Internet-delivered cognitive behavioral therapy versus standard information brochures in advanced cancer caregivers:...

Cancer caregiving is associated with elevated psychological burden, yet scalable interventions remain limited. This randomized controlled trial evaluated a therapist-guided, internet-delivered cognitive behavioral therapy program versus standardized information brochures in informal caregivers of patients with advanced cancer, with caregiver burden specified as the primary outcome and anxiety, depression, and caregiver self-efficacy as secondary outcomes.

A parallel two-arm randomized controlled trial was conducted among 200 informal caregivers, randomized to either the cognitive-behavioral therapy intervention (n = 100) or the control (n = 100). The intervention comprised an 8-week online cognitive behavioral therapy program supervised by licensed therapists. Primary (caregiver burden) and secondary (anxiety, depression, and caregiver self-efficacy) outcomes were measured using the Zarit Burden Interview-22 caregiver burden scale, the Generalized Anxiety Disorder-7 anxiety scale, the Patient Health Questionnaire-9 depression scale, and the Caregiver Self-Efficacy Scale, administered at baseline, week 4, and week 8. Analyses used linear mixed-effects models with intention-to-treat and sensitivity analyses.

At week 8, caregiver burden decreased by -11.6 ± 6.2 in the internet-delivered cognitive behavioral therapy group versus -2.1 ± 5.9 in the control group (p = 0.027; Cohen's d = 1.35); anxiety decreased by -5.2 versus -0.8 (p = 0.009; d = 1.40); depression decreased by -6.4 versus -1.2 (p = 0.008; d = 1.42); and caregiver self-efficacy increased by +21.9 versus +2.9 (p = 0.021; d = 1.44). A clinical reduction in caregiver burden occurred in 67.0 % of participants in the internet-delivered cognitive-behavioral therapy group, compared with 19.0 % in the control group (odds ratio 8.60; p = 0.005).

In this randomized trial, internet-delivered CBT produced greater improvements than information brochures in caregiver burden (primary outcome) and in anxiety, depression, and self-efficacy over 8 weeks.