A pragmatic factorial randomized controlled trial of transdiagnostic internet-delivered cognitive behavioural therapy: Exploring benefits of homework reflection questionnaires and twice-weekly therapist support
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With the growing demand for internet-delivered cognitive behavioural therapy (iCBT), this pragmatic factorial (2 × 2 × 2) randomized controlled trial evaluated strategies for facilitating iCBT engagement and outcomes in routine care. Specifically, the benefits to patients and therapists of using homework reflection questionnaires and offering patients twice-weekly therapist support were examined. Patients (n = 632) accepted into iCBT for depression and/or anxiety were randomly assigned to complete homework reflection questionnaires or not (factor 1), receive once- or twice-weekly support (factor 2), and to receive care from therapists employed in one of two settings (iCBT clinic or a community mental health clinic; factor 3). Outcomes were measured at pre-treatment, and 8, 12, and 24-weeks post-enrollment. Therapist time was tracked and a focus group was conducted to examine therapist experiences. No differences in patient outcomes were found between therapists employed in the two settings; as such, these two groups were combined for further analyses. In terms of engagement, homework reflection questionnaires were associated with fewer website log-ins and days accessing iCBT; twice-weekly support was associated with more patient emails sent to therapists. Despite engagement differences, homework reflection questionnaires and twice-weekly support did not significantly impact primary outcomes; all groups showed large improvements in depression and anxiety that were maintained at 24-week follow-up. Therapists perceived a number of benefits and challenges associated with responding to homework reflection questionnaires and offering twice-weekly support; most notably the strategies did not benefit all patients. Twice-weekly support was associated with increased therapist time and organizational challenges. It is concluded that neither completion of homework questionnaires nor offering twice-weekly support significantly improve iCBT in routine care.
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Outcomes 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 ).”
Mean pretreatment social anxiety symptoms were considerably less severe in the present sample than in the Online Therapy Unit's clients.
“However, mean pretreatment social anxiety symptoms were considerably less severe in the present sample than in the Online Therapy Unit’s clients [63]”
From Initial Outcomes of Transdiagnostic Internet-Delivered Cognitive Behavioral Therapy Tailored to Public Safety Personnel: Longitudinal Observational Study (2021) · cites this paper as [63]
PSP participating in this study reported concurrent use of psychotropic medication less frequently than clients of the Wellbeing Course.
“PSP participating in this study reported concurrent use of psychotropic medication less frequently than clients of the Wellbeing Course [63].”
From Initial Outcomes of Transdiagnostic Internet-Delivered Cognitive Behavioral Therapy Tailored to Public Safety Personnel: Longitudinal Observational Study (2021) · cites this paper as [63]
These outcomes are comparable to the most recent published outcomes of the Wellbeing Course offered by the Online Therapy Unit to the general population of Saskatchewan.
“Descriptively, these outcomes are comparable to the most recent published outcomes of the Wellbeing Course offered by the Online Therapy Unit to the general population of Saskatchewan [63].”
From Initial Outcomes of Transdiagnostic Internet-Delivered Cognitive Behavioral Therapy Tailored to Public Safety Personnel: Longitudinal Observational Study (2021) · cites this paper as [63]
Effect sizes, percentage changes, and reliable change rates were comparable for all available symptom measures with the possible exception of the SIAS-6/SPS-6, which appeared to show better outcomes for the Wellbeing Course.
“Effect sizes, percentage changes, and reliable change rates were comparable for all available symptom measures with the possible exception of the SIAS-6/SPS-6, which appeared to show better outcomes for the Wellbeing Course.”
From Initial Outcomes of Transdiagnostic Internet-Delivered Cognitive Behavioral Therapy Tailored to Public Safety Personnel: Longitudinal Observational Study (2021) · cites this paper as [63]
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- Authors
- Hadjistavropoulos, H. D., Peynenburg, V., Thiessen, D. L., Nugent, M., Adlam, K., Owens, K. M. B., Karin, E., Dear, B. F., & Titov, N.
- Affiliations
- University of Regina (CA)
- Saskatchewan Health Authority (CA)
- Macquarie University (AU)
- Corresponding author
- Hadjistavropoulos, H.D.
- ORCID
- Venue
- Internet Interventions
- Publisher
- Elsevier BV
- Published
- 2020-12
- Volume
- 22
- Pages
- 100357
- ISSN
- 2214-7829 (ISSN-L)
- PMC
- PMC7734229
- OpenAlex
- W3109502355
- Cited by
- 25
- References
- 59
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 7 · 2023: 6 · 2022: 7 · 2021: 3
- FWCI
- 3.62
- Type
- journal article
- Language
- en
- 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
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- internet-based cognitive behavioral therapy, transdiagnostic treatment, depression, anxiety, treatment engagement, community mental health centers, usual care, therapist experience
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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