. All groups showed large improvements in symptoms of depression and anxiety maintained at 52-week follow-up, strong engagement and positive treatment experiences. Therapists viewed challenges of responding to patient emails within one-business-day to outweigh benefits. Contrary to expectations, supplementing once-weekly therapist support with a one-business-day response to all patient emails did not benefit patients and increased therapist time as well as therapist challenges when delivering iCBT in routine care.
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Increasing therapist support beyond once weekly does not improve effects and is associated with higher costs and operational challenges.
“Importantly, this past research shows increasing therapist support beyond once weekly does not improve effects and in fact is associated with higher costs and operational challenges. 20,21”
From Utilization, Patient Characteristics, and Longitudinal Improvements among Patients from a Provincially Funded Transdiagnostic Internet-delivered Cognitive Behavioural Therapy Program: Observational Study of Trends over 6 Years (2022) · cites this paper as [20]
The Conclusions report that adding one-business-day email responses to once-weekly support did not improve outcomes and increased therapist time and burden. The Results (Therapist time and Focus group; page not provided) document the extra time and operational challenges. The paper does not measure financial costs, and its finding concerns this specific form of additional support rather than every increase beyond once weekly. (LLM, conf=0.86)
Experimental — accuracy not yet measuredOutcomes are comparable with varying support (once-weekly support compares to optional support, twice-weekly support, and one-business-day support).
“Furthermore, outcomes are comparable with varying support (i.e., once-weekly support compares to optional support, 17,18 twice-weekly support, 19 and one-business-day support 20 ).”
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- Authors
- Hadjistavropoulos, H. D., Peynenburg, V., Nugent, M., Karin, E., Titov, N., & Dear, B. F.
- Affiliations
- University of Regina (CA)
- Macquarie University (AU)
- Corresponding author
- Hadjistavropoulos, H.D.
- Venue
- Internet Interventions
- Publisher
- Elsevier BV
- Published
- 2020-12
- Volume
- 22
- Pages
- 100347
- ISSN
- 2214-7829 (ISSN-L)
- PMC
- PMC7508705
- OpenAlex
- W3081684335
- Cited by
- 32
- References
- 54
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 6 · 2023: 7 · 2022: 7 · 2021: 5 · 2020: 1
- FWCI
- 4.52
- Type
- journal article
- Language
- en
- Update notices
- erratum (2021-09-01)
- Open access
- gold
- doi.org
- Licence
- Locations
- Internet Interventions (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Canadian Institutes of Health Research
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- internet-based cognitive behavioral therapy, transdiagnostic treatment, therapist support, depression, anxiety, patient engagement, treatment satisfaction, therapist workload, usual care, community mental health centers
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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