A Randomized Factorial Trial of Internet-Delivered Cognitive Behaviour Therapy for Post-Secondary Students: Examining Motivational Interviewing and Booster Lessons (Preprint)

Abstract

Internet-delivered cognitive behaviour therapy (ICBT) can improve access to mental healthcare for students, although high attrition rates are concerning, and little is known about long-term outcomes. Motivational interviewing (MI) exercises and booster lessons can improve engagement and outcomes in face-to-face CBT.

The current study was designed to examine the use of pre-treatment MI exercises and booster lessons in ICBT for post-secondary students.

In this factorial trial (factor 1: online MI pre-treatment; factor 2: self-guided booster lesson 1-month post-treatment), 308 clients were randomized to one of four treatment conditions, with 277 (89.9%) clients starting treatment. All clients received a 5-week transdiagnostic ICBT course (the UniWellbeing Course). Primary outcomes included changes in depression, anxiety, and perceived academic functioning from pre-treatment to post-treatment and 1- and 3-month follow-up.

Overall, 54.0% (n=150) of students completed treatment and reported large improvements in symptoms of depression and anxiety, and small improvements in academic functioning at post-treatment, which were maintained at 1- and 3-month follow-up. Pre-treatment MI did not contribute to better treatment completion or engagement, but small between-group effects favoured MI for reductions in depression (Cohen’s d: 0.23) and anxiety (Cohen’s d: 0.25) at post-treatment. Only 30.9% (n=43) of students randomized to one of the booster conditions accessed the booster. No main effects were found for booster overall. Sub-analyses revealed that clients who accessed the booster had larger decreases in depressive symptoms (Cohen’s d: 0.31) at 3-month follow-up. No interactions were found between MI and booster.

Rather than offering MI at pre-treatment, clients may experience more benefit from MI exercises later in ICBT when motivation wanes. Low uptake of the self-guided booster limits our conclusions about its effectiveness. Future research should examine offering a booster at a longer duration after treatment, with therapist support, and with a longer follow-up period.

ClinicalTrials.gov: (NCT04264585)