Initial Outcomes of Transdiagnostic Internet-Delivered Cognitive Behavioral Therapy Tailored to Public Safety Personnel: Longitudinal Observational Study

Abstract

Background Canadian public safety personnel (PSP) experience high rates of mental health disorders and face many barriers to treatment. Internet-delivered cognitive behavioral therapy (ICBT) overcomes many such barriers, and is effective for treating depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms. Objective This study was designed to fill a gap in the literature regarding the use of ICBT tailored specifically for PSP. We examined the effectiveness of a tailored ICBT program for treating depression, anxiety, and PTSD symptoms among PSP in the province of Saskatchewan. Methods We employed a longitudinal single-group open-trial design (N=83) with outcome measures administered at screening and at 8 weeks posttreatment. Data were collected between December 5, 2019 and September 11, 2020. Primary outcomes included changes in depression, anxiety, and PTSD symptoms. Secondary outcomes included changes in functional impairment; symptoms of panic, social anxiety, and anger; as well as treatment satisfaction, working alliance, and program usage patterns. Results Clients reported large symptom reductions on measures of depression and anxiety, as well as moderate reductions on measures of PTSD and secondary symptoms, except for social anxiety. Most clients who reported symptoms above clinical cut-offs on measures of depression, anxiety, and PTSD during screening experienced clinically significant symptom reductions. Results suggested good engagement, treatment satisfaction, and working alliance. Conclusions Tailored, transdiagnostic ICBT demonstrated promising outcomes as a treatment for depression, anxiety, and PTSD among Saskatchewan PSP and warrants further investigation. Trial Registration Clinicaltrials.gov NCT04127032; https://www.clinicaltrials.gov/ct2/show/NCT04127032

Insights into internet-delivered cognitive behavioural therapy for public safety personnel: Exploration of client experiences during and after treatment

“…Before accessing the PSP Wellbeing Course, clients completed the Patient Health Questionnaire-9 (PHQ-9; Kroenke et al, 2001 ), Generalized Anxiety Disorder-7 (GAD-7; Spitzer et al, 2006 ), and PTSD Checklist for DSM-5 (PCL-5; Blevins et al, 2015 ) as part of the online screening (in addition to other measures, the results of which are reported elsewhere; Hadjistavropoulos et al, 2021 ). The current qualitative data were collected from three sources and de-identified prior to analyses.…”

“…The PSPNET team used the results of this study to help tailor a transdiagnostic ICBT course (the PSP Wellbeing Course ) specifically to meet the needs of PSP. Preliminary quantitative outcomes (e.g., symptom change scores) from the PSP Wellbeing Course are promising and are described in a separate paper ( Hadjistavropoulos et al, 2021 ). However, there is still no published qualitative research on PSP's experiences using ICBT.…”

Why Do Public Safety Personnel Seek Tailored Internet-Delivered Cognitive Behavioural Therapy? An Observational Study of Treatment-Seekers

“…All of the current results are based on data obtained from the eligibility screening questionnaires. The procedures through which PSP enrol in and complete PSPNET courses are described elsewhere [30].…”

“…The current study has several limitations that highlight opportunities for future research. First, the current study was not designed to evaluate the ICBT services provided by PSPNET; however, the initial outcomes have previously been published [30]. Second, the current study explores only the experiences of PSP who signed up for PSPNET and provides no information on PSP who did not sign up for PSPNET.…”

“…Our research unit, PSPNET, has developed a transdiagnostic ICBT program tailored specifically for Canadian PSP, in keeping with recommendations to tailor digital mental health interventions towards specific user groups (e.g., [28,29]). PSPNET's ICBT has demonstrated promising initial outcomes for treating symptoms of several mental disorders among PSP [30]. At the time this article was written, at least two other Canadian research groups were also developing ICBT interventions for PSP [31,32].…”