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General Mental Health - B

197: Care dependency, passive stance, therapeutic alliance, and the wish for treatment continuation in a CBT-treatment analogue training study among students.

Naline Geurtzen, Radboud University, Behavioural Science Institute, Nijmegen, The Netherlands; NijCa2re, Nijmegen, The Netherlands; Pro Persona Mental Health Services, Wolfheze, The Netherlands;Ger P.J.Keijsers, Radboud University, Behavioural Science Institute, Nijmegen, The Netherlands; NijCa2re, Nijmegen, The Netherlands; Department of Clinical Psychological Science, University Maastricht, Maastricht, The Netherlands Johan C. Karremans , Radboud University, Behavioural Science Institute, Nijmegen, The Netherlands; Giel J. M. Hutschemaekers, Radboud University, Behavioural Science Institute, Nijmegen, The Netherlands; NijCa2re, Nijmegen, The Netherlands; Pro Persona Mental Health Services, Wolfheze, The Netherlands

Care dependency in mental health care has been considered an unwanted side-effect of psychological treatments (Berk & Parker, 2009; Geurtzen, Keijsers, Karremans, & Hutschemaekers, 2018; Rozental, Kottorp, Boettcher, Andersson, & Carlbring, 2016). For example, care dependency has been linked to increased passiveness of patients and to prolonged treatment duration. However, there is only limited empirical evidence supporting these assumptions. The current study examined potential negative correlates of care dependency in a treatment analogue study with students in clinical training, and tested whether care dependency predicted the wish for treatment continuation and symptom levels at the end of the treatment. A total of 136 students following a training in Cognitive Behavioral Therapy participated in the study. The students received treatment for psychological symptoms as part of their professional schooling, conducted by a fellow student as their therapist. Students’ care dependency levels, passive stance, wish for treatment continuation, and symptom levels, as well as the therapeutic alliance were administered multiple times during treatment by means of self-report questionnaires. Results showed that two dimensions of care dependency, submissive dependency and the lack of perceived alternatives, were positively associated with students’ passive stance. The latter also predicted students’ wish for treatment continuation, even when controlled for symptom levels. Care dependency was not related to symptom levels. Surprisingly, a third dimension of care dependency, the need for contact, was positively associated with the therapeutic alliance. Together these results partly confirm the potential negative consequences of care dependency, suggesting that care dependency may lead to an increased passivity in students and to unnecessary treatment prolongation. However, as care dependency is also partly related to a better therapeutic alliance, it is argued that some degree of dependency could have potential beneficial effects as well. Future research should examine to what extent the current findings could be generalized to a clinical population and whether care dependency among patients can predict treatment outcome and actual duration. Berk, M., & Parker, G. (2009). The elephant on the couch: Side-effects of psychotherapy. Australian and New Zealand Journal of Psychiatry, 43(9), 787–794. doi:10.1080/00048670903107559 Geurtzen, N., Keijsers, G.P.J., Karremans, J.C., & Hutschemaekers, G.J.M. (2018). Patients’ care dependency in mental health care: Development of a self-report questionnaire and preliminary correlates. Journal of Clinical Psychology. Advance online publication. doi:10.1002/jclp.22574 Rozental, A., Kottorp, A., Boettcher, J., Andersson, G., & Carlbring, P. (2016). Negative effects of psychological treatments: An exploratory factor analysis of the negative effects questionnaire for monitoring and reporting adverse and unwanted events. PLoS ONE, 11(6), e0157503. doi:10.1371/journal.pone.0157503

183: Approaching depersonalization symptoms as panic symptoms.

Alicia Facio, Maria Cecilia Sireix and Cecilia Degani, Asociación de Terapia Cognitiva y Conductual del Litoral, Argentina

Presenting Problem Patricia, aged 31, sought help for panic symptoms and depersonalization-derealization episodes that she interpreted as signaling different severe physical illnesses and impending psychosis. These problems begun when her father was diagnosed cancer and increased gradually since then. Case Conceptualization and Intervention When a child, Patricia was terrified that her mother, who suffered  a dramatic health anxiety, might die and leave her alone. At age 10,  she began experiencing depersonalization-derealization episodes that continued for three years.   She was diagnosed Illness Anxiety Disorder and Major Depressive Disorder. It was hypothesized that Patricia learnt to interpret somatic sensations as indicative of disease and experiences of depersonalization-derealization –a normal part of human experience- as a sign that she was getting “crazy”. These beliefs increased the attention directed to somatic and mental sensations, the chances of noticing them and the associated distress. Behaviors like repeated bodily checking,  reassurance seeking and avoidance  maintained symptoms in the long run. It was decided to address symptoms of depersonalization in the same way as panic symptoms. Psychoeducation and cognitive restructuring targeting the normality and harmlessness of both types of sensations was followed by interoceptive and in-vivo exposure and the combination of both. Outcome After 24 sessions, Patricia no longer met criteria for both disorders. Her recovery was evident in the MMPI-2 test: very high T scores at the beginning of treatment decreased to the normal range. Gains were maintained at follow up. Review and Evaluation Conceptualizing depersonalization symptoms within the CBT model for panic symptoms  probably contributed to treatment success.  



Introduction: A number of studies has shown a reduced ability to retrieve specific memories in trauma survivors. Hence, overgeneral memory retrieval has been linked to the development of posttraumatic and depressive symptoms. However, few studies have explored specificity vs. overgenerality in memory retrieval among victims of chronic or repetitive traumas. Method: The present study assessed overgenerality in trauma narratives from 50 battered women and in stressful narratives from 50 control women using the Coding and Assessment System for Narratives of Trauma (CASNOT). Results: Battered women reported more specific memories as compared with those from control women. Contrary to expectations, women with PTSD diagnosis and depressive symptoms did not differ significantly in specificity. However, battered women with higher levels of trauma centrality, intrusion symptoms and nightmares reported significantly greater overgeneralization in their trauma memories. Discussion: All in all, a better understanding of autobiographical memory in trauma could lead to the development of innovative strategies focused on the event elaboration for the prevention, detection and treatment of trauma-related symptoms. 




Introduction: Making sense appears to be an important cognitive aspect for the individual adaptation to stressful life events. However, evidence is inconclusive. In addition, few studies have explored this aspect in women victims of intimate partner violence, and all of them have used American samples. Method: This study analyses trauma narratives by 50 Spanish battered women (trauma group) in comparison with stressful narratives by 50 non-traumatized women (controls).  The use of words and language expressions related to making sense were coded using the Coding and Assessment System for Narratives of Trauma (CASNOT) and the Language Inquiry and Word Count (LIWC). Results: Trauma narratives from battered women contained significantly more words and language expressions related to helplessness, insight, control, uncertaintyand causation. However, no significant associations were found between making sense expressions andpsychological symptoms. Discussion: Overall, this study provides further evidence about the role of making sense in the trauma adaptation, specifically for women victims of intimate partner violence. Clinical implications and future research directions will be discussed.




Introduction: Narrative studies have associated the use of emotional expressions and the psychological adaptation after trauma. However, few studies have analysed the relationship between the emotional narrative content and the adjustment after trauma in battered women. Method: The current study explored the use of emotional expressions in trauma narratives from 50 battered women, by comparing them with stressful narratives from 50 non-traumatized women. Emotional narrative content was assessed using the Coding and Assessment System for Narratives of Trauma (CASNOT) and the Language Inquiry and Word Count (LIWC). Results: Narratives from battered women contained significantly more words related to a range of negative emotions. Unexpectedly, for the trauma group humiliation/shame and guilt were not associated neither with intimate partner violence characteristics norwith psychological symptoms. However, posttraumatic symptoms were associated to the use of more affective words and negative emotions. Discussion: Altogether, the analysis of emotional content in narratives from victims of intimate partner violence could help us to identify specific emotional responses linked to a poor trauma adaption, and therefore to further develop psychological interventions focused on the management of such emotions.


175: User’s perceptions about Be a Mom: Comparing completers and non-completers of a web-based intervention to prevent postpartum depression

Ana Fonseca, Fabiana Monteiro, Stephanie Alves, Center for Research in Neuropshychology and Cognitive-Behavior Intervention, University of Coimbra, Portugal; Ricardo Gorayeb, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brasil; Maria Cristina Canavarro , Center for Research in Neuropshychology and Cognitive-Behavior Intervention, University of Coimbra, Portugal;

Introduction: Be a Mom is a self-guided web-based intervention, grounded on Cognitive Behavioral Therapy principles, and delivered at postpartum women to prevent PPD. This study examined the user’s perceptions about several features of the program (e.g.,layout, navigation, content, exercises) and the differences and similarities in such perceptions, among users who completed and users who did not complete Be a Mom. Method: A pilot randomized, two-arm controlled trial was conducted. Women assigned to the intervention group (Be a Mom, n =98), regardless having completed or not the program, filled out a form examining user’s perceptions about several features of the program. Results: 41.8% (n=41) of women completed the program. More than half of dropouts (50.9%) occurred before completing any module. 65 women completed the user’s perception form. Women who completed Be a Mom were highly satisfied with the program (p<.001), reported a significantly higher intention to use it if needed (p<.001), perceived the program as more useful (p=.006) and credible (p=.001), but no significant differences were found in perceived demandingness (p=.620). The users who completed Be a Mom had more positive perceptions, particularly related with navigation and layout (p<.05), with the program’s content (p<.05) and to the exercise tips (p<.05) than users who did not complete Be a Mom. Discussion: These results allow us to reflect on some improvements that can be done in Be a Mom, to promote engagement with the program. Further studies with the revised version of Be a Mom will be needed to establish its efficacy.


170: Comparison of Predictors of Psychological Health in Adolescents and Adults: Cognitive Emotion Regulation, Perceived Parental Attitude and Perceived Social Support

Kıymet Yiğit Demir, Psychology Department of Yıldırım Beyazıt University, Ankara, Turkey
Assoc. Prof. Özden Yalçınkaya Alkar, Yıldırım Beyazıt University

INTRODUCTION: Individuals go through the periods of development, from childhood to old age, where different psychological and physiological stages are involved.Because of the sensitivities of the developmental periods, adverse effects on the psychological health can occur as a result of negative experiences.Thus it is important to understand the mechanism that affect psychological health from developmental point of view. Cognitive emotion regulation strategies (self-blame, acceptance, rumination, positive refocusing, refocus on planning, positive reappraisal, Putting into perspective, catastrophizing, other-blame), perceived parental attitude from mother and father and perceived social support (friends and family support for adolescents; friends, family and special person support for adults) which are thought to be related to psychological health, were included in this study. Purpose of the study is to examine comparatively how the variables of the study affect psychological health during adolescence and adulthood.MATERIAL-METHOD: The data obtained from the adolescent and adult participants using the Demographic Information Form, Brief Symptom Inventory, Cognitive Emotional Regulation Scale, Perceived Parental Attitude Scale, Family and Friend Perceived Social Support Scale and Perceived Multiple Social Support Scale. Data were analyzed by using multiple regression and MANOVA analyzes . RESULTS: 223 adolescents (%57.7 were female, %42.3 were male) with an average age 16,4 years and 215 adults (%20.9 were female, %79.1 were male) with an average age 26 years were participated in the study. Psychological health, cognitive emotional regulation strategies, perceived parental attitude and perceived social support variables of adolescents and adults were examined by MANOVA analysis and it was found that there was a significant difference between groups. According to the results; in terms of psychological health, adolescents had more psychological symptoms than adults. There was a significant difference between adolescents and adults in terms of cognitive emotional regulation strategies as well. While, adults had higher scores in the positive refocusing, refocus on planning, positive reappraisal, putting into perspective; the adolescents had higher scores in the other-blame.  However, there was a no difference in the self-blame, acceptance, rumination, and catastrophizing strategies. Also, in terms of frequency of use of cognitive emotional regulation strategies, refocusing on planning is the most frequently used cognitive emotional regulation strategy; catastrophizing is the least used strategy in both adolescents and adults. Regarding the perceived parental attitude and social support, it was found that while adolescents had higher maternal protection scores than adults; adults had higher social support scores than adolescents.  When the variables that predict psychological symptoms are examined by regression analysis; variables of the study explained 48.8% of total variance in adolescents and 46.3% in adults.  It can be said that mother's emotional warmth and social support from friends in adults were  predictors of psychological symptoms   However, in adolescents, catastrophizing and blaming others were predictors of psychological symptoms. CONCLUSION: In this study, cognitive emotion regulation, perceived parental attitude and perceived social support, which are related to psychological health, have been examined comparatively in terms of how psychological health affects adolescences and adults. The findings are thought to be developmentally and clinically significant.   Key words: psychological health, adolescence, adult, cognitive emotion regulation, parental attitude and social support        


169: Explaining the Protective Role of Social Support: The Intrapersonal and Interpersonal Emotion Regulatory Routes

Emine Yücel, Psychology Department of Selçuk University, Konya, Turkey; Derya Karanfil, Yankı Süsen, Emine İnan, Özden Yalçınkaya-Alkar, Psychology Department of Ankara Yıldırım Beyazıt University, Ankara, Turkey

Introduction: Benefits of social support for an optimal human functioning have been naturally evidential in the literature given the fact that one of the basic needs of human beings is to belong. However, there are also cases in which social support might lead to negative mental health outcomes. Such inconsistent empirical evidence is an emergent call for the researchers to better appreciate the working principles of social support. For that reason, current study probed the potential mediating roles of both intra-individual (i.e., cognitive reappraisal and suppression) and interpersonal emotion regulation (ER) strategies (i.e., enhancing positive affect, perspective taking, soothing, and social modeling) in the link between social support and psychological distress (i.e., depression and anxiety). Accordingly, a serial affective processing model (social support → ER strategies → difficulties in ER → psychological distress) was tested across six different ER strategies. Method: 480 volunteers (366 females, 114 males), with a mean age of 22.48, completed an online survey for the present attempt. Main study variables were assessed via Multidimensional Scale of Perceived Social Support, Interpersonal and Intrapersonal ER Questionnaires, Difficulties in ER Scale, and the depression and anxiety related items of Depression, Anxiety, and Stress Scale. Results: Social support was found to be negatively associated with psychological distress. Such a link was partially mediated by the preference for certain ER strategies which amplified or mitigated the ER difficulties. The proposed serial mediation model was confirmed with respect to suppression and reappraisal as intrapersonal ER strategies, and with respect to perspective taking, soothing, and modeling as interpersonal ER strategies. Discussion: The present findings are in line with the previous empirical evidence in confirming the value of a supportive social environment for the psychological health. However, the nature of the relationship between social support and mental functioning can vary in consideration of different ER mediatory routes. Those alternative affective pathways will be discussed in answering the question that how social support can be beneficial or detrimental for human psyche. Conclusion: Even though the accessibility of interpersonal resources has the power to shield people from the psychological distress, the current affect regulatory routes of social support are revealing about the exceptional ways wherein social support might not function for the benefit of its recipients. Keywords: social support, emotion regulation, intrapersonal, interpersonal, psychological distress


154: Cognitive Behavior Therapy in Egypt; historical developments and pathway to the future

Reham Aly Hisham Ramy, Egyptian Association of Cognitive Behavior Therapy

Egypt has a central position in Africa and the Middle East. The country is the heart of the Arab world. Basically, the development and practice of psychotherapy in Egypt has followed the development of psychology. This presentation explores the evolution, development, and current status of psychotherapy in general and cognitive behavior therapy (CBT) specifically. The current status of CBT in Egypt is explored in the light of the Egyptian Association of Cognitive behavior therapy (EACBT). Starting from times of the development of clinical psychology in Egypt, we discuss the theoretical orientation of contemporary psychotherapy in the country, its status in the health care system, its training and research opportunities, and its current and future challenges. Nowadays, the training and practice of cognitive behavior therapy have perceived many roundabouts in Egypt. In local settings, the evidence based gold standard psychotherapy is subject to individual and cultural changes and progressions. Despite the long years of development in the western countries, the current situation of CBT in Egypt remains developing. Hence, the Egyptian Association of CBT (EACBT) has prioritized a general goal of increasing awareness & knowledge of CBT. This can only be accomplished through cultivating an environment of structured training & research of CBT in Egypt and thus, in the Arab region. The newly developed Egyptian route of CBT education, training, certification and accreditation is thoroughly reviewed. Future expectations and provisional plans for implementing CBT in Egypt will finally be presented.


83: Say-do-report correspondence in therapy: an exploratory study.

Elisabeth Lozano, Centro de Estudios e Investigaciones en Comportamiento, Universidad de Guadalajara; Miguel Núñez de Prado-Gordillo, Carolina Trujillo, Isabel Ávila-Herrero, María Xesús Froxán-Parga, Universidad Autónoma de Madrid

Introduction: A significant deal of what constitutes CBT might be characterized in terms of what the therapists ask the clients to do outside the clinic, what the clients say they will do, what they effectively do and what they report having done in the following session. A close parallel can be drawn between this procedural characterization of CBT and the say-do-report correspondence phenomenon, extensively documented in experimental settings as a means of studying rule-governed behavior (i.e., the linguistic control of extra-linguistic behavior). Along these lines, the general aim of our work will consist in drawing connections among the results of the experimental analysis of behavior and the therapeutic process as it has been depicted above. Specifically, our research will tackle two issues: a) how to assess the say-do-report correspondence in an ecological setting with natural stimuli (i.e., the therapeutic context); b) how therapy influences the say-do-report correspondence. Method: The experimental design will be a non-equivalent control group quasi-experimental design. 8 subjects will participate in the study, 4 in the control group (i.e., no therapy group) and 4 in the experimental group (i.e., therapy group). Say-do-report correspondence will be assessed both before and after therapy. Self-reports will be employed to assess the “say” and “report” phases, while a systematic observation of target behaviors (i.e., eating, drinking and leisure time) through a purpose-designed category system will be applied to assess the “do” phase. Results: Regarding our first objective, we expect that the employed analysis tools will prove useful to assess the say-do-report correspondence in a natural setting. Regarding our second objective, we expect to find an increase of the say-do-report correspondence after therapy in the experimental group and no significant change in the control group. Discussion: Due to the obvious methodological limitations of this exploratory study, a causal relationship between therapy and the increase of the say-do-report correspondence cannot be concluded. However, the applied research on the therapeutic process gives us reason to believe that, during therapy, therapists systematically reinforce both the clients’ utterances regarding pro-therapeutic behaviors to be performed outside the clinic and their precise behavioral reports. In addition, the experimental analysis of rule-governed behavior has repeatedly evinced that when the probability that a person says that he/she will behave in a certain way increases, the probability that the person behaves accordingly increases too. It is thus reasonable to expect that, when therapists reinforce the clients’ anticipation of their future pro-therapeutic behaviors, the probability that they behave accordingly outside the clinic increases. In addition, they will be later reinforced for precisely reporting what they effectively did. Therefore, the effect we expect to find in the experimental group might well be due to a generalization of the say-do-report correspondence relations specifically trained during therapy.


82: Refinement of a category system in a verbal therapeutic behavior study

Elena Ruiz-Sancho, Universidad Camilo José Cela; Alejandro Ricote-Hernández , Gladis Pereira, María Xesús Froxán-Parga, Universidad Autónoma de Madrid

Introduction: the processes research in therapy since decades, seeks to shed what is happening in all steps of any psychological intervention that truly makes possible the change in therapy. Our research team investigates in this area, analyzing the verbal behavior of therapists when in session, in order to identify de function of his verbalizations, and its possible relation with de clinical change. So far we have used the Verbal Behavior of Therapists Category System (SISC-INTER-CVT), but we’ve been working for years to improve it. Therefore the goal of this work is to show the depuration process of the SISC – CVT and its resulting categories. Method: the therapists verbal behavior was recorded in 30 sessions from 6 different clinical cases, treated by 3 cognitive behavioral psychologists. For the observation, coding of the sessions and the inter and intra-observer reliability, we have used the software The Observer XT 11.0. 3 expert observers in behavior change and observational methodology made the depuration process. First of all, a non-systematic observation was made to prove the new categories system. Afterwards, the instrument was changed and the agreements and disagreements between the observers were analyzed. During the whole process the inter and intra- observer reliability measures were made. Results: the verbal behavior of the therapists can be categorized by Antecedent Stimuli (discriminative; elicitation; instructional discrimination), Consequent Stimuli (reinforcement; punishment) or Dispositional Variables (establishing or abolishing motivational operation, which includes clinic information with or without appetitive and aversive conditioning). Also, reliability analysis with kappa higher than 0,7 and distribution of all 30 categories recorded are presented Discussion: We consider that, with this kind of studies, we can move forward in the clarification and comprehension of the therapeutical change processes that are given in the clinical environment, with the ultimate goal of improve the psychologists performance. Identifying the verbalization functions given by the therapist during session, can help us to be more effective when fostering the mentioned change, to be more efficient in our interventions and to teach future psychologist, highlighting the importance of the therapeutical relationship (verbal) between the professional and the client.

284: A preliminary study of the intervention of cognitive behavioral therapy in home-visit nursing for patients with schizophrenia

Masayuki Katsushima, Teikyo Heisei University

In Japan, psychiatric home nursing is effective as a method to support patients’ daily lives, and it has recently been increasingly adopted. It is most frequently selected for patients with schizophrenia. These patients have depression and anxiety. In future regional daily life support, psychosociological interventional support may be provided in addition to medical care. In Japan, few clinical psychologists are involved in regional support practice, and no environment to provide regional residents with CBT has been established. A previous study investigated the provision of CBT for regional residents through home nursing by public health nurses in the United Kingdom, and suggested its efficacy. With the consideration that basic CBT with a workbook provided by nurses and occupational therapists can reduce depression or anxiety in schizophrenia patients receiving home nursing, we preliminarily examined its effects. In 8 subjects (48.8 ± 17.3 years) for whom CBT with a workbook was performed, significance was tested using Friedman’s test at each evaluation point by single-group comparison. The effect size was compared using Hedge’s g. Furthermore, the correlation between a primary endpoint, K6, and the homework compliance rate was analyzed by calculating Spearman’s rank correlation coefficient. Based on the subjects’ homework compliance rate, we investigated the level of effort in each session. In addition, a questionnaire survey involving the subjects and home nurses/occupational therapists who performed CBT was conducted, and data on their impressions were collected. Prior to this study, its protocol was approved by the Ethics Review Boards of Teikyo Heisei University and participating institutions. There were no significant differences in K6 before study intervention, after study completion, or 1 month after study completion (p=0.167). The effect size was -0.79 (CI=-1.81-0.23) one month after study completion, indicating moderate effects. There was a strong correlation between K6 and the homework compliance rate (r=0.76, p=0.045). The mean homework compliance rate over a total of 8 sessions was 55.6%, but the compliance rate was the lowest in the 6th session (47.5%). Furthermore, the questionnaire survey involving the subjects showed that they preferred supportive intervention for behaviors rather than cognitive issues. The questionnaire survey involving home nurses/occupational therapists indicated that it was difficult for patients with schizophrenia to approach CBT, and that supporters themselves were aware of insufficient intervention techniques regarding CBT. There were no significant differences in the rate of change in K6. On the other hand, the effect size suggested moderate effects. Furthermore, there was a positive correlation between the degree of depression/anxiety, as represented by K6, and homework compliance rate; self-recognition of depression/anxiety may promote efforts on homework. The survey results suggest the importance of flexible CBT in accordance with individual schizophrenia subjects rather than standardized package-type CBT.In this study, specific effects were achieved.

Supported internet-delivered cognitive behavior therapy programs for depression, anxiety, and stress in university students: Feasibility, acceptability, effectiveness, and satisfaction
Jorge E. Palacios, Derek Richards, Riley Palmer, Carissa Coudray, Stefan G. Hofmann, Patrick A. Palmieri, and Patricia Frazier

University campuses have limited mental health services that cannot cope with the high demand for treating depression and anxiety related conditions. One alternative is to use internet-delivered CBT (iCBT) as a way of tackling barriers such as stigma, lack of availability, and scheduling issues.
This study aimed to assess the feasibility, acceptability, effectiveness, and satisfaction of a supported iCBT interventionoffering three distinct programs on depression, anxiety, and stress to students within a large university.
Participants were recruited from 3 counseling centers at a large midwestern University in the US.  Those agreeing to take part chose one of three iCBT programs - Space from Depression, Anxiety, or Stress - all comprised of 8 modules of media-rich interactive content. Participants were supported on the use of the platform throughout the trial by a trained professional. The PHQ-9, GAD-7, and stress subscale of the DASS-21 were completed at baseline, 8 weeks, and 3-month follow-up. A satisfaction with treatment (SAT) questionnaire was completed at 8 weeks, and qualitative interviews were completed by a subsample of participants at 3 months.
182 participants were recruited, 52 choosing Space from Anxiety, 31 Space from Depression, and 19 Space from Stress. Mixed effects models showed a significant decrease in symptoms of depression (F = 6.36, p< .001), anxiety (F = 7.97, < .001), and stress (F = 8.50, p< .001) over time - with the highest decrease in PHQ-9 scores among those participants choosing the Space from Depression program (5.0 mean difference at 8 weeks and 4.3 at 3 months), the highest decrease in GAD-7 scores among those choosing the Space from Anxiety programme (2.5 mean difference at 8 weeks and 3.6 at 3 months), and a high decrease in DASS-21 stress subscale scores among those choosing the Space from Stress program (2.3 mean difference at 8 weeks and 3.5 at 3 months). The mean time spent using the platform per session was 27.4 minutes (SD = 33.8), and participants completed 53.4% (SD = 37.6) of the total program content on average.  Most (69%) participants found the programs helpful/very helpful, and liked theconvenience, flexibility, access, and ability to control the pace of the use of the intervention. Qualitative interviews indicated the intervention met students’ expectations, and they saw it as valuable complement to face-to-face treatment.
The iCBT programs tested in our study appear to be feasible, acceptable, and effective in a university environment. Participants described the benefits of having a flexible, supported online intervention available on campus. Larger trials should be conducted to further test the significance of supported online interventions that give students a choice of program depending on the symptom profile.