Internet-Delivered Cognitive Behaviour Therapy (ICBT) for Depression and Anxiety among Clients Referred and Funded by Insurance Companies: Benchmarking Outcomes with Publicly-Funded ICBT (Preprint)
Authors: Hadjistavropoulos Heather D. , Peynenburg Vanessa , Mehta Swati , Adlam Kelly , Nugent Marcie , Gullickson Kirsten M. , Titov Nickolai , Dear Blake 
Published: August 2019

BACKGROUND

Anxiety and depression are leading causes of disability, but are often undertreated. Internet-delivered cognitive behaviour therapy (ICBT) improves access to treatment by overcoming barriers to obtaining care, such as location, time, and privacy. ICBT has been found to be efficacious in research trials and routine care, but there has been limited study of ICBT when ICBT is recommended and funded by insurance companies for clients on or recently in receipt of disability benefits or accommodations.

OBJECTIVE

The goal of this study was to examine ICBT engagement, acceptability, and effectiveness among individuals involved with two insurance companies. The two samples were benchmarked against previously published outcomes obtained in a publicly-funded ICBT clinic.

METHODS

Individuals who were on or recently in receipt of disability benefits and were either employees of an insurance company (n = 21) or plan members of an insurance company (n = 19) were referred to ICBT funded by the respective insurance companies. Outcomes from these two samples were benchmarked against outcomes of ICBT obtained in a publicly-funded ICBT clinic, with clients in the clinic divided into those who reported no involvement with insurance companies (n = 414) and those who self-reported being on short-term disability (n = 44). All clients received the same 8-week, therapist-assisted, transdiagnostic ICBT course targeting symptoms of anxiety and depression. Engagement was assessed by examining ICBT completion rates, and number of emails exchanged and log-ins. Acceptability was assessed using post-treatment satisfaction questions. Effectiveness was assessed using measures of depression, anxiety, and disability administered at pre-treatment, post-treatment and 3-month follow-up.

RESULTS

All samples showed high levels of ICBT engagement and acceptability. Insurance company employees experienced significant effects on outcome measures at post-treatment (depression d = 0.48; anxiety d = 0.81; disability d = 0.72) that were maintained at 3-month follow-up. Insurance company plan members, who notably had greater pre-treatment disability than the other samples, experienced significant moderate effects on outcome measures at post-treatment (depression d = 0.56, anxiety d = 0.53, disability d = 0.48), but gains were not maintained at 3-month follow-up. Effect sizes in both insurance company samples were significantly smaller than in the publicly-funded sample who reported no insurance benefits (depression d = 1.17-1.20; anxiety d = 1.31-1.36; disability d =.93-1.06 at post-treatment and 3-month follow-up) and the publicly-funded sample who reported having short-term disability benefits (depression d = .89-1.06; anxiety d = 1.01-1.18; disability d =.86-1.03 at post-treatment and 3-month follow-up).

CONCLUSIONS

Many clients referred and funded by insurance companies were engaged with ICBT and found it acceptable and effective. Results, however, were not maintained among those with very high levels of pre-treatment disability. Directions for future research related to ICBT funded by insurance companies are described.