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

Abstract

Objective: There is strong evidence supporting internet-delivered cognitive behaviour therapy (iCBT) and consequently growing demand for iCBT in Canada. Transdiagnostic iCBT that addresses both depression and anxiety is particularly promising as it represents an efficient method of delivering iCBT in routine care. The Online Therapy Unit, funded by the Saskatchewan government, has been offering transdiagnostic iCBT for depression and anxiety since 2013. In this article, to broadly inform implementation efforts, we examined trends in utilization, patient characteristics, and longitudinal improvements for patients receiving transdiagnostic iCBT over 6 years. Methods: Patients who completed telephone screening between November 2013 and December 2019 were included in this observational study. Patients provided demographics and mental health history at screening and completed measures at pre-treatment, post-treatment and at 3- to 4-month follow-up. Treatment engagement and satisfaction were assessed. Results: A total of 5,321 telephone screenings were completed and 4,283 of patients were accepted for treatment over the 6-year period (80.5% acceptance). The most common reason for referral to another service was high suicide risk/severe symptoms (47.1%). Examination of trends showed growing use of transdiagnostic iCBT over time (37% increase per year). There was remarkable stability in patient characteristics across years. Most patients were concurrently using medication (57.3%) with 11.9% reporting using iCBT while on a waiting list for face-to-face treatment highlighting the importance of integrating iCBT with other services. Consistent across years, large improvements in depression and anxiety symptoms were found and maintained at 3- to 4-month follow-up. There was strong patient engagement with iCBT and positive ratings of treatment experiences. Conclusions: As there is growing interest in iCBT in Canada, this large observational study provides valuable information for those implementing iCBT in terms of likely user characteristics, patterns of use, and improvements. This information has potential to assist with resource allocation and planning in Canada and elsewhere.

A Comparison of Self-Referral and Referral via Primary Care Providers, through Two Similar Digital Mental Health Services in Western Australia

“…Clinical deterioration on the K-10 was less than 3% for both clinics, and patient satisfaction was high. These outcomes are consistent with previous reports [ 24 , 25 ], and compare favorably with outcomes from other DMHSs that offer online treatment as part of routine care in public health systems around the world [ 46 , 47 , 48 , 49 , 50 , 51 ].…”

Factors associated with treatment uptake, completion, and subsequent symptom improvement in a national digital mental health service

“…The clinical outcomes of psychological interventions such as internet-delivered cognitive behavioural therapy (iCBT) have been shown to be equivalent to high quality face-to-face psychological interventions ( Carlbring et al, 2018 ). DMHS already provide treatment as part of routine care in several countries ( Titov et al, 2019a ; Titov et al, 2018 ) ( Hadjistavropoulos et al, 2021 ; Nordgreen et al, 2019 ; Titov et al, 2019b ; Ruwaard et al, 2012 ; Johansson et al, 2019 ; Staples et al, 2021 ).…”

Examining the Utility of a Sleep Resource in Transdiagnostic Internet-Delivered Cognitive Behavior Therapy: An Observational Study

“…Transdiagnostic internet-delivered cognitive behavior therapy represents a valuable approach for improving patient access to care [ 1 ]. In this approach, patients access carefully developed web-based lessons or modules that provide psychoeducation and support people to learn and use broadly relevant cognitive and behavioral skills.…”