The Impacts of a Psychoeducational Alcohol Resource During Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety: Observational Study

Abstract

Background Problematic alcohol use is common among clients seeking transdiagnostic internet-delivered cognitive behavioral therapy (ICBT) for depression or anxiety but is not often addressed in these treatment programs. The benefits of offering clients a psychoeducational resource focused on alcohol use during ICBT for depression or anxiety are unknown. Objective This observational study aimed to elucidate the impacts of addressing comorbid alcohol use in ICBT for depression and anxiety. Methods All patients (N=1333) who started an 8-week transdiagnostic ICBT course for depression and anxiety received access to a resource containing information, worksheets, and strategies for reducing alcohol use, including psychoeducation, reasons for change, identifying risk situations, goal setting, replacing drinking with positive activities, and information on relapse prevention. We assessed clients’ use and perceptions of the resource; client characteristics associated with reviewing the resource; and whether reviewing the resource was associated with decreases in clients’ alcohol use, depression, and anxiety at posttreatment and 3-month follow-up among clients dichotomized into low-risk and hazardous drinking categories based on pretreatment Alcohol Use Disorders Identification Test (AUDIT) scores. Results During the 8-week course, 10.8% (144/1333) of clients reviewed the resource, and those who reviewed the resource provided positive feedback (eg, 127/144, 88.2% of resource reviewers found it worth their time). Furthermore, 18.15% (242/1333) of clients exhibited hazardous drinking, with 14.9% (36/242) of these clients reviewing the resources. Compared with nonreviewers, resource reviewers were typically older (P=.004) and separated, divorced, or widowed (P<.001). Reviewers also consumed more weekly drinks (P<.001), scored higher on the AUDIT (P<.001), and were more likely to exhibit hazardous drinking (P<.001). Regardless of their drinking level (ie, low risk vs hazardous), all clients showed a reduction in AUDIT-Consumption scores (P=.004), depression (P<.001), and anxiety (P<.001) over time; in contrast, there was no change in clients’ drinks per week over time (P=.81). Reviewing alcohol resources did not predict changes in AUDIT-Consumption scores or drinks per week. Conclusions Overall, ICBT appeared to be associated with a reduction in alcohol consumption scores, but this reduction was not greater among alcohol resource reviewers. Although there was some evidence that the resource was more likely to be used by clients with greater alcohol-related difficulties, the results suggest that further attention should be given to ensuring that those who could benefit from the resource review it to adequately assess the benefits of the resource.

Satisfaction, engagement, and outcomes in internet-delivered cognitive behaviour therapy adapted for people of diverse ethnocultural groups: an observational trial with benchmarking

“…All eligible PDEG participants (N=41) enrolled in ICBT at the Online Therapy Unit between June 2022 and November 2022 were included (see Figure 1 ). Sub-sample (e.g., self-identified non-White/Caucasian) data (N=134) collected between December 2021 and May 2022 at the same site with an equivalent protocol were used as the benchmarking sample [see ( 15 ) for details about benchmarking sample].…”

“…The current pilot study was conducted to assess the effectiveness, satisfaction, and engagement of the adapted ICBT by PDEGs benchmarked against data from PDEGs who took a non-adapted version of the same ICBT program in the past. Given the changes made, we expected similar effect sizes, but increased engagement and satisfaction with the adapted ICBT when benchmarked against a sample of PDEGs who took a nonadapted version of the ICBT program (see 15).…”

Satisfaction, Engagement, and Outcomes in Internet-Delivered Cognitive Behaviour Therapy Adapted for People of Diverse Ethnocultural Groups: An Observational Trial with Benchmarking

“…All eligible PDEG (N=41) who enrolled in ICBT at the Online Therapy Unit (www.onlinetherapyuser.ca) between June 2022 and November 2022 were included (see Figure 1). Sub-sample (e.g., self-identified non-White/Caucasian) data (N=134) collected between December 2021 and May 2022 at the same site with an equivalent protocol as part of regular service delivery were used as a benchmarking sample see [15]. At post-treatment, ~32% (n=13) consenting participants in the pilot study were interviewed asking about their expectations and experience with the adapted ICBT Wellbeing Course and for suggestions for further improvement.…”

“…The current pilot study was conducted to assess the effectiveness, satisfaction, and engagement of PDEGS in the adapted ICBT. Given the changes made, we expected similar effect sizes, but increased engagement and satisfaction with the adapted ICBT when benchmarked against a sample of PDEGs drawn from data from the previous non-adapted version of the ICBT program see [15].…”

Evaluation of additional resources used in therapist-assisted transdiagnostic internet-delivered cognitive behaviour therapy

“…Recently, several studies were conducted to examine predictors of clients accessing specific additional resources, clients' perceptions of the resources, and the association between accessing certain resources and client outcomes at post-treatment. Each of these studies focused on a single resource including building motivation ( Horse et al, 2023 ), managing insomnia symptoms ( Peynenburg et al, 2022 ), and managing problematic alcohol use ( Peynenburg et al, 2023 ), that were available to clients during an 8-week transdiagnostic ICBT course. Out of 763 clients, 15 % downloaded an additional resource focused on building motivation ( Horse et al, 2023 ).…”