Internet-Delivered Cognitive Behavioral Therapy for Postsecondary Students: Randomized Factorial Trial for Examining...

Area of Science:

• Mental Health
• Digital Therapeutics
• Cognitive Behavioral Therapy

Background:

• Internet-delivered cognitive behavioral therapy (ICBT) offers improved access to mental health care for students.
• High attrition rates in ICBT are a significant concern, with limited understanding of long-term outcomes.
• Motivational interviewing (MI) and booster lessons are known to enhance engagement in traditional face-to-face therapy.

Purpose of the Study:

• To investigate the efficacy of pretreatment motivational interviewing (MI) exercises and booster lessons within an ICBT framework for postsecondary students.
• To assess the impact of these interventions on treatment completion, engagement, and mental health outcomes.

Main Methods:

• A factorial trial randomized 308 students to 4 conditions, including web-based MI before treatment and a self-guided booster lesson one month post-treatment.
• All participants received a 5-week transdiagnostic ICBT course (UniWellbeing).
• Primary outcomes measured changes in depression, anxiety, and academic functioning at post-treatment and 1- and 3-month follow-ups.

Main Results:

• 54% of students completed treatment, reporting significant improvements in depression and anxiety, and modest improvements in academic functioning, sustained at follow-ups.
• Pretreatment MI did not significantly improve treatment completion or engagement but showed small benefits for depression and anxiety reduction.
• Low uptake (30.9%) of the booster lesson limited its evaluation, though accessed boosters correlated with greater depression reduction at 3 months.

Conclusions:

• Motivational interviewing exercises may be more beneficial later in ICBT when student motivation declines.
• The low uptake of the self-guided booster necessitates further research into optimized delivery methods and therapist support.
• Future studies should explore longer booster durations, therapist involvement, and extended follow-up periods to better understand long-term effectiveness.