JMIR Publications

ABSTRACT

Background:

Internet-delivered cognitive behavioural therapy 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 healthcare services. Client engagement and clinical outcomes are better in ICBT when it is therapist-guided, but ICBT is easier to implement on a large scale when it is self-guided. Identifying strategies to make ICBT more engaging could help improve outcomes and engagement in self-guided ICBT and other digital mental health interventions. One such strategy is the use of online discussion forums to provide ICBT clients with opportunities for 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.

Objective:

Our objectives were 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 participant’s positive and constructive feedback to inform future research and implementation efforts.

Methods:

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. All enrollment and participation occurred online. We assessed changes in depression, anxiety, and posttraumatic stress, as well as several secondary outcome measures (e.g., treatment engagement and satisfaction) using questionnaires at pretreatment, 8 weeks post-enrollment, and 20 weeks post-enrollment. Mixed-methods analyses included multilevel modelling and qualitative content analysis.

Results:

Participants engaged minimally with the forum, creating a total of 9 posts. There were no differences in treatment outcomes between participants who were assigned to access the forum (n = 56) and those who were not (n = 51). Across conditions, participants who reported clinically significant symptoms at pretreatment showed large and and statistically significant reductions in symptoms (Ps < .05, ds > 0.97). Participants also showed good treatment engagement and satisfaction, with 43.0% of participants (46/107) fully completing the intervention during the course of the study and 96.3% (79/82) indicating that the intervention was worth their time.

Conclusions:

Prior 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 prior research. We discuss several possible interpretations of this finding (e.g., 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. Clinical Trial: ClinicalTrials.gov NCT05145582