Previously submitted to: Journal of Medical Internet Research (no longer under consideration since Jun 29, 2026)
Date Submitted: Sep 22, 2025
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Delivering online cognitive behavioural therapy to address mental health challenges in correctional workers: A randomized controlled trial
ABSTRACT
Background:
Correctional workers (CWs), are frequently exposed to traumatic workplace events, placing them at higher risk of experiencing mental health disorders, including major depressive disorder (MDD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD). Despite high prevalence of mental health challenges, CWs underutilize mental health services due to stigma, irregular work schedules, and accessibility issues. While cognitive behavioural therapy (CBT) is effective, it poses accessibility challenges. Electronic CBT (eCBT) offers a scalable, accessible alternative, but use among CWs remains underexplored.
Objective:
This study aimed to evaluate the efficacy of diagnosis-specific eCBT programs designed for CWs in reducing symptoms of MDD, GAD, and PTSD compared to treatment as usual (TAU).
Methods:
A randomized controlled trial (RCT) was conducted with 84 CWs in Ontario, assigned to either eCBT (n=40) or TAU (n=44). The eCBT program provided diagnosis-specific modules with synchronous personalized feedback from care providers over 12-weeks via the Online Psychotherapy Tool (OPTT). Symptom severity was measured at baseline, week-6, and post-treatment using validated scales for depression, anxiety, PTSD, and quality-of-life. Data analysis included paired samples t-tests, mixed linear models, and effect size calculations (Cohen's d).
Results:
The eCBT group exhibited significant reductions in symptom severity for depression, anxiety, and PTSD from baseline to post-treatment compared to TAU (p<0.01), with a moderate effect size (Cohen’s d=0.68). Symptom severity decreased by 61.37% for eCBT versus 23.29% in TAU. Mixed linear models confirmed a significant treatment-by-time interaction, favouring eCBT (p<0.01). However, no significant differences in quality-of-life improvements were observed between groups.
Conclusions:
Diagnosis-specific eCBT programs are effective in reducing symptoms of depression, anxiety, and PTSD for CWs. The asynchronous, accessible format of eCBT addresses current key barriers. Future research should explore strategies to improve adherence and increase the accessibility of services for CWs. Clinical Trial: Clinicaltrials.gov (NCT04666974).
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