Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Dec 1:22:100357.
doi: 10.1016/j.invent.2020.100357. eCollection 2020 Dec.

A pragmatic factorial randomized controlled trial of transdiagnostic internet-delivered cognitive behavioural therapy: Exploring benefits of homework reflection questionnaires and twice-weekly therapist support

H D Hadjistavropoulos  1 , V Peynenburg  1 , D L Thiessen  2 , M Nugent  1 , K Adlam  1 , K M B Owens  3 , E Karin  4 , B F Dear  4 , N Titov  5
Affiliations

A pragmatic factorial randomized controlled trial of transdiagnostic internet-delivered cognitive behavioural therapy: Exploring benefits of homework reflection questionnaires and twice-weekly therapist support

H D Hadjistavropoulos et al. Internet Interv. .

Abstract

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.

Keywords: Cognitive behaviour therapy; Internet-delivered; Therapist support, homework.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that appear to have influenced the work reported in this paper.

Figures

Fig. 1
Fig. 1
Patient flow from screening to 24-week follow-up.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Allen A.R., Newby J.M., Mackenzie A., Smith J., Boulton M., Loughnan S.A., Andrews G. Internet cognitive-behavioural treatment for panic disorder: randomised controlled trial and evidence of effectiveness in primary care. BJPsych Open. 2016;2(2):154–162. doi: 10.1192/bjpo.bp115.001826. - DOI - PMC - PubMed
    1. Andersson G. Internet-delivered psychological treatments. Annu. Rev. Clin. Psychol. 2016;12:157–179. doi: 10.1146/annurev-clinpsyc-021815-093006. - DOI - PubMed
    1. Andersson G., Carlbring P., Titov N., Lindefors N. Internet interventions for adults with anxiety and mood disorders: a narrative umbrella review of recent meta-analyses. Can. J. Psychiatr. 2019;64(7):465–470. doi: 10.1177/070653719839381. - DOI - PMC - PubMed
    1. Baumeister H., Reichler L., Munzinger M., Lin J. The impact of guidance on internet-based mental health interventions — a systematic review. Internet Interv. 2014;1(4):205–215. doi: 10.1016/j.invent.2014.08.003. - DOI
    1. Bendelin N., Hesser H., Dahl J., Carlbring P., Nelson K.Z., Andersson G. Experiences of guided Internet-based cognitive behavioural treatment for depression: a qualitative study. BMC Psychiatry. 2011;11:107. doi: 10.1186/1471-244X-11-107. - DOI - PMC - PubMed

LinkOut - more resources