Department of Psychology, University of Regina, Regina, SK, Canada.
PSPNET, University of Regina, Regina, SK, Canada.
J Med Internet Res. 2024 Aug 14;26:e59699. doi: 10.2196/59699.
Internet-delivered cognitive behavioral therapy (ICBT) is an effective and accessible treatment for various mental health concerns. ICBT has shown promising treatment outcomes among public safety personnel (PSP), who experience high rates of mental health problems and face barriers to accessing other mental health services. Client engagement and clinical outcomes are better in ICBT with therapist guidance, but ICBT is easier to implement on a large scale when it is self-guided. Therefore, it is important to identify strategies to improve outcomes and engagement in self-guided ICBT and other self-guided digital mental health interventions. One such strategy is the use of online discussion forums to provide ICBT clients with opportunities for mutual social support. Self-guided interventions accompanied by online discussion forums have shown excellent treatment outcomes, but there is a need for research experimentally testing the impact of online discussion forums in ICBT.
We aimed to evaluate a transdiagnostic, self-guided ICBT intervention tailored specifically for PSP (which had not previously been assessed), assess the impact of adding a therapist-moderated online discussion forum on outcomes, and analyze participants' feedback to inform future research and implementation efforts.
In this randomized trial, we randomly assigned participating PSP (N=107) to access an 8-week transdiagnostic, self-guided ICBT course with or without a built-in online discussion forum. Enrollment and participation were entirely web-based. We assessed changes in depression, anxiety, and posttraumatic stress as well as several secondary outcome measures (eg, treatment engagement and satisfaction) using questionnaires at the pre-enrollment, 8-week postenrollment, and 20-week postenrollment time points. Mixed methods analyses included multilevel modeling and qualitative content analysis.
Participants engaged minimally with the forum, creating 9 posts. There were no differences in treatment outcomes between participants who were randomly assigned to access the forum (56/107, 52.3%) and those who were not (51/107, 47.7%). Across conditions, participants who reported clinically significant symptoms during enrollment showed large and statistically significant reductions in symptoms (P<.05 and d>0.97 in all cases). Participants also showed good treatment engagement and satisfaction, with 43% (46/107) of participants fully completing the intervention during the course of the study and 96% (79/82) indicating that the intervention was worth their time.
Previous research has shown excellent clinical outcomes for self-guided ICBT accompanied by discussion forums and good engagement with those forums. Although clinical outcomes in our study were excellent across conditions, engagement with the forum was poor, in contrast to previous research. We discuss several possible interpretations of this finding (eg, related to the population under study or the design of the forum). Our findings highlight a need for more research evaluating the impact of online discussion forums and other strategies for improving outcomes and engagement in self-guided ICBT and other digital mental health interventions.
ClinicalTrials.gov NCT05145582; https://clinicaltrials.gov/study/NCT05145582.
互联网提供的认知行为疗法（ICBT）是一种有效的、可及的治疗各种心理健康问题的方法。ICBT 在公共安全人员（PSP）中显示出有希望的治疗结果，他们经历着高比例的心理健康问题，并面临着获得其他心理健康服务的障碍。在有治疗师指导的情况下，ICBT 的客户参与度和临床结果更好，但当它是自我指导时，更容易大规模实施。因此，确定改善自我指导的 ICBT 和其他自我指导的数字心理健康干预措施的结果和参与度的策略非常重要。一种这样的策略是使用在线讨论论坛为 ICBT 客户提供相互社会支持的机会。自我指导的干预措施伴随着在线讨论论坛已经显示出了极好的治疗结果，但需要研究实验来测试在线讨论论坛在 ICBT 中的影响。
我们旨在评估专门为 PSP 量身定制的、基于症状的自我指导的 ICBT 干预措施（之前尚未进行评估），评估添加治疗师主持的在线讨论论坛对结果的影响，并分析参与者的反馈信息，为未来的研究和实施工作提供信息。
在这项随机试验中，我们将参与的 PSP（N=107）随机分配，使用或不使用内置的在线讨论论坛访问为期 8 周的基于症状的自我指导的 ICBT 课程。注册和参与完全是基于网络的。我们使用问卷在注册前、8 周注册后和 20 周注册后评估抑郁、焦虑和创伤后应激的变化以及几个次要结果测量（例如，治疗参与度和满意度）。混合方法分析包括多级建模和定性内容分析。
参与者与论坛的互动很少，仅创建了 9 个帖子。随机分配访问论坛的参与者（56/107，52.3%）和未分配的参与者（51/107，47.7%）之间的治疗结果没有差异。在所有条件下，在注册期间报告有临床显著症状的参与者表现出症状的大幅且统计学显著减少（所有情况下 P<.05，d>0.97）。参与者也表现出良好的治疗参与度和满意度，43%（46/107）的参与者在研究过程中完全完成了干预，96%（79/82）的参与者表示干预值得他们花时间。
先前的研究表明，自我指导的 ICBT 伴随着讨论论坛和良好的参与度可以产生极好的临床结果。尽管我们的研究中所有条件下的临床结果都非常出色，但与先前的研究相比，参与者与论坛的互动很少。我们讨论了几种可能的解释（例如，与研究人群或论坛的设计有关）。我们的研究结果强调需要更多的研究来评估在线讨论论坛和其他策略对改善自我指导的 ICBT 和其他数字心理健康干预措施的结果和参与度的影响。
ClinicalTrials.gov NCT05145582；https://clinicaltrials.gov/study/NCT05145582。
