Lab

 

Results of Former Student Research Studies


  • Joelle Soucy (2020), Doctoral Dissertation Results

    Online motivational interviewing for enhancing internet-delivered cognitive behaviour therapy: A randomized controlled trial

    • Background: Despite the fact that internet-delivered cognitive behaviour therapy (iCBT) can be used to effectively reduce symptoms of anxiety and depression, not all clients benefit from treatment. Opportunities exist to further enhance treatment outcomes in order to maximize the impact of iCBT. Motivational Interviewing (MI) is a clinical tool used by therapists to help facilitate clients' motivation to change. Integrating MI and face-to-face therapy in the treatment of anxiety has been shown to result in better treatment response and completion relative to face-to-face therapy alone. Therefore, there is a possibility that combining iCBT with online MI can result in similar outcomes. This investigation sought to first develop a brief, interactive online MI pre-treatment that was designed to increase motivation to engage in iCBT for anxiety and depression. Once the protocol was developed and piloted, we examined the impact of the online MI pre-treatment on motivation levels, symptom change, and treatment engagement/completion.

      Methods: A total of 480 clients applying to iCBT were randomly assigned to first receive the MI pre-treatment or no pre-treatment. The online MI pre-treatment consisted of a single lesson that comprised of videos, exercises, and feedback designed to increase intrinsic motivation to engage in iCBT. All clients then participated in an 8-week transdiagnostic iCBT program for anxiety and/or depression that consisted of 5 lessons aimed at providing psychoeducation and coping techniques for managing symptoms of anxiety and depression.

      Results: Contrary to prediction, little evidence of using online MI to further improve iCBT outcomes for anxiety and depression was found in the study. Engagement in iCBT was high across groups, with clients completing the same number of lessons and logging into the program a comparable number of times. Clients in both groups also reported high levels of motivation both prior to and following the MI period. Similarly, across groups, clients reported large reductions in anxiety and depression from pre- to post-treatment. During the 6-month follow-up, cliens in the iCBT only group continued to report small reductions in symptoms of anxiety, whereas clients in the MI plus iCBT group did not continue making improvements. The addition of MI to iCBT was also associated with minor increases in symptoms of depression during follow-up, wheras symptom improvements were maintained for clients in the iCBT only group.

      Conclusions: Results from this study suggest that online MI may not enhance client outcomes when motivation at pre-treatment is high. In some instances, online MI may also prevent further treatment progress, especially among individuals with high motivation to engage in treatment. Moving forward, it will be important to determine if specific client populations benefit more from online MI.

  • Hugh McCall (2020), Masters Thesis Results

    Does persuasive design predict efficacy in unguided ICBT? A meta-regression analysis

    • Background: Internet-delivered cognitive behavioural therapy (ICBT) is an innovative treatment for common mental health problems like depression and anxiety. It is similarly efficacious to face-to-face therapy when it is offered with therapist support by phone or secure email. It is not as efficacious when it is offered in a purely self-guided format, but it is easier to implement on a large scale. Various research groups have suggested that persuasive design - designing an intervention to be more engaging and stimulating for users - can help improve the efficacy of ICBT and other digital interventions for health and mental health problems. The objective of this study was to explore the relationship between persuasive design elements and efficacy among previously published trials of unguided ICBT for depression and anxiety.

      Methods: A systematic review of five databases was conducted to identify randomized controlled trials of unguided ICBT for depression and anxiety. Meta-analyses were conducted, and meta-regression was used to determine whether the effect size of each unguided ICBT program could be predicted by the number of persuasive design elements it included. Meta-regression was also used to explore changes in the efficacy and persuasive design of unguided ICBT over time.

      Results: A total of 41 studies (N = 10,301) were identified through the systematic search. Meta-analyses revealed a small to moderate weighted mean effect size (Hedges' g = 0.29) for unguided ICBT for depression and a moderate effect size (Hedges' g = 0.48) for unguided ICBT for anxiety. The results of the meta-regressions showed that the number of persuasive design elements identified in each intervention predicted the efficacy of ICBT for depression but not ICBT for anxiety. Additional meta-regressions showed that year of study did not predict the efficacy of each intervention or the number of persuasive design elements each intervention included.

      Conclusions: The results suggest that more persuasively designed ICBT interventions are more efficacious, at least for treating symptoms of depression. There was no evidence that efficacy or persuasive design has increased over time in unguided ICBT for depression and anxiety. However, further research will be required to clarify the role of persuasive design in ICBT; in particular, experimental research comparing versions an ICBT intervention with and without specific persuasive design elements and qualitative research exploring how clients experience persuasive design elements would help advance this literature.

  • Angelo Sison (2020), Honours Thesis Results

    Perceptions on internet-delivered cognitive behaviour therapy among public safety personnel

    • High rates of mental health disorders are prevalent among public safety personnel (PSP). To inform the implementation Internet-delivered Cognitive Behaviour Therapy (ICBT) with PSP, this study sought to understand perceptions of ICBT. Participants (n=132) from various PSP sectors in Saskatchewan were randomly assigned to receive a poster or poster and client story, and then completed an online survey assessing perceptions of ICBT. PSP had relativity positive perceptions of ICBT with positive ratings in the Credibility and Expectancy Questionnaire and Treatment Adherence and Acceptability Scale. Data confirmed that 93% of participants would access ICBT if they needed help with mental health concerns. Furthermore, ICBT with therapist support was ranked second out of 13 treatment options. Female participants found ICBT to be more credible than male participants. There were no differences in perceptions of ICBT between conditions (e.g., poster vs. poster with story). This study suggests that perceptions of ICBT among PSP will not likey be a barrier to implementations of ICBT for PSP within Canada.

  • Carly Chadwick (2020), Honours Thesis Results

    Pre-treatment Change in Internet-Delivered Alcohol Use Disorder Treatment

    • Alcohol misuse is a common mental disorder that can have devastating effects on an individual's physical and mental health. Internet-delivered cognitive behaviour therapy (ICBT) may serve as a promising option for some clients as it minimizes concerns about the stigma surrounding seeking treatment. Previous studies in alcohol treatment literature address a phenomenon named Assessment Reactivity (AR) which suggests that assessment interviews are predictive of significant changes in pre-treatment drinking. This may be of clinical importance as early abstinence from alcohol has been significantly associated with longer periods of continuous abstinence. The primary of this study was to explore pre-treatment change by experimentally manipulating assessment in an ICBT program for alcohol misuse. 87 clients were randomly assigned to receive an assessment interview or no assessment interview prior to beginning treatment. It was hypothesized that clients who received an assessment interview would experience greater reductions in alcohol consumption and depression, as well as increased motivation to improve their drinking behaviours. Results indicated that there were no significant differences in drinking behaviours between groups at pre-treatment. However, significant reductions in alcohol consumption were observed amongst both groups, suggesting that factors other than an assessment interview may contribute to client's willingness to improve their drinking behaviours. No significant differences in motivation to change or depressive symptoms were observed between groups, although, both groups experienced a significant increase in motivation and decrease in depressive symptoms over time. The results have implications for the delivery of ICBT in routine care.

  • Vanessa Peynenburg (2019), Masters Thesis Results

    Perceptions of and preferences for internet-delivered cognitive behaviour therapy among post-secondary students

    • Background: Anxiety and depression are prevalent mental health concerns experienced by post-secondary students. Rates of help-seeking are often low in this population, and students face several barriers to accessing psychological treatment. Internet-delivered cognitive behaviour therapy (ICBT) is an effective alternative to face-to-face therapy that addresses these barriers in adult populations with some evidence showing ICBT can also be effective with students. Additional research is necessary to identify students perceptions of and preferences for ICBT to assist with future implementation efforts in student populations.

      Methods: 314 Canadian post-secondary students completed an online survey and completed questionnaires about their symptoms of depression, anxiety, alcohol and drug use, and medical service utilization over the last 12 months. Students rated the acceptability and credibility of three treatment options (ICBT, face-to-face therapy, and medication) for the treatment of anxiety and depression. They also rated the utility of different kinds of content to be included in an ICBT course.

      Results: The three treatment options were rated as moderately acceptable and credible. Students expressed a preference for face-to-face services (44.6%), followed by medication (31.9%), and finally ICBT (23.5%). ICBT became more preferable once students would have to wait to receive face-to-face therapy. Students who were female and had less severe symptoms of depression had more positive perceptions of the use of ICBT in the treatment of anxiety and depression.

      Conclusions: While many students expressed a preference for face-to-face therapy or medication over ICBT, a substantial number preferred ICBT. Students often have to wait to receive face-to-face therapy, so ICBT may also be more desirable in these circumstances. Implementation trials in student populations are necessary to identify barriers to implementation efforts.

  • Luke Schneider (2019), Doctoral Dissertation Results

    Efficacy of Internet-delivered cognitive behavioural therapy following an acute coronary event: A randomized controlled trial

    • Background: Depression and anxiety are common after a heart attack or other acute cardiac event, however, evidence-based mental health interventions are not routinely available in cardiac rehabilitation programs.

      Purpose: The focus of this study was to explore the effectiveness and acceptability of the Cardiac Wellbeing Course: an Internet-delivered cognitive behavioural therapy program to help survivors of cardiac events manage depression and anxiety.

      Method: The Cardiac Wellbeing Course was offered between August 2016 to April 2018 to Canadians who recently experienced a cardiac event (heart attack or unstable angina) in the last two years. A total of 25 participants were enrolled in the course and their levels of depression, anxiety, physical activity, and quality of life were compared to 28 participants who did not receive the course.

      Results: The findings of the study were favourable, such that large and statistically significant improvements in depression and anxiety were observed among participants who received the course. A rise in physical activity levels and quality of life was also observed among participants who received the course. Satisfaction with the course was high and a majority of participants (92%) completed the course.

      Conclusion: The results of this study highlight the potential of the Cardiac Wellbeing Course to help people who have experienced an acute cardiac event to manage depression and anxiety. Future research should look at evaluating the Cardiac Wellbeing Course in a larger sample, preferably in a cardiac rehabilitation setting.

  • Cynthia Beck (2019), Honours Thesis Results

    Mixed-method Evaluation of an Online Motivational Interviewing Intervention as a Potential Adjunct to Internet-delivered Cognitive Behaviour Therapy: Immediate Benefits and User Feedback

    • Background: While Internet-delivered cognitive behaviour therapy (ICBT) can effectively reduce anxiety and depression, not all clients benefit equally from treatment. Motivational Interviewing (MI) can result in behaviour change and, coupled with face-to-face therapy, can lead to enhanced outcomes; however, little research has examined MI as an adjunct to ICBT.

      Purpose: The aim of the current study was to evaluate user feedback on a newly developed online MI intervention and to explore the immediate impact of the MI lesson on motivation for change.

      Method: Two samples of participants, one with ICBT experience (n = 21) and one without ICBT experience (n = 20), worked through the exercises and watched the videos in the online MI intervention. Pre and post lesson participants reviewed and evaluated the online MI intervention.

      Results: Following MI, both samples of participants reported a statistically significant increase in ability to reduce symptoms (p < .0001) and an increase that approached statistical significance in perceived importance of reducing symptoms (p < .052). Furthermore, after completing the MI intervention, participants reported increased confidence in recommending the lesson to a friend (p < .002) and increased belief that the lesson would be successful in helping someone to prepare for ICBT (p < .0001). Examination of ratings of the MI intervention and open-ended comments were positive, with participants recommending to expand the exercises and content to assist with self-reflection.

      Conclusion: The current research provides evidence for the face validity of the MI intervention and sets the foundation for research on MI as a potential adjunct to ICBT for improving motivation prior to active treatment.

  • Giuliano La Posta (2019), Honours Thesis Results

    Internet-delivered cognitive behaviour therapy for chronic health conditions with and without guidance: exploring changes in benefit finding

    • Background: Internet-delivered cognitive-behaviour therapy (ICBT) is effective in reducing symptoms of anxiety and depression when targeted to specific groups with chronic health conditions (e.g., pain, cancer, cardiac, spinal cord injury). Nevertheless, there are some gaps in the literature regarding:
      - the efficacy of ICBT programs that are transdiagnostic and address multiple chronic health conditions;
      whether outcomes are improved when offered with support of team of providers compared to when ICBT is self-directed; and whether ICBT is associated with improvements in benefit finding.

      Purpose: To examine the efficacy of self-directed versus team-directed transdiagnostic ICBT Chronic Health Conditions course in improving benefit finding, as well as anxiety and depression among individuals with diverse chronic health conditions.

      Method: Semi-structured interviews were conducted with patients (n = 8). The interviews were audio-recorded, transcribed verbatim, and examined by means of thematic analysis. Emerging themes were summarised and explored.

      Results: There were no between group differences or interactions. For both self-directed and team-directed groups, significant time effects were present for anxiety (Cohen's d=0.83), depression (Cohen's d=0.69), distress (Cohen's d=0.65) and disability (Cohen's d=0.18). Benefit finding did not change significantly over time, although a small effect was seen when examining Cohen's d=.30.

      Conclusions: The transdiagnostic ICBT Chronic Conditions course when either self-directed or team-directed shows promise in reducing symptoms of anxiety and depression, distress, and disability over time. Low sample size and completion rates of measures limited conclusions and thus data collection continues in order to allow for analysis of the research questions.

  • Danielle Earis (2018), Honours Thesis Results

    Patient perspectives of Internet-delivered cognitive behavioural therapy for psychosocial issues post-spinal cord injury

    • Background: Individuals with a spinal cord injury (SCI) confront numerous physical and psychological adjustments. Many report clinically significant depression and anxiety disorders post-SCI; thus, attention to psychological distress is crucial. Cognitive behaviour therapy (CBT) has been shown to be effective in reducing anxiety and depression. Despite the availability of treatment, there are barriers such as accessibility, cost, and transport to appointments. Internet-delivered CBT (ICBT) can increase access to psychological services.

      Purpose: The purpose of this study is (a) to evaluate patient perspectives on the acceptability of an eight-week guided ICBT course (Chronic Conditions Course for Persons with SCI) and (b) to gain understanding of SCI experiences that may impact ICBT.

      Method: Semi-structured interviews were conducted with patients (n = 8). The interviews were audio-recorded, transcribed verbatim, and examined by means of thematic analysis. Emerging themes were summarised and explored.

      Results: Patient comments were organized into three broad categories: SCI experience, ICBT experience, and ICBT outcomes. Interviews provided insight into SCI outcomes and support ICBT acceptability with identified strengths (e.g., accessibility, flexibility, guided support). Suggested changes included improved breadth of case stories, course timeframe, and more support from the guide.

      Conclusions: This research provides a better understanding of ICBT as an acceptable treatment for psychosocial issues post-SCI. Patient feedback provided valuable information for improving and tailoring the ICBT course to the SCI population and in understanding SCI experiences.

  • Michael Edmonds (2018), Masters Thesis Results

    Can patient characteristics at intake predict patient response to therapist-assisted transdiagnostic internet-delivered cognitive behavioural therapy?

    • Background: The Wellbeing Course is a transdiagnostic online program designed to treat anxiety and depression. The five lesson course teaches patients skills for managing anxiety and depression based on principals of cognitive behavioural therapy and includes weekly therapist contact via telephone or secure message. The program has been shown to reduce symptoms in patients overall and, on average, patients report a high degree of satisfaction. Although the program is effective overall, only 75% of patients complete the program and only 50% of patients complete the program and report a reliable reduction in either anxiety or depression. The aim of this research was therefore to examine patient outcomes further and look for relationships with patient characteristics that might allow us to predict which patients are most likely to benefit from online therapy.

      Method: Patient case records from 1201 patients who enrolled in the Wellbeing Course were compiled and analyzed to look for relationships between patient characteristics at intake and patient outcomes. Autoregressive latent trajectory modeling was used to look for relationships between patient characteristics and patient symptom change over time. Classification trees were created to predict treatment dropout and overall treatment success.

      Results: Younger people were found to be at greater risk of dropping out from online therapy. Higher initial severity of anxiety or depression was related to greater improvement over the course of therapy. Age and relationship status were related to anxiety symptom trajectories, while education and initial psychological distress and disability scores were related to depressive symptom trajectories.

      Conclusions: Although some groups were identified as being at higher risk of dropout or not improving, none of these effects were strong enough to suggest that exclusion criteria for the program should be changed. Instead, future research should look at how the program can be modified to improve outcomes for at-risk groups.

  • Dale Dirkse (2018), Doctoral Dissertation Results

    A randomized trial of technician-guided and self-guided ICBT: Wellbeing After Cancer

    • Background: Internet-delivered cognitive behviour therapy (ICBT) has only recently been used to treat anxiety and depression within a cancer population but has demonstrated promising results. The focus of this study was to assess the effectiveness of two forms of non-therapist assisted ICBT for cancer survivors with symptoms of depression and anxiety in a larger sample. The Wellbeing After Cancer course was offered to Canadians from August 2016 to May 2017. In this study we were interested in the impact of Wellbeing After Cancer on symptoms of depression, anxiety, fear of cancer recurrence, and overall quality of life after the course.

      Method: Wellbeing After Cancer included education about depression and anxiety, strategies to identify and modify unhelpful thoughts, manage physical symptoms of anxiety and depression, overcome avoidance, cope with uncertainty, and maintain improvements after treatment. The course was administered to a randomized group of cancer survivors; 42 individuals who were guided by a technician and 44 individuals who independently progressed through the course.

      Results: The findings were very encouraging. The results of this study showed that participants' symptoms of anxiety and depression improved significantly from pre to post treatment. Participants also reported strong satisfaction ratings with the program. Furthermore, there was no difference in anxiety or depression symptom improvement or overall satisfaction between those who were guided by a technician or those who independently progressed through the course. Participants also improved on secondary measures of fear of cancer recurrence and quality of life.

      Conclusions: Results from this study demonstrate the ability to provide effective treatment to Canadian cancer survivors with symptoms of anxiety and depression from one centralized site. Providing ICBT has the potential to change the mental health care landscape for cancer survivors across Canada. Future research should focus on best practices for implementation of ICBT.

  • Victoria Owens (2017), Masters Thesis Results

    Increasing favourable expectations of therapist-assisted Internet-delivered cognitive behaviour therapy: Importance of testimonial-based versus statistically-based information

    • Background: Transdiagnostic ICBT has effectively reduced symptoms of depression, generalized anxiety, social phobia, and panic. The current study examined whether transdiagnostic ICBT can effectively reduce symptoms of health anxiety, characterized by excessive worry about one's health and fear that one will acquire an illness, often resulting in frequent medical consultations at a significant economic cost. Further, the impact of level of therapist support (therapist-initiated vs. client-initiated) was investigated.

      Method: 96 clients participating in the Wellbeing Course, an 8-week transdiagnostic ICBT program, with elevated health anxiety symptomatology (>15 on the Short Health Anxiety Inventory [SHAI]) were randomly assigned to a therapist-initiated (n = 52; consistent, weekly messages from therapist) or client-initiated (n = 44; message received from therapist only when client initiates communication) contact condition.

      Results: Health anxiety symptoms decreased significantly from pre-treatment to post-treatment (Χ2 = 25.05, p < 0.001), lending support to the efficacy of transdiagnostic ICBT in the treatment of health anxiety. Pertinently, the level of therapist support (therapist-initiated vs. client-initiated) did not appear to impact symptom reduction.

      Conclusions: The level of therapist support did not directly impact symptom reduction, yet consistent and weekly messages from a therapist did promote more favourable treatment engagement when compared to optional therapist communication (4.48 vs. 3.86 lessons completed; 4.21 vs. 1.77 messages sent) and was associated with higher treatment completion rates (76.9% vs. 54.5%). Future research is warranted to disentangle the role of therapist contact on symptom reduction and treatment engagement.

  • Kristen Klassen (2017), Honours Thesis Results

    Analyzing therapist emails in Internet-delivered cognitive behavioural therapy

    • Background: Internet-delivered cognitive behaviour therapy (ICBT) arose as a response to barriers associated with face-to-face therapy and has shown to be efficacious especially when offered with therapist assistance. Despite the importance of therapist-assistance to ICBT, there has been minimal research on this topic. No scales have been developed to specifically assess presence of therapist behaviours during ICBT.

      Purpose: The purpose of this study was to: 1) develop an ICBT rating scale that captures the main elements of the therapist/client interactions in secure email messages, and 2) evaluate a random selection of ICBT therapists using this scale to assess average ratings on therapist/client interactions during the course of ICBT.

      Method: The initial scale was developed based on past content analysis of therapist behaviours during ICBT. Five therapists trialed this initial measure and provided feedback on their experiences during a focus group. The measure was then revised and inter-rater reliability was established between three student raters. The scale was used to examine emails that were sent to 50 patients who completed an 8-week transdiagnostic ICBT course for depression and anxiety (Wellbeing Course).

      Results: Review of ratings suggested that most therapists were providing high quality emails. Multiple significant correlations were found which indicated that clients who sent more emails to their therapist were receiving better quality emails, that therapists who were solely focused on delivering ICBT, and therapists with a psychology background obtained higher ratings on the scale.

      Conclusions: Numerous directions for future research exist, such as exploring the applicability of the scale to other ICBT units.

  • Catherine Couture (2017), Honours Thesis Results

    Client correspondence in Internet-delivered cognitive behaviour therapy: An examination into client communication with therapists and symptom improvement

    • Background: Internet-delivered cognitive behavioral therapy (ICBT) is an efficacious treatment for anxiety and depression. Most ICBT programs include therapist assistance in the form of secure online messaging; however, a high degree of variability has been found in the content of client and therapist correspondence. Recent research conducted by Svartvatten et al. (2015) found that client statements suggesting alliance bolstering and text expressing a positive change in mood after the implementation of a suggested skill or exercise appear to correlate with greater symptom improvement.

      Purpose: The current study sought to examine: (1) if previously identified themes in client communication with their Internet therapist (Svartvatten et al., 2015) would replicate in a transdiagnostic ICBT program for depression and anxiety; and (2) if these themes correlated with symptom improvement and treatment completion.

      Method: The present study used data from 80 randomly selected patients from a previously published trial of ICBT for depression and or anxiety. Client emails (on average 5.69 per client) were examined for the presence of 10 themes reported by Svartvatten et al. (2015).

      Results: Statistically significant differences were found in the frequency of all themes between the two studies. Further, in the current study, greater frequency of statements classified as maladaptive repetitive thinking and problems with treatment content correlated with smaller improvements in symptoms of anxiety from pre- to post-treatment.

      Conclusions: This research provides a better understanding of the parameters of client communication and information for future therapists regarding the content of clients' correspondence in ICBT.

  • Joelle Soucy (2016), Masters Thesis Results

    Treatment acceptability and preference among primary care patients experiencing severe health anxiety: The role of Internet-delivered cognitive behaviour therapy

    • Background: Although cognitive behaviour therapy (CBT) is a helpful intervention for health anxiety, many individuals are unable to receive this treatment because of difficulties accessing it. Internet-delivered cognitive behaviour therapy (ICBT) is a new and accessible treatment that has been shown to successfully manage symptoms of health anxiety; however, it remains unclear whether ICBT would be used if in fact offered to individuals with health anxiety. The goal of this study was to see how patients perceive ICBT compared to other existing treatments for health anxiety.

      Method: Primary care patients who were experiencing symptoms of health anxiety were presented with descriptions of three different treatments for health anxiety. The treatments were medication, CBT, and ICBT. Perceptions of the treatments were assessed following the presentation of each treatment description. Participants were also asked to rank the three treatments based on the likelihood wanting to receive that intervention for health anxiety.

      Results: Results indicated that all three treatments were similarly rated as moderately acceptable. The highest preference ranks were for CBT and medication. That said, a small sample of participants ranked ICBT as the preferred intervention.

      Conclusions: While CBT and medication were the preferred treatments for health anxiety, the generally favourable perceptions of ICBT found in the study suggest that it would likely be considered a desirable treatment option by a number of potential users.

  • Christina Drost (2016), Doctoral Dissertation Results

    Examination of therapist behaviours in therapist-assisted Internet-delivered cognitive behavioural therapy for generalized anxiety disorder

    • Background: Therapist-Assisted Internet-Delivered Cognitive Behavioural Therapy (TAICBT) for the treatment of generalized anxiety disorder (GAD) is found to be efficacious. The nature of therapist-assistance, however, is not well understood. This research aimed to enhance understanding of the nature of therapist-assistance by examining: 1) therapist behaviours in emails sent to clients treated with TAICBT for GAD and the extent to which these qualitatively overlap with behaviours described in face-to-face therapy; and 2) if therapist behaviours in the current study (using a larger and more diverse therapist sample) compared to therapist behaviours reported in a past study of TAICBT for GAD (Paxling et al., 2013). The relationship between therapist behaviours and treatment outcome, treatment satisfaction, and therapeutic alliance was also examined.

      Method: Data was collected as part of an open trial investigating a 12 module TAICBT program delivered to 107 clients presenting with symptoms of GAD. TAICBT was provided by 21 registered therapists or 31 graduate students; therapist-assistance was delivered through secure e-mails. Anxiety was assessed before and after treatment.

      Results: Nineteen therapist behaviours were identified in the secure messages sent from therapist to patients. These behaviours qualitatively overlapped with therapist behaviours that are commonly observed in face-to-face therapy. Alliance Bolstering was the most frequently coded therapist behaviour. Eight therapist behaviours were found that largely overlapped with behaviours reported in a past study of therapist behaviour in TAICBT (Paxling et al. 2013); however, the frequency of these behaviours varied substantially between studies. Correlational analyses suggested that therapists provided more frequent feedback on weekly mood ratings and self-report questionnaires when clients demonstrated less improvement on anxiety measures. Analyses also suggested that therapists were more likely to provide Psychoeducation and Task Prompting when clients demonstrated less improvement on anxiety. Of note, Repair of Potential Alliance Ruptures was significantly and positively associated with higher client ratings of therapeutic alliance. Therapist e-mails received during the first two modules by treatment completers contained significantly more instances of statements coded as Course Procedure and Goal Setting than e-mails received during the first two modules by treatment non-completers.

      Conclusions: Overall, preliminary evidence was found to suggest that: 1) there is both overlap and variability in terms of therapist-assistance provided in face-to-face therapy and across different TAICBT programs, and 2) the relationship between therapist behaviours, treatment outcome, therapeutic alliance, and treatment satisfaction is complex and needs to be examined further. The findings shed substantial light on the nature of therapist-assistance in TAICBT.

  • Victoria Owens (2015), Honours Thesis Results

    Increasing favourable expectations of therapist-assisted Internet-delivered cognitive behaviour therapy: Importance of testimonial-based versus statistically-based information

    • Background: Internet-delivered Cognitive Behaviour Therapy (ICBT) is an effective method of treating anxiety and depression. Nevertheless, many individuals have low expectations about this treatment given that it is novel. This presents a problem, as higher expectations of treatment have been linked to more favourable treatment outcomes.

      Objective: The aim of the present study was to determine if an educational video about ICBT is an effective way to increase individuals' views of this treatment.

      Methods: Participants were assigned to view an educational video about ICBT containing testimonial-based (n = 44) or statistically-based information (n = 53). Questionnaires administered pre- and post-video were analyzed to assess for changes in attitudes towards ICBT, and to determine whether one video was more effective. Correlates between participant characteristics and views of ICBT were examined.

      Results: Perceptions of ICBT significantly improved post-video; however, the difference between the two video conditions was not significant. While participant characteristics (e.g., age, sex) were not correlated with views of ICBT, how participants rated the video were.

      Conclusion: Educational videos effectively increase expectations of ICBT, and the quality of information presented in the video is more important than the particular information presented.

      Practice Implications: In order to facilitate the greatest therapeutic benefit from an ICBT treatment program, it may be beneficial for clients to watch an educational video prior to the onset of treatment.

  • Lindsay Friesen (2015), Doctoral Dissertation Results

    A randomized controlled trial of Internet-delivered cognitive behaviour therapy for individuals with fibromyalgia

    • The focus of this study was to assess the efficacy of Internet-delivered cognitive behaviour therapy (ICBT) for individuals with fibromyalgia (FM) who experience difficulties with pain, depression and or anxiety. The Pain Course for Fibromyalgia was offered to Canadians from January 2014 to January 2015. In this study, we were interested in the impact of the Pain Course for Fibromyalgia on FM symptoms, pain, depression and/or anxiety, and improving overall quality of life after the course.

      The Pain Course for Fibromyalgia included topics of symptom identification, examining and challenging unhelpful thoughts, controlled breathing, pleasant activity scheduling, pacing, graded exposure, and relapse prevention. The course was administered to a randomized group of 30 individuals with FM and compared to a group of 30 individuals with FM who received standard care alone.

      The findings were very encouraging. The results of this study showed that symptoms of FM, anxiety, and depression improved significantly from pre to post treatment. Participants also rated the course as highly acceptable and identified several course strengths.
      Results from this study indicate to health professionals that ICBT is a viable avenue to improve the clinical management and the health status of individuals with FM.

  • Nicole Alberts (2014), Doctoral Dissertation Results

    Transdiagnostic Internet-delivered cognitive-behaviour therapy for recent cancer survivors: A feasibility trial and examination of clinician perspectives

    • This dissertation involved two studies. In Study 1, Wellbeing After Cancer was made available to cancer survivors in Saskatchewan from February 2013 to May 2014. The therapist-guided Internet delivered cognitive behaviour therapy (ICBT) program was based on the Wellbeing Course, which is a transdiagnotic ICBT program developed and tested by the eCentre Clinic in Australia. The Wellbeing Course was modified for recent cancer survivors who experience anxiety and/or depression. Eighteen individuals who completed primary cancer treatment within the past 18 months received CBT-based online lessons, homework assignments, once weekly contact from a therapist via e-mail or phone, and automated emails. Results of Study 1 showed that symptoms of anxiety and depression improved significantly from pre to post treatment. Participants also rated the program as highly acceptable and identified several program strengths.

      Study 2 examined the acceptability of Wellbeing After Cancer and ICBT more generally among clinicians currently working within cancer care in Saskatchewan. Ten clinicians viewed a brief online video and completed a telephone interview regarding their perceptions of the program. ICBT and the program were viewed as acceptable by clinicians, with most envisioning themselves referring clients to the program. Several program strengths as well as areas for improvement were identified. Approval from directors as well as clinician availability and time were seen as factors likely to influence training, delivery, and implementation.

      Together, the results of both studies indicate to researchers, clinicians, and healthcare providers that ICBT is a viable avenue for offering mental health services to cancer survivors.

  • Dale Dirkse (2014), Masters Thesis Results

    Linguistic analysis of communication in a therapist-assisted Internet-based cognitive behaviour therapy program for individuals with generalized anxiety disorder

    • Background: Therapist-assisted Internet-based Cognitive Behaviour Therapy (TAICBT) is an effective method of treating generalized anxiety disorder (GAD). In addition to the cognitive and behavioural elements found within face-to-face Cognitive Behaviour Therapy (CBT), TAICBT includes elements of expressive writing, through email communication with a therapist. Expressive writing has been associated with positive outcomes; furthermore, certain linguistic dimensions have been associated with psychological and physical health benefits.

      Objective: The purpose of the present study was to understand how clients with symptoms of GAD are communicating with their online therapists, and explore whether their communication style was related to successful participation.

      Method: Written communication submitted to therapists by 107 adult clients with symptoms of GAD during the course of a 12 module TAICBT program was analyzed along with symptom measures of anxiety, worry, and adjustment. Clients' written communication was analyzed by a linguistic software (Linguistic Inquiry and Word Count Software) which categories words into several categories (e.g., negative emotion words, insight words).

      Results: Negative emotion words, anxiety words, insight words, and past tense words were associated with symptom measures of anxiety and worry and they changed over time. A higher number of negative emotion and anxiety words differentiated clients that dropped out of the program earlier versus those that dropped later, and were associated with reduced therapeutic alliance and treatment satisfaction.

      Discussion: Results suggest it may be useful to pay attention to linguistic categories as they can be used as indicators of client progress and well-being. Findings improve our understanding of the client experience of participating in TAICBT, with some linguistic trends being consistent with what clinicians would expect to see from a client's successful participation in therapy. Other findings offer new insight into communication that may be particularly relevant to clients with symptoms of GAD. Findings confirm that clients are engaging with the program and opening up to their therapists.

  • Chantalle M. Fuchs (2014), Honours Thesis Results

    Development and initial evaluation of a psychoeducational resource to facilitate social support for cancer survivors

    • Most cancer survivors appear to adjust well to having a cancer diagnosis over time, but research has shown that some cancer survivors experience clinical levels of anxiety and depression. In addition, it has been shown that social support often decreases after cancer treatment.

      Wellbeing After Cancer (WAC) is an online cognitive behavioural therapy program designed to treat anxiety and depression among cancer survivors. Feedback from program participants suggested that information and strategies regarding social support would be beneficial.

      To date, no known online educational resource has been developed to address social support among cancer survivors and family members. The objectives of the study were to:

      1. 1) Develop a supplementary psychoeducational resource focused on social support to accompany the WAC online program. Information discussed on the resource included fatigue, concentration and memory changes, pain, swelling, nervous system changes, low moods, anxious feelings, worries about cancer returning, feeling alone, benefits of social support, communication strategies, styles of communication, and sources of support.

      2. 2) Conduct a preliminary evaluation of this resource. Assessing the face-validity of this resource is an important first step in adding educational materials to online programs like WAC.


      Survivors and family members reviewed the resource, rated different sections within the document, and responded to open-ended questions pertaining to the acceptability and helpfulness of the resource. Participants indicated that the resource was informative, applied to their personal relationships, enhance their understanding of what can occur after completing cancer treatment, and that the suggestions listed within the resource were feasible. All individual sections within the resource were deemed informative as well as accurate.

      The open-ended responses revealed areas for improvement such as integrating more specific examples and information on additional challenges faced by survivors. Additional challenges described by cancer survivors included feelings of anger and frustration, difficulties with eating, as well as sexual and intimate concerns.

      After minor changes are completed, the resource will be ready to be delivered to accompany the WAC online program. Future research could determine the effectiveness of the resource in improving relationships and social support among cancer survivors and their family members.

  • Shannon L. Jones (2014), Doctoral Dissertation Results

    GAD Online for Older Adults: A randomized controlled trial

    • 'GAD Online for Older Adults' was made available to adults in Saskatchewan aged 60 years and older from March 2012-November 2013. The therapist-assisted Internet delivered Cognitive Behaviour Therapy (ICBT) program was modified for older adults who experience generalized anxiety (e.g., worry about many topics, difficulty controlling worry). The ICBT program involved 7 interactive modules that included text, graphics, animations, audio, and video. Topics included: (a) education about general anxiety, (b) monitoring anxiety and worry, (c) relaxation techniques and enjoyable activities, (d) examining and challenging unhelpful thoughts, (e) worry reduction strategies, overcoming avoidance and worry behaviours, and (f) problem-solving and sleep hygiene. Forty-six older adults with generalized anxiety disorder or subclinical anxiety were randomized to receive ICBT or waited for treatment.

      The findings were very encouraging. General anxiety and depressive symptoms decreased more quickly for adults who received ICBT when compared to those who waited for treatment. Significant differences were also found between the two groups on measures of geriatric anxiety and depression, and on most quality of life scales. ICBT participants continued to improve during the four-week follow-up period - in fact, participants tended to improve the most on symptoms of worry and depression during the follow-up period.

      It was also found that ICBT participants who rated the credibility of treatment higher before starting ICBT, improved at a faster rate on a measure of anxiety. Completing more treatment modules, sending more e-mail to the therapist, and writing more to the therapist in the weekly Check-In page was predictive of lower anxiety scores at follow-up, whereas writing more to the therapist in e-mails and taking longer to complete ICBT was predictive of higher anxiety scores at follow-up.

      The final component of the study asked older adults about their experiences with 'GAD Online for Older Adults'. Numerous positive experiences and challenges were identified. Older adults valued being able to access therapy online, liked the convenience, felt that ICBT promoted insight, found the information educational and helpful, and they liked the easy-to-follow format of the program. Older adults appreciated having therapist support while using ICBT. Some participants noted that the content of the program did not always fully match their experiences or difficulties, and felt that there was too much content to cover in the time recommended. Narrative feedback from older adults who took part in this study will help to inform revisions of existing or future ICBT programs in this age group.

  • Nicole E. Pugh (2014), Doctoral Dissertation Results

    Maternal Depression Online: A preliminary study

    • Maternal Depression Online (MDO) was made available to Saskatchewan women from May 2012-Feburary 2014. The therapist-assisted Internet delivered Cognitive Behaviour Therapy program was designed specifically for the treatment of postpartum depression. MDO consisted of 7 interactive modules including text, graphics, animation, audio and video, and covered:(a) psychoeducation on maternal depression, (b) activity planning, (c) relaxation, (d) thinking styles, (e) cognitive restructuring, (f) problem solving, and (g) relapse prevention. Using a randomized control design, 50 women with mild to moderate postpartum depression either received MDO or waited for treatment.


      Results were very promising. Symptoms of postpartum depression decreased more quickly for women participating in MDO when compared to those who waited for treatment. These results were maintained at four-week follow-up, providing preliminary support of the durability of the program. Participants who received MDO also demonstrated a reduction in symptoms of postnatal anxiety, general stress, and parental distress and an increase in quality of life when compared to participants who waited for the treatment. Participants reported high satisfaction with MDO and indicated that they enjoyed working with their Internet therapist. Discussion for future implementation of this program is underway.


  • Luke H. Schneider (2013), Masters Thesis Results

    Initial perceptions of Internet-based cognitive-behaviour therapy for chronic pain among potential users: Examining interest, perceived barriers, and strengths

    • Background:

      Chronic pain is an important area of study given that 15 to 18% of the Canadian population will develop a chronic pain condition during their lifetime. One difficulty in the self-management of chronic pain is the lack of resources available for those who suffer from this condition. Although preliminary research has demonstrated Internet Cognitive Behaviour Therapy (ICBT) for chronic pain to be a viable treatment option, potential users' initial perceptions towards this mode of delivery may pose a barrier for participation in such programs. The purpose of the study was threefold:

      To develop an ICBT perceptions questionnaire (ICBT-PQ) that captures the perceptions of potential users of the service

      To examine variables that may predict early perceptions of ICBT (e.g., age, sex, computer self-efficacy)

      To identify perceptions of what intervention features would be perceived by potential users as most desirable for ICBT

      Methods:

      Given the steps necessary to address the research questions, the overall project was divided into two studies. In study one, the ICBT-PQ was developed based on a comprehensive review of the literature and telephone interviews with 11 participants who had chronic pain. The preliminary version of the ICBT-PQ was then reviewed by researchers with ICBT experience and by a lay audience to ensure readability and acceptability.

      In study two, a total of 129 people with chronic pain completed a web-based survey consisting of a demographic questionnaire, the finalized ICBT-PQ, and measures of computer self-efficacy and computer anxiety. Participants were predominantly female (82%), Caucasian (90%), middle-aged (average age = 47), and had chronic pain for an average of 12 years.


      Results:

      Through the factor analysis, the ICBT-PQ items were grouped into two categories: statements of potential ICBT strengtdhs and statements of potential ICBT limitations.

      The majority of participants endorsed ICBT strength statements and disagreed with ICBT limitation statements.


      ICBT strength statements that participants most agreed with


      "ICBT is important for patients who have difficulty moving or getting around"

      "ICBT is important for patients who have a hard time attending appointments for various reasons"

      "ICBT is important for patients who live in rural areas"

      "People with a high school education could use ICBT"

      ICBT limitation statements that participants most disagreed with


      "If I used ICBT I would worry about the security of my personal information"

      "If I used ICBT I would worry about getting a computer virus"

      "ICBT is not necessary because there is already enough information available on chronic pain management on the Internet"

      "If I used ICBT I would worry about making a mistake using the computer"

      "Patients don't really need extra information on how to manage chronic pain"

      Regressions indicated that female participants and participants high in computer self-efficacy were likely to endorse statements of ICBT strengths and disagree with statements of ICBT limitations.

      Many participants indicated that they desired video content and group contact features in ICBT.

      Conclusion:

      Even though participants had no prior experience with ICBT, they generally had positive perceptions of ICBT such as accessibility and convenience. They did not perceive ICBT to have many negative limitations, such as computer concerns or concerns about the security of their personal information. The perceived strengths of ICBT outweighed the perceived limitations among study participants, which may indicate that ICBT may be well received if offered to Canadians with chronic pain.

      Females participants and those with high computer self-efficacy were more likely to perceive ICBT favorably. Participants felt that it would be positive to include multimedia and group contact features in the ICBT program. Future research, however, needs to investigate whether these features are necessary and or improve the efficacy of ICBT.

      Overall, the results of this study provide important information that could assist with future attempts to deliver ICBT to people with chronic pain.

      Thank you to everyone for their participation in this research. The reserch findings have been submitted and accepted for publication in the academic journal Pain Research and Management.


  • Melissa D. Kehler (2013), Doctoral Dissertation Results

    Emotional adjustment to multiple sclerosis

    • Study Purpose:

      The purpose of the current research was to study emotional adjustment to multiple sclerosis (MS) in a sample of Canadians.

      Background:

      Emotional adjustment to MS is most commonly studied by focusing on psychopathology symptoms, such as depression or anxiety. In the current study, emotional adjustment was measured as including both positive (i.e., quality of life, positive affect, satisfaction with life) and negative (i.e., depression and anxiety symptoms, negative affect) dimensions. To examine what factors contribute to emotional adjustment, two psychological models of emotional adjustment were evaluated and compared: Lazarus and Folkman's (1984) stress and coping model, and a model of Taylor's (1983) theory of cognitive adaptation

      1. Stress and Coping Model: This model consists of appraising a stressor, such as stressors associated with MS, and then selecting ways of coping with the stressor. In the current study, appraisals included primary appraisals (i.e., evaluating the harm, threat, or loss associated with a stressor) and secondary appraisals (i.e., evaluating how much control a person feels over the stressor, and how much of a challenge the stressor will be to overcome). Coping strategies in the current study included: (a) problem-solving and cognitive restructuring coping, (b) emotional and social coping, and (c) escape and avoidance coping.

      2. Theory of Cognitive Adaptation:
      3.  This model consists of optimistic beliefs as a base in working towards achieving the interrelated tasks of searching for benefits or positive appraisals about life after a stressor, attempting to gain a sense of mastery over one's life, and efforts toward increasing self-esteem.

      Study Findings:


      1. Data were collected from 431 Canadians with MS who completed questionnaires online or through the mail.

      2. For measures of emotional adjustment:
        1. Positive Adjustment
          1. Participants' satisfaction with life was similar to people with MS in other research; average scores were between "slightly dissatisfied" and "neutral".
          2. Participants' levels of positive affect were similar to other people with MS, but were lower than participants from a small non-medical Canadian sample.
          3. Participants' levels of different aspects of health-related quality of life were lower when compared to non-medical samples, but were similar to other people with MS for physical and psychological health-related quality of life

        1. Negative Adjustment
          1. Over one-third of study participants (37.5%) scored above the recommended clinical cut-off for depression symptoms and almost two-thirds of participants (59.6%) scored above the recommended clinical cut-off for anxiety symptoms. Depression scores in the current study were either similar to, or higher than, other MS research in Canada. Anxiety scores in the current study were higher than participants in other MS studies in Canada.
          2. Participants' levels of negative affect were similar to both another study of people with MS and to a small, non-medical Canadian sample.

      3. The Stress and Coping Model described above was able to be statistically tested for its contribution to predicting negative adjustment outcomes, but not positive adjustment outcomes. For negative adjustment outcomes, the model was mostly supported in its fit to the data. The strongest predictor of negative adjustment outcomes was the use of escape-avoidance coping strategies, as well as using primary appraisals of stress. Cognitive restructuring and problem-solving coping helped to mediate (i.e., explain some of the relationship) between appraisals and negative adjustment.

      4. The Theory of Cognitive Adaptation model described above was able to be statistically tested for its contribution to predicting both positive and negative adjustment outcomes. Optimism was tested by itself first, and it was found that optimism alone was a better predictor of lower negative adjustment outcomes than it was of higher positive adjustment outcomes. When the other variables were added to the model, including mastery, self-esteem, and benefit-finding, the results were that the model was mostly supported in its fit to the data for both of the adjustment outcomes. For positive adjustment outcomes, self-esteem was the greatest direct predictor, followed by having a sense of mastery, optimism, and a smaller relationship with benefit-finding. For negative adjustment outcomes, again the strongest predictors were lower self-esteem and a lower sense of mastery.

      5. Variables from the two models were also combined to determine whether a more comprehensive model would help to predict adjustment outcomes. Statistically, the models were not able to be tested.

      Usefulness of the Findings:


      1. This study provides useful information for clinicians who work with people with MS.

      2. High levels of depression symptoms and, in particular, anxiety symptoms were identified. Few participants in the current study were receiving psychological interventions (17%) or medication for psychological conditions (43%).

      3. It will be important to monitor, over time, both depression and anxiety symptoms in people with MS in order to identify people in need of treatment. Finding treatment options that are accessible, such as internet- or telephone-administered cognitive-behavioural therapy, may also be helpful.

      4. Coping strategies, particularly using escape-avoidance coping strategies, will also be useful to evaluate. Interventions to reduce reliance on escape-avoidance coping strategies may be helpful to improve emotional adjustment.

      5. The appraisal of stressors as being associated with harm, loss, and threats was also associated with poorer adjustment. Interventions targeting how people appraise stressors in their lives may be helpful.

      6. Enhancing optimism, self-esteem, mastery, and (to a lesser extent) benefit-finding would all contribute to improvements in positive adjustment outcomes. Enhancing self-esteem and mastery would also contribute to improving negative adjustment outcomes.

      Thank you to all respondents for your participation in this research. The next step is to inform other researchers and clinicians of the study findings.


  • Lindsay Friesen (2012), Master's Thesis Results

    First time users of therapist-assisted Internet cognitive behaviour therapy: A qualitative examination of psychology graduate students in training

    • Study Purpose:


      Depression and anxiety are the most commonly experienced mental health conditions in Canada. Research has shown that one of the significant factors in the under-treatment of mental health conditions is a lack of access to providers. Researchers have begun to create novel ways to address the problem of a lack of access to mental health services, such as offering Therapist-Assisted Internet Cognitive Behaviour Therapy (TAICBT). This involves clients reviewing psychoeducational information on the use of cognitive and behavioural strategies for coping with a mental health condition over the Internet. This is combined with communicating with a therapist who provides support in the application of the material, typically over email or the phone. TAICBT has been shown to be more accessible and inexpensive, than traditional therapy. The four objectives of this study were to (1) Document the implementation process of TAICBT with clinical psychology students, (2) Investigate positive and negative experiences of student therapists using TAICBT, (3) Understand students' perceptions of facilitators and barriers of providing TAICBT, and (4) Generate practical recommendations for training students in TAICBT.


      Study Methodology:


      The 12 participants were Ph.D. students at the University of Regina. All participants had to have completed at minimum a 600 hour practicum, the TAICBT workshop, and have provided the TAICBT program to at least one client. Participants were recruited through an email to eligible Online Therapy USER student therapists at the University of Regina. Participants completed a 45-60 minute semi-structured interview. All interviews were recorded and transcribed. Thematic content analysis was completed by two coders and reviewed by an additional researcher and supervisor.


      Study Results:


      There were six major content areas that were generated from the interviews. Within each content area there were several themes that were identified. Below is a breakdown of some of the results.


      Positive Aspects of Graduate Students experience with TAICBT

      1. Themes:
        1. TAICBT training workshop was instructive and educational
        2. TAICBT beneficial to clinical training
        3. Email communication conducive to training novice therapists
        4. Exceptional supervision and support from staff members
        5. TAICBT overall was a valuable service to clients with less time commitment from the therapist


      Challenges and Weaknesses of TAICBT

      1. Themes:
        1. Challenges working with some clients
        2. Challenges in deciding what to write to clients
        3. Challenges with some of the policies and procedures
        4. Challenges with perceived obligation to take on clients


      Facilitators of the Graduate Students Experience with TAICBT

      1. Themes:
        1. High-quality supervision and support from staff members
        2. Therapist comfort with technology
        3. Flexibility in location, day, and time emails could be written
        4. Ease of use of the program Online Therapy USER website


      Barriers of the Graduate Students Experience with TAICBT

      1. Themes:
        1. Students had many other demands on their time
        2. Some aspects of the program were inconvenient
        3. Learning a new program was a significant time investment
        4. Clients behaviour can act as a barrier


      Future Utilization of TAICBT

      1. Theme:
        1. Therapists are open to future usage of TAICBT as professionals


      Suggested Improvements to TAICBT

      1. Themes:
        1. Improvements to the TAICBT training workshop
        2. Improvements to the screening and set-up of clients on the system
        3. Suggested improvements to modules
        4. Improvements to the website
        5. Modifications to the policy and procedures


      Recommendations for future TAICBT training Programs:


      It was evident that students saw considerable value in learning TAICBT. Drawing on the perceived strengths and challenges of our program, others who develop a TAICBT training program should consider several points including:

      1. More in-depth training workshop
      2. Formalizing students' role in the form of practicum
      3. Make students aware of client variability
      4. Flexibility in client document review
      5. High level of commitment from staff and supervisors
      6. Formalize peer supervision


      At the present time, we are working to inform clinicians and other researchers of these findings through publications and presentations at conferences. Thank you again for your participation in our research. Should you have any questions, please feel free to contact Dr. Heather Hadjistavropoulos at 585-5133.


  • Kirsten M. Gullickson (2011), Honours Thesis Results

    Understanding the Implications of Health Anxiety Following Breast Cancer Diagnosis

    • Background:


      Breast cancer has been classified as the most prevalent type of cancer affecting Canadian women. Recent research suggests that a proportion of women diagnosed with breast cancer experience elevated health anxiety, as well as generalized anxiety and depression. However, further research is needed in order to understand the implications of health anxiety among women with breast cancer. To date, it is unknown whether health anxiety is associated with increased body vigilance and reduced reassurability among this population. Furthermore, it is unclear whether health anxiety uniquely predicts quality of life over and above other factors such as general negative affect (i.e., depression and anxiety), cancer-specific anxiety, or, alternatively, vulnerability factors that are associated with other anxiety disorders (i.e., intolerance of uncertainty and anxiety sensitivity). Given the multiple constructs that can be assessed by psychologists, it is important to identify those constructs that are unique and provide valuable information to understanding the emotional experience of women who have been diagnosed with breast cancer.


      Results:


      Participants were Canadian women who were diagnosed with breast cancer within the past ten years (n = 198) whom completed a series of online questionnaires. The results illustrated that:

      1. Individuals with elevated health anxiety also reported being more preoccupied with bodily sensations, less reassured by medical personnel, and had poorer physical quality of life than those with lower health anxiety

      2. Health anxiety was a significant factor over and above other health-related and cancer-related variables

      3. The longer time that had elapsed since diagnosis the better the individual's physical quality of life


      Conclusion:


      The results of the study are important because they provide unique information about the relationship between health anxiety, body vigilance, reassurability, and quality of life in women with breast cancer. It also added to the literature supporting the cognitive-behavioral model of health anxiety and demonstrates how the model is applicable to women with a history of breast cancer. This study provides direction for researchers who have an interest in studying the psychological well-being of women with breast cancer by establishing the importance of health anxiety in this population. Above all, the knowledge gained from this project may aid clinicians in understanding which constructs are important to assess when treating women with a history of breast cancer.


      Your participation in this study is greatly appreciated. If you have any questions about the study findings, please contact Kirsten Gullickson at gullickk@uregina.ca.


  • Nicole Alberts (2011), Master's Thesis Results

    The role of parental medical illness in health anxiety: A test of the interpersonal and cognitive-behavioural models

    • Individuals with a medically ill parent are at increased risk for psychological distress. However, it is not known whether they may also be at risk for developing health anxiety. The interpersonal model of hypochondriasis (Stuart & Noyes, 1999) proposes that parental illness and insecure attachment styles may contribute to increased levels of health anxiety in adults. The cognitive- behavioural model of health anxiety (Salkovskis & Warwick, 2001) predicts that exposure to parental illness may increase dysfunctional core beliefs regarding health (e.g., perceived increase in risk of illness) which could increase health anxiety. This study explored the relationship between parental health status (i.e., ill or healthy), adult attachment style, dysfunctional health beliefs, and health anxiety in 328 emerging adults with healthy parents and 116 emerging adults with ill parents. Participants completed measures of health anxiety, adult attachment style, and health beliefs. Those with an ill parent answered additional questions designed to assess illness-related variables such as perceptions of illness severity and age at diagnosis. The primary results were as follows:


      1. Emerging adults in the ill parent group reported higher levels of health anxiety than those in the healthy parent group.
      2. In support of the cognitive-behavioural model, the relationship between parental illness and health anxiety was also shown to be dependent upon the formation of beliefs regarding the likelihood of illness.
      3. As predicted by the interpersonal model, emerging adults with an insecure attachment style reported higher levels of health anxiety as compared to those with the secure attachment style. Contrary to our predictions, this relationship was not stronger in the ill parent group.
      4. In directly comparing the ability of the interpersonal and cognitive-behavioural models to predict health anxiety, perceptions of the likelihood of illness, difficulty coping with illness, and the parent's ability to cope with their illness were all significant unique predictors of health anxiety, while attachment style was not.

      These results have important theoretical and clinical implications. As support was provided for both models of health anxiety, future research should focus on integrating these two models. An integrated model would recognize parental medical illness, attachment style, and dysfunctional health beliefs as necessary for providing a more comprehensive account of the development of health anxiety in emerging adults. In terms of clinical implications, increased awareness of perceptions of the likelihood of illness could lead to better identification of early health anxiety and improved treatment for clients who present with elevated health anxiety. Moreover, the current findings suggest that treatment focused directly on addressing attachment problems may be beneficial for clients.


      Thank you to all for their participation in this research. The findings will be reported in a manuscript and soon submitted for publication to an academic journal.


  • Amy Janzen Claude (2011), Doctoral Dissertation Results

    Understanding diabetic treatment adherence

    • Study Purpose:


      To investigate beliefs and emotions that may influence health behaviours (treatment activities), such as diet, exercise, medication use, and blood glucose monitoring in individuals with diabetes.


      Background:


      In this study, we were interested in examining whether there is evidence to support two models of health behaviour - the Theory of Planned Behaviour and Protection Motivation Theory. Both models suggest that how we think influences our health behaviours. The models have different ideas, however, about the thoughts or beliefs that influence health behaviours. The key beliefs and attitudes are listed below:


        Theory of Planned Behaviour: This theory suggests the following beliefs/attitudes influence health behaviour:
      1. Attitudes: Belief about the health behaviour (for example, how beneficial and valuable participation in each health behaviour is)
      2. Subjective Norms: Belief about how much other people, such as family and friends, would like the individual to participate in the health behaviour
      3. Perceived Behavioural Control: Belief about the individual's ability to engage in each health behaviour
      4. Response Efficacy: Belief about how effective engaging in each health behaviour is


        Protection Motivation Theory: This theory suggests the following beliefs/attitudes influence health behaviour:
      1. Perceived Vulnerability: Belief about how likely the individual is to experience complications from diabetes
      2. Perceived Severity: Belief about how serious not participating in each of the health behaviours is and how serious potential complications are
      3. Response Costs: Beliefs about barriers towards participating in each health behaviour (interference with life, discomfort, pain, embarrassment, etc.)
      4. Self-Efficacy: Belief about the individual's ability to engage in each health behaviour


      Study Findings:


      1. Participants varied in their engagement in the health behaviours:
        1. 88.1% of participants took their medications the number of times recommended daily;
        2. 66.4% engaged in at least 30 minutes of physical activity or a specific exercise session at least 3 days of the week;
        3. 52.8% tested their blood sugars the recommended number of times daily;
        4. 28.2% participated in a healthy eating plan for the majority of each day

      1. Anxiety was related to health behaviours:
        1. Individuals with Type 1 and Type 2 diabetes who had higher anxiety about their health were less likely to follow dietary guidelines
        2. Those who were anxious about health also had lower participation in exercise activities - this was mostly true of individuals with Type 1 diabetes
        3. Those who were anxious about their health were more likely to monitor their blood glucose levels - this was mostly true of individuals with Type 1 diabetes

      1. Certain beliefs related to anxiety about health were also found to influence participation in the health behaviours. Individuals were less likely to participate in the health behaviours if they believed:
        1. coping with diabetes was difficult
        2. medical services are inadequate
        3. they are vulnerable to illness
        4. diabetes is awful

      1. The Theory of Planned Behaviour described above was supported overall. That is, the more favorable the individuals' attitudes towards the health behaviours, the more confidence in performing the health behaviours and the less anxious they were, the more individuals intended to and actually participated in each of the health behaviours.
      2. The Protection Motivation Theory described above was also supported. Specifically, findings suggested that the more vulnerable to complications the individual believed they were, the more effective each of the health behaviours was believed to be, the fewer barriers towards participation in the health behaviours, the more confident in performing the health behaviours and the less anxious they were, the higher the individual's intention to and actual participation in each of the health behaviours.

      Usefulness of the Findings:


      1. The information that was gathered from this study can be used in the future to develop strategies to help people who are having difficulties with participation in each of the health behaviours.
      2. It appears that helping people change their beliefs and emotions could help them change their adherence to treatment guidelines.
      3. Some specific recommendations include providing information:

        1. on risks of not participating in each health behaviour,
        2. on the effectiveness of each health behaviour in managing diabetes,
        3. instruction on how to properly engage in the health behaviours by an expert and role model, and
        4. spending time examining and solving barriers involved in each health behaviour on an individual basis

      Thank you again for your participation in this research. Our next step is to work towards informing other researchers and clinicians of the study findings.


  • Nicole M. Alberts, Heather D. Hadjistavropoulos, Nicole E. Pugh, & Shannon L. Jones (2011)

    Dementia anxiety among older adults caregivers: An exploratory study of older adult caregivers in Canada

    • Background:


      Although caring for individuals with dementia is known to result in increased burden and depression among caregivers, little research has investigated caregiver's anxiety or concern about eventually developing dementia themselves. This is referred to as dementia anxiety. Existing research has reported mixed findings regarding factors that predict dementia anxiety among caregivers and non-caregivers. Potential relationships among caregiver burden, depression and dementia anxiety have not been extensively examined. This study explored caregiver and care recipient factors as predictors of dementia anxiety in older adult caregivers.


      Methods:


      A sample of 116 older adult caregivers answered demographic/background questions and completed a series of self-report measures assessing dementia anxiety, caregiver burden, depression, and the physical disability of the care recipient.


      Results:


      The majority of caregivers were female, Caucasian, and reported caring for a spouse. Analyses revealed that background variables were generally not related to dementia anxiety, while depression and caregiver burden were significantly associated. Using linear regression analysis, it was found that a diagnosis of dementia in the care recipient and caregiver depression were both significant predictors of caregiver dementia anxiety.


      Conclusion:


      Health care providers should be aware that dementia anxiety is associated with caring for individuals with dementia as well as with depression. Dementia anxiety may place additional strain on caregivers of individuals who have dementia and are suffering from depression and thus should be the focus of future research.


  • Alyssa Counsell, Heather Hadjistavropoulos, Melissa Kehler, & Gordon Asmundson (2011)

    Examination of posttraumatic stress disorder symptoms in individuals with multiple sclerosis

    • Study Purpose & Method:


      The purpose of our research was to further understand the relationship between posttraumatic stress disorder (PTSD) symptoms in individuals diagnosed with multiple sclerosis (MS). Research supports the idea that PTSD is more prevalent in individuals with chronic health conditions, but PTSD symptoms amongst individuals with MS have not been widely studied. Thus, we sought to examine the extent to which MS-related disability, MS type, and time since diagnosis contributed to symptoms of PTSD. Participants with MS, another health condition (e.g., arthritis, chronic pain), or no health conditions (controls) completed an Internet survey with questions regarding demographics, chronic health conditions, anxiety, depression, PTSD, and MS disability (MS group only).


      Study Results:


      When participants were asked to rate the extent to which they perceive having MS to be a traumatic experience, almost a quarter of the sample found their disability to be considerably or extremely traumatic.


      Based on our regression analyses, time since diagnosis of MS, MS type, and the perception of MS as traumatic were not significant predictors of PTSD symptoms. However, MS-related disability, and having another chronic health condition were found to significantly predict PTSD symptoms. Using PTSD diagnosis criteria assessed based on the Internet survey, 22.2% of the MS group and 22.9% of the non-MS health conditions group were likely to have PTSD, compared to only 11.9% of the control sample.


      Our results support the notion that individuals with chronic health conditions such as MS, may be at an increased risk for developing PTSD symptoms. These findings underscore the need for physicians or care providers to tailor treatment regimes to specific individuals, and assess the amount of distress caused by the experience of having MS and other chronic health conditions. As there is limited research regarding MS and PTSD, replication of our results and further examination of PTSD in MS is important.


      We are currently in the process of informing clinicians and others researchers about the study findings through publications and presentations at conferences.


      Thank you again for your participation in our research. If you have any questions regarding this research, please free to contact Dr. Heather Hadjistavropoulos at 585-5133.


  • Nicole E. Pugh (2010), Master's Thesis Results

    Elucidating our understanding of health anxiety and behaviour

    • Health anxiety (HA) refers to a preoccupation and fear about acquiring or having a serious disease. The fear results from the negative misinterpretation of harmless bodily sensations. While past research has found that individuals who worry about their health commonly engage in distinctive maladaptive behaviours (e.g., seeking repeated reassurance from physicians, excessively scanning their bodies), the relationship between HA and wellness behaviour, such as physical activity, has not been adequately examined. Furthermore, the extent to which HA may be associated with other maladaptive behaviours, such as the tendency to use excess medication, has not yet been addressed. The goal of this study was to clarify the relationships between HA, thoughts about health, maladaptive behaviours, and physical activity. Undergraduate participants (N =144) completed an online questionnaire. The primary results of this study are as follows:


      1. HA was not significantly related to general physical activity.
      2. Students who tend to focus on their body were more inclined to engage in extreme physical activity, and reported symptoms of exercise tolerance and exercise withdrawal.
      3. Students with HA were more likely to engage in a variety of maladaptive behaviours including body scanning, medication use, and diagnostic verification.
      4. When students reported negative thoughts about their health (e.g., the belief that they are at risk of becoming sick) they were more likely to engage in maladaptive behaviours.


      The results of this study have two important implications. First, the relationship between HA and a variety of maladaptive behaviours was expanded upon. For instance, students who worry about their health were more likely to use medication and seek out medical treatment. Second, students who tend to focus on their body may be at risk of engaging in extreme physical activity. As this research only investigated the experiences reported by university students, future research should determine if similar relationships are found in other samples. While this study had its limitations, including using self-report measures, the results clarify that HA is more related to maladaptive behaviour than wellness behaviour, such as physical activity.


  • Nicole M. Alberts, Donald Sharpe, Melissa D. Kehler, Heather D. Hadjistavropoulos (2010)

    Health anxiety: Comparison of the latent structure in medical and non-medical samples

    • The Short Health Anxiety Inventory (SHAI; Salkovskis, Rimes, Warwick, & Clark, 2002) is a self-report measure designed to assess health anxiety in individuals with medical illnesses as well as individuals who are healthy. In this psychometric study, we examined data from a community sample with no serious medical conditions (n = 232) and a medical sample with multiple sclerosis (n = 245). In addition to other measures, both samples completed the SHAI. Factor analysis found the same two-factor solution for both samples, with the two factors labelled: 1) Thought Intrusion, and 2) Fear of Illness. Comparable item loadings were found for both samples, but the two factors were more strongly related in the non-medical sample. There was also a very large difference in scores between patients who had MS and those who did not have MS on the Thought Intrusion scale, and only a small difference between these groups on the Fear of Illness scale. These differences indicate that the experience of health anxiety in patients with MS appears to be different from the experience of health anxiety in individuals who do not have MS.


  • Heather Hadjistavropoulos, Amy Janzen, Melissa Kehler, Jocelyne Leclerc, Michelle Bourgault-Fagnou, Donald Sharpe (2008-2010)

    Development and validation of the health cognitions questionnaire

    • Lab Project


      Study Purpose


      This study was conducted to obtain a better understanding of health anxiety in individuals with and without medical conditions or emotional concerns. Health anxiety is worry you may experience due to bodily sensations or anxiety about health related information. By obtaining a better understanding of health anxiety, we believe that clinicians who work with individuals with health anxiety will be better able to effectively assess and treat such individuals.


      Study Findings


      Results from this study indicated that individuals who are health anxious hold four primary thoughts that contribute to health anxiety. These include: 1) thoughts concerning how likely it is they will develop or experience worsening of an illness; 2) thoughts concerning how awful the illness would be; 3) thoughts regarding their ability to cope with the illness; and 4) thoughts about the ability of medical services to assist them in dealing with their illness.


      We were also able to examine differences in the presentation of health anxiety between individuals with and without a medical condition or emotional difficulty. Results revealed that health anxiety is increased in individuals who have a health condition or a history of anxiety and depression.


      We also sought to examine the differences in the four primary thoughts (identified above) between individuals who have a medical condition and those who do not. We found that all four of the thoughts related to health anxiety in individuals with medical conditions. In individuals who did not have a medical condition, however, health anxiety was most strongly related to thoughts about how likely it is they would develop an illness and their inability to cope with the illness. These findings are important for clinicians working with individuals with health anxiety as they show that health anxiety may present slightly differently in individuals with and without a medical condition. Knowledge of such differences will assist clinicians in identifying increased health anxiety and developing treatment strategies to reduce the amount of health related thoughts and worries an individual may have.


      At the present time, we are working to inform clinicians and other researchers of these findings through publications and presentations at conferences.


      Thank you again for your participation in our research. Should you have any questions, please feel free to contact Dr. Heather Hadjistavropoulos at 585-5133.


  • Shannon L. Jones (2009), Master's Thesis Results

    Health anxiety and breast cancer: Does social support make a difference?

    • Women commonly experience anxiety and depression following a breast cancer diagnosis; however, less is known about health anxiety in this population. Persons with health anxiety may have excessive fear or worries about illness or disease, hold strong beliefs that one is ill, pay close attention to bodily sensations, and seek reassurance repeatedly from family, friends, and medical personnel that they are healthy. Health anxiety is important to study in women previously diagnosed with breast cancer because severe forms of health anxiety can contribute to significant disability, is associated with other types of anxiety and depression, and can result in reduced health-related quality of life.


      It is also recognized that having adequate social support is associated with positive outcomes after a diagnosis of breast cancer, such as better psychological health and immune function. However, some research reports how even well-intentioned people may respond in unhelpful or distressing ways to women diagnosed with breast cancer. Given that reduced social support and negative responses by social network members is associated with increased anxiety and depression, this study sought to investigate whether similar relationships would be observed between health anxiety and social factors.


      Canadian women previously diagnosed with early-stage breast cancer (stages 0, I, or II) were recruited across to participate in an internet-based survey. One-hundred sixty-six women were included in the final analyses. The findings that are reported in a manuscript recently submitted for publication in an academic journal are reported below:


      1. Roughly one-third of the sample reported elevated health anxiety
      2. Health anxiety was higher amongst women more recently diagnosed and treated for breast cancer
      3. On average, health anxiety was lower amongst women with breast cancer as compared to samples of patients with chronic pain and multiple sclerosis (based on previously published data); yet, health anxiety in women with breast cancer was higher than that reported by community and control samples
      4. Women who perceived that their support system was adequate also tended to report seeking support to alleviate their health worries
      5. Women who reported receiving unsupportive responses from social network members also reported being more excessively health anxious and holding health anxious beliefs (e.g., the belief that others were not taking their health concerns seriously)


      The results of this study have important implications for our theoretical understanding of health anxiety in a medical sample. In particular, social factors have been neglected in the cognitive-behavioral model of health anxiety, and this research suggests a need for such variables to be taken into account. Clinically, this research underscores the need for practitioners to obtain information regarding a breast cancer patient's social network should she present with health anxiety. Future research might attempt to better understand the links among unsupportive social network behaviours and health anxiety.


  • Jocelyne Leclerc (2009), Master's Thesis Results

    The relationship between health anxiety, body weight and binge eating

    • Study Purpose:


      The purpose of this project was to obtain a better understanding of the relationship between health anxiety, obesity, and binge eating. Obesity is a growing concern in our society that is associated with increased health problems. Individuals who suffer from both obesity and binge eating have a greater risk of increased health problems as well as depression and anxiety. Thus, due to the potential increased risk of health problems it is possible individuals who are overweight, and engage in binge eating may also worry and interpret bodily sensations as a sign of illness or experience anxiety when exposed to health- related information.


      Study Findings:


      Surprisingly, findings from this study revealed that individuals with elevated body weight (i.e., overweight or obese) were not more likely to have increased health anxiety.


      However, we did find that individuals who binge eat have increased health anxiety and increased thoughts associated with health anxiety such as thoughts about how likely it is that they will develop an illness, thoughts about how awful it would be to experience and illness, thoughts about their ability to cope with an illness, as well as thoughts about the ability or inability of medical services to assist them in dealing with their illness. These results were also shown after we accounted for individuals who had a chronic medical condition at the time of completing the study.


      As this was the first study to examine body weight, binge eating and health anxiety it will be important for future research to examine how binge eating may contribute to the development and maintenance of health anxiety, or alternatively the extent to which health anxiety may be a risk factor for binge eating.


      We are currently in the process of informing clinicians and others researchers about the study findings through publications and presentations at conferences.


      Thank you again for your participation in our research. If you have any questions regarding this research, please free to contact Dr. Heather Hadjistavropoulos at 585-5133.