Internet-Delivered Cognitive Behavioral Therapy for Postsecondary Students: Randomized Factorial Trial for Examining Motivational Interviewing and Booster Lessons
BackgroundInternet-delivered cognitive behavioral therapy (ICBT) can improve access to mental health care for students, although high attrition rates are concerning and little is known about long-term outcomes. Motivational interviewing (MI) exercises and booster lessons can...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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JMIR Publications
2022-09-01
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| Series: | Journal of Medical Internet Research |
| Online Access: | https://www.jmir.org/2022/9/e40637 |
| _version_ | 1797734770782765056 |
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| author | Vanessa Peynenburg Heather Hadjistavropoulos David Thiessen Nickolai Titov Blake Dear |
| author_facet | Vanessa Peynenburg Heather Hadjistavropoulos David Thiessen Nickolai Titov Blake Dear |
| author_sort | Vanessa Peynenburg |
| collection | DOAJ |
| description |
BackgroundInternet-delivered cognitive behavioral therapy (ICBT) can improve access to mental health care for students, although high attrition rates are concerning and little is known about long-term outcomes. Motivational interviewing (MI) exercises and booster lessons can improve engagement and outcomes in face-to-face cognitive behavioral therapy.
ObjectiveThis study aimed to examine the use of pretreatment MI exercises and booster lessons in ICBT for postsecondary students.
MethodsIn this factorial trial (factor 1: web-based MI before treatment; factor 2: self-guided booster lesson 1 month after treatment), 308 clients were randomized to 1 of 4 treatment conditions, with 277 (89.9%) clients starting treatment. All clients received a 5-week transdiagnostic ICBT course (the UniWellbeing course). Primary outcomes included changes in depression, anxiety, and perceived academic functioning from before treatment to after treatment and at the 1-month and 3-month follow-ups.
ResultsOverall, 54% (150/277) of students completed treatment and reported large improvements in symptoms of depression and anxiety and small improvements in academic functioning after treatment, which were maintained at the 1-month and 3-month follow-ups. Pretreatment MI did not contribute to better treatment completion or engagement, although small between-group effects favored MI for reductions in depression (Cohen d=0.23) and anxiety (Cohen d=0.25) after treatment. Only 30.9% (43/139) of students randomized to one of the booster conditions accessed the booster. Overall, no main effects were found for the booster. Subanalyses revealed that clients who accessed the booster had larger decreases in depressive symptoms (Cohen d=0.31) at the 3-month follow-up. No interactions were found between MI and the booster.
ConclusionsRather than offering MI before treatment, clients may experience more benefits from MI exercises later in ICBT when motivation wanes. The low uptake of the self-guided booster limited our conclusions regarding its effectiveness. Future research should examine offering a booster for a longer duration after treatment, with therapist support and a longer follow-up period.
Trial RegistrationClinicalTrials.gov NCT04264585; https://clinicaltrials.gov/ct2/show/NCT04264585 |
| first_indexed | 2024-03-12T12:48:09Z |
| format | Article |
| id | doaj.art-271add7f9a33402fb7a89fbf8929cab2 |
| institution | Directory Open Access Journal |
| issn | 1438-8871 |
| language | English |
| last_indexed | 2024-03-12T12:48:09Z |
| publishDate | 2022-09-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | Journal of Medical Internet Research |
| spelling | doaj.art-271add7f9a33402fb7a89fbf8929cab22023-08-28T23:02:10ZengJMIR PublicationsJournal of Medical Internet Research1438-88712022-09-01249e4063710.2196/40637Internet-Delivered Cognitive Behavioral Therapy for Postsecondary Students: Randomized Factorial Trial for Examining Motivational Interviewing and Booster LessonsVanessa Peynenburghttps://orcid.org/0000-0001-8686-2717Heather Hadjistavropouloshttps://orcid.org/0000-0002-7092-9056David Thiessenhttps://orcid.org/0000-0002-1167-1585Nickolai Titovhttps://orcid.org/0000-0002-7268-729XBlake Dearhttps://orcid.org/0000-0001-9324-3092 BackgroundInternet-delivered cognitive behavioral therapy (ICBT) can improve access to mental health care for students, although high attrition rates are concerning and little is known about long-term outcomes. Motivational interviewing (MI) exercises and booster lessons can improve engagement and outcomes in face-to-face cognitive behavioral therapy. ObjectiveThis study aimed to examine the use of pretreatment MI exercises and booster lessons in ICBT for postsecondary students. MethodsIn this factorial trial (factor 1: web-based MI before treatment; factor 2: self-guided booster lesson 1 month after treatment), 308 clients were randomized to 1 of 4 treatment conditions, with 277 (89.9%) clients starting treatment. All clients received a 5-week transdiagnostic ICBT course (the UniWellbeing course). Primary outcomes included changes in depression, anxiety, and perceived academic functioning from before treatment to after treatment and at the 1-month and 3-month follow-ups. ResultsOverall, 54% (150/277) of students completed treatment and reported large improvements in symptoms of depression and anxiety and small improvements in academic functioning after treatment, which were maintained at the 1-month and 3-month follow-ups. Pretreatment MI did not contribute to better treatment completion or engagement, although small between-group effects favored MI for reductions in depression (Cohen d=0.23) and anxiety (Cohen d=0.25) after treatment. Only 30.9% (43/139) of students randomized to one of the booster conditions accessed the booster. Overall, no main effects were found for the booster. Subanalyses revealed that clients who accessed the booster had larger decreases in depressive symptoms (Cohen d=0.31) at the 3-month follow-up. No interactions were found between MI and the booster. ConclusionsRather than offering MI before treatment, clients may experience more benefits from MI exercises later in ICBT when motivation wanes. The low uptake of the self-guided booster limited our conclusions regarding its effectiveness. Future research should examine offering a booster for a longer duration after treatment, with therapist support and a longer follow-up period. Trial RegistrationClinicalTrials.gov NCT04264585; https://clinicaltrials.gov/ct2/show/NCT04264585https://www.jmir.org/2022/9/e40637 |
| spellingShingle | Vanessa Peynenburg Heather Hadjistavropoulos David Thiessen Nickolai Titov Blake Dear Internet-Delivered Cognitive Behavioral Therapy for Postsecondary Students: Randomized Factorial Trial for Examining Motivational Interviewing and Booster Lessons Journal of Medical Internet Research |
| title | Internet-Delivered Cognitive Behavioral Therapy for Postsecondary Students: Randomized Factorial Trial for Examining Motivational Interviewing and Booster Lessons |
| title_full | Internet-Delivered Cognitive Behavioral Therapy for Postsecondary Students: Randomized Factorial Trial for Examining Motivational Interviewing and Booster Lessons |
| title_fullStr | Internet-Delivered Cognitive Behavioral Therapy for Postsecondary Students: Randomized Factorial Trial for Examining Motivational Interviewing and Booster Lessons |
| title_full_unstemmed | Internet-Delivered Cognitive Behavioral Therapy for Postsecondary Students: Randomized Factorial Trial for Examining Motivational Interviewing and Booster Lessons |
| title_short | Internet-Delivered Cognitive Behavioral Therapy for Postsecondary Students: Randomized Factorial Trial for Examining Motivational Interviewing and Booster Lessons |
| title_sort | internet delivered cognitive behavioral therapy for postsecondary students randomized factorial trial for examining motivational interviewing and booster lessons |
| url | https://www.jmir.org/2022/9/e40637 |
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