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Highlights • Internet-delivered cognitive behaviour therapy (ICBT) often involves weekly support. • In this trial, patients chose ICBT with standard or optional therapist support. • Few patients chose optional support (22%) compared to standard support (78%). • Patients who chose optional support had lower symptoms of anxiety and panic. • Engagement, completion rates, and outcomes were similar between groups. Abstract Emerging evidence from research trials suggests that Internet-delivered cognitive behaviour therapy (ICBT) produces similar symptom improvements whether patients receive weekly therapist support (standard support) or therapist support only when requested (optional support). It remains unknown, however, how many patients receiving ICBT as part of routine clinical care would prefer optional support compared to standard support and how outcomes compare when patients select their preferred treatment option. In this uncontrolled trial, we investigated patient preference and outcomes for standard versus optional support among patients with depression and or anxiety who were offered an 8-week transdiagnostic ICBT intervention in routine care. Of 401 patients accepted for ICBT, 22% selected optional support and 78% selected standard support. At assessment, patients who selected optional support had lower symptoms of anxiety and panic than patients who selected standard support. At post-treatment, both groups achieved similar large improvements in symptoms of anxiety and depression, with improvements sustained at 3-month follow-up. Patients receiving optional support sent and received fewer messages compared to patients receiving standard support. This study demonstrates the potential of optional therapist support to meet the needs and preferences of patients and to also reduce therapist costs in routine care. [ABSTRACT FROM AUTHOR]

Internet-delivered cognitive behavioral therapy (ICBT) is effective for treating anxiety and depression, but not for all patients. Predictors of dropout and outcomes from ICBT remain unclear and the literature could benefit from study of response to ICBT among larger community samples using advanced statistical techniques. In this study, we sought to identify predictors of dropout and symptom change in a large community sample ( n   =  1201) who received therapist-assisted transdiagnostic ICBT targeting anxiety and/or depression. Logistic regression was used to assess dropout, and showed that those who fully completed ICBT lessons ( n  = 880) were older and endorsed lower psychological distress at intake than those who only partially completed ICBT lessons ( n  = 321). During the course of therapy, patients responded to the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 at six time points. Autoregressive latent trajectory models were fitted to this data to assess the ability of demographic variables, program engagement, psychological and medical service usage, and psychological distress to explain individual variance in initial symptom levels and symptom change over time. Higher symptom scores at pre-treatment were predictive of greater symptom improvement. Symptom improvement was greater in those who were off work on disability and those without higher post-secondary education. Clinical implications are discussed. [ABSTRACT FROM AUTHOR]

Internet-delivered cognitive behaviour therapy (ICBT) is effective for treating anxiety and depression. The relative benefits of offering standard weekly compared to optional weekly therapist support in conjunction with ICBT within routine care has not been examined. Patients seeking ICBT for depression and or anxiety in routine care were randomized to standard ( n = 92) or optional ( n = 88) weekly support. The optional approach resulted in therapists receiving half as many messages from (1.70 vs. 3.96) and sending half as many messages to patients (3.62 vs. 7.29). Optional Support was associated with lower completion rates (56.6% versus 82.4%), but, similar to Standard Support, resulted in large reductions on the GAD-7 (within Cohen’s d ≥ 1.08; avg. reduction ≥47%) and PHQ-9 (within Cohen’s d ≥ 0.82; avg. reduction ≥43%) at post-treatment and 3-month follow-up. Optional weekly support appears clinically effective and acceptable for many patients and may reduce costs, but safety requires monitoring given lower completion rates. [ABSTRACT FROM AUTHOR]

Effects of Internet-delivered cognitive behaviour therapy (ICBT) for anxiety and depression are not well understood when delivered in non-specialized as compared to specialized clinic settings. This open trial ( n = 458 patients) examined the benefits of transdiagnostic-ICBT when delivered in Canada by therapists (registered providers or graduate students) working in either a specialized online clinic or one of eight nonspecialized community clinics. Symptoms of depression and anxiety were assessed at pre-treatment, post-treatment and at 3-month follow-up. Completion rates and satisfaction were high. Significant and large reductions (effect sizes 1.17–1.31) were found on symptom measures. Completion rates, satisfaction levels and outcomes did not differ whether ICBT was delivered by therapists working in a specialized online clinic or nonspecialized community clinics. Differences were also not found between registered providers and graduate students, or therapists trained in psychology or another discipline. The findings support the public health potential of ICBT. [ABSTRACT FROM AUTHOR]

Internet-delivered cognitive behaviour therapy (ICBT) is effective for treating anxiety and depression among post-secondary students, although outcomes are modest. Booster lessons have been proposed for maintaining and improving outcomes but have not been investigated following ICBT for students. This study used a mixed-methods approach to examine student (N = 146) use of a self-guided booster lesson offered 1 month after a 5-week ICBT course, whereby the booster lesson provided a review of ICBT skills and suggestions for maintaining motivation and problem solving. A survey about the booster was administered shortly after the booster to understand student preferences for the booster lessons, reasons for completing/not completing the booster, and satisfaction with the booster. Approximately one-third of students (n = 47) utilized the booster lesson. Completing a greater number of lessons during the main ICBT course was associated with uptake of the booster. The booster survey was completed by 20 of the 47 (∼43%) students who completed the booster lesson and 42 of the 99 who did not (∼42%). Students varied in perceptions of the ideal timing of the booster (1–2 weeks to 3–6 months) and approximately 60% expressed preference for completing the booster independently. Among non-completers of the booster, academic-related time constraints were the primary barrier to booster completion. Among those who completed the booster, the booster lesson was perceived as worthwhile, satisfaction was high, and the length was perceived as appropriate. Future research should examine if flexible delivery of booster lessons in terms of timelines and therapist support would increase booster uptake. Key learning aims: As a result of reading this paper, readers should: (1) Understand the uptake of a self-guided booster lesson in internet-delivered cognitive behaviour therapy (ICBT) among post-secondary students. (2) Understand students' preferences for the content, timing, and therapist support for booster lessons. (3) Understand the need for alternative delivery methods of booster lessons to reach students who might benefit the most from a booster. [ABSTRACT FROM AUTHOR]