Internet-delivered cognitive behavioural therapy

Heather D. Hadjistavropoulos, Hugh C. McCall, and Jill A. B. Price, walk us through internet-delivered cognitive behavioral therapy tailored to public safety personnel

Public safety personnel (PSP) are first responders and others who ensure the safety of citizens. Canadian PSP report high rates of mental health disorders and face unique treatment barriers, such as limited time, geographical location, and stigma. Internet-delivered cognitive behavioral therapy (ICBT) is a private and convenient mental health treatment that can be accessed anytime and virtually anywhere.

Specifically, clients are provided with treatment strategies in an online course with or without therapist support. Therapist support is typically offered via secure, brief, weekly messages and/or phone calls that are designed to complement, rather than replace, online treatment materials. Hundreds of randomized controlled trials show that ICBT is effective for treating symptoms of anxiety, depression, posttraumatic stress, and more.

Treating many mental health concerns

To improve PSP’s access to mental health treatment, the Canadian Government funded the development of a clinical research unit called PSPNET, which conducted stakeholder interviews and focus groups to tailor previously established, evidence-based ICBT courses for Canadian PSP and continues to use client feedback to tailor its ICBT courses further. ⁽¹⁾ PSPNET first offered therapist-guided ICBT designed to treat a wide range of mental health concerns ⁽²⁾ and later added therapist-guided ICBT designed specifically to treat PTSD symptoms. ⁽³⁾

Subsequently, PSPNET offered self-guided ICBT for various mental health concerns to PSP and a similar course for spouses and significant others of PSP. PSPNET Families was then created through a collaboration with the Family Matters Research Group at Queen’s University and the Child Trauma Research Centre at the University of Regina to provide information and support to PSP families as a complement to PSPNET. Courses are available in English and French.

Each course includes five core lessons that teach clients about:

1. The nature of their symptoms and the cognitive behavioral approach to treatment.
2. Skills for detecting and changing unhelpful thoughts.
3. Skills for managing common physical symptoms of psychological problems.
4. Skills for engaging in more helpful behaviors and,
5. Strategies for staying well in the future.

Each lesson includes text, diagrams, case stories, suggested homework assignments, audio, and video.

Additional resources have also been developed to provide support with anger, alcohol problems, assertiveness, communication skills, cultural awareness, enhancing relationships, grief, health anxiety, information for families, managing unhelpful beliefs, motivation, pain, problem-solving and worry, PTSD, risk calculation, self-care, sleep problems, supporting colleagues, and workplace accommodations.

Internet-delivered cognitive behavioral therapy research

As of December 2023, 1,041 clients have enrolled in PSPNET’s therapist- guided ICBT, 489 in self-guided ICBT, and 174 in self-guided ICBT for spouses and significant others. Some courses have been available for longer than others, and enrollment has been similar across PSP courses since they have all been operational.

PSP from all sectors have enrolled with roughly equal representation of men and women. Most clients report clinically significant symptoms of one or more mental health disorders, while approximately 23% enroll in an effort to manage minimal or mild symptoms proactively. Most clients learn of PSPNET via work-related sources.

PSPNET’s peer-reviewed research has demonstrated that clients with clinically significant symptoms in either therapist-guided course report significant reductions in symptoms of depression and anxiety and moderate reductions in PTSD symptoms. (2,3) Clients also report high treatment satisfaction, with 99% of clients indicating that PSPNET was worth their time and that they would feel confident recommending PSPNET to a friend.

Client feedback indicates that PSP appreciate several aspects of PSPNET, including the format, content, accessibility, additional resources, examples, and therapist guidance. Clients also note that ICBT helps them manage various work-related stressors, including potentially psychologically traumatic events, demanding or combative individuals, and PTSD symptoms.

PSPNET has established agreements to deliver therapist-guided ICBT in five of 13 provinces and territories (Ontario, Quebec, New Brunswick, Nova Scotia, and Prince Edward Island), representing 70% of the Canadian population, and offers self-guided ICBT to PSP and their spouses or significant others in all provinces and territories. PSPNET has distributed promotional materials over 2,300 times to various PSP organizations across the country.

Federal funding for PSPNET is secured until 2028. Factors that facilitate the implementation of PSPNET include relationships with PSP organizations and leaders who support mental health initiatives. A key barrier to implementation is the challenge of promoting PSPNET nationally to a narrow segment of the population via a multitude of decentralized PSP organizations.

Delivering ICBT to public safety personnel

Initial outcomes of PSPNET’s research show progress in reaching and effectively delivering ICBT to Canadian PSP. Research is currently underway to:

1. Understand the role of case stories in ICBT.
2. Understand the outcomes of self-guided ICBT for PSP and their spouses or significant others.
3. Explore the impact of ICBT on PSP leaders and,
4. Look into new directions for PSPNET as identified by a research advisory group comprised of Indigenous PSP.

Future research is needed on:

1. PSP outreach and recruitment.
2. Ways to address PSP concerns with digital mental health interventions.
3. How to effectively highlight how digital mental health interventions can complement other care, including face-to-face therapy and medication and,
4. Whether ICBT outcomes found in Canada generalize to PSP in other countries.

For more information about PSPNET’s peer-reviewed academic research, please see the sample articles below or visit https://www.pspnet.ca/en/research-studies.

References

1. Beahm, J. D., McCall, H. C., Carleton, R. N., Titov, N., Dear, B., & Hadjistavropoulos, H. D. (2021).
   Insights into internet-delivered cognitive behavioural therapy for public safety personnel: Exploration of client experiences during and after treatment. Internet Interventions, 26, 100481.
   • https://doi.org/10.1016/j.invent.2021.100481
2. Hadjistavropoulos, H. D., McCall, H. C., Thiessen, D. L., Huang, Z., Carleton, R. N., Dear, B. F., & Titov, N. (2021). Initial outcomes of transdiagnostic internet-delivered cognitive behavioral therapy tailored for public safety personnel: A longitudinal observational study. Journal of Medical Internet Research, 23(5), e27610.
   • http://dx.doi.org/10.2196/27610
3. McCall, H. C., Dear, B. F., Landry, C. A., Beahm, J. D., Gregory, J., Titov, N., Carleton, R. N., & Hadjistavropoulos, H. D. (2023). Internet-delivered cognitive behavioural therapy for symptoms of PTSD among public safety personnel: Initial outcomes of an open cohort preference trial of transdiagnostic and disorder- specific therapy. Internet Interventions, 33, 100656.
   • https://doi.org/10.1016/j.invent.2023.100656

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