Examining the Effectiveness of Transdiagnostic, Internet-Delivered Cognitive Behaviour Therapy in New Mothers Experiencing Anxiety and Depression

Study Overview
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Brief Summary
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In the proposed study, the investigators will examine the efficacy of transdiagnostic, Internet-delivered cognitive behaviour therapy (ICBT) in the treatment of postpartum anxiety and depression. Half of participants will receive the treatment immediately, and half of the participants will be assigned to a treatment-as-usual control condition. Participants assigned to the control condition will be offered the treatment after a 12-week waiting period, although data from this portion will not be included in the current study. All participants will complete questionnaires prior to the start of the treatment, following treatment (or corresponding 8-week waiting period), at 1-months follow-up (or corresponding 12-week waiting period), and at 6-months follow-up (in those assigned to the treatment condition). Further, those who receive the treatment will complete questionnaires on a weekly basis. The primary outcome measures include anxiety and depression. As part of the battery of questionnaires administered after the completion of the program, participants will be asked to rate the program content, the overall service, and their satisfaction with the program.

Official Title
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Examining The Acceptability and Effectiveness of Transdiagnostic, Internet-Delivered Cognitive Behaviour Therapy for Symptoms of Postpartum Anxiety and Depression: A Randomized Controlled Trial

Conditions
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Depression, Postpartum, Anxiety

Intervention / Treatment
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* Behavioral: Therapist-assisted ICBT


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18 years of age or older female have given birth and have a child under one year of age score of 10 or above on EPDS or a score of 9 or above on the GAD-7 be a resident of Saskatchewan have access to a secure computer and the Internet, and be comfortable using technology be available to work through treatment each week be willing to provide a medical contact as an emergency contact Exclusion Criteria: younger than 18 years not female have not given birth to a child less than one year of age are experiencing minimal to no symptoms of anxiety and/or depression are not a resident of Saskatchewan have been hospitalized within the last year for mental health and/or suicide risk concerns; have unmanaged problems with alcohol, drugs, psychosis or mania, or are at increased suicide risk (specific plans and intent reflected by the Suicide Behaviors Questionnaire-Revised) started a new psychotropic medication within the past month do not have access to a secure computer and the Internet or is not comfortable using technology are not available to work through treatment each week are not willing to provide a medical contact as an emergency contact

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Therapist-assisted ICBT<br>An 8-week transdiagnostic internet-delivered cognitive behavioural therapy (ICBT) will be delivered to participants. In addition to the program, participants will receive support from registered social workers, psychologists or supervised graduate students, with experience delivering ICBT, with contact provided on a weekly basis. | Behavioral: Therapist-assisted ICBT<br>* An 8-week transdiagnostic internet-delivered cognitive behavioural therapy (ICBT) will be delivered to participants. In addition to the online program, therapists, registered social workers, psychologists or supervised graduate students will provide support by email once a week.<br>|
| No Intervention: Treatment as usual control<br>Participants will not receive access to the transdiagnostic internet-delivered cognitive behavioural therapy (ICBT) program for 12-weeks. Participants will be permitted to access community resources (e.g., support groups). After 12-weeks, participants will be offered the program although their treatment data will not be included in the current study. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in postpartum depression | Measured by the Edinburgh Postnatal Depression Scale (EPDS). 10 items are summed into a total score ranging from 0 to 30, with higher scores indicating more severe depression. | Baseline, weeks 1-9, 13, and 37 | 
| Change in anxiety | Measured by the Generalized Anxiety Disorder Scale 7-Item (GAD-7). 7 items are summed into a total score ranging from 0 to 21, with higher scores indicating more severe self-reported levels of anxiety. | Baseline, weeks 1-9, 13, and 37 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in depression | Measured by the Patient Health Questionnaire 9-Item (PHQ-9). 9 items are summed into a total score, with scores ranging from 0 to 27. Higher scores are associated with higher depression severity. | Baseline, weeks 1-9, 13, and 37 | 
| Change in depression, anxiety, stress | Measured by the Depression and Anxiety Stress Scales (DASS-21). 21 items are summed into a total score ranging from 0 to 42, with higher scores indicating more severe symptoms with respect to the depression, anxiety, and stress subscales. | Baseline, 8 weeks, 1 month, and 6 months | 
| Mother-infant bonding | Measured by the Postnatal Bonding Questionnaire (PBQ). 25 items are summed into a total score ranging from 0 to 125, with higher scores indicating more reported difficulties bonding with one's baby. | Baseline, weeks 9, 13, and 37 | 
| Relationship satisfaction | Measured by the Dyadic Adjustment Scale-7 item (DAS-7). 7 items are summed into a total score ranging from 0 to 32, with higher scores indicating greater perceived relationship quality. | Baseline, weeks 9, 13, and 37 | 
| Treatment credibility | Measured by the Credibility/Expectancy Questionnaire (CEQ). 6 items are summed into a total score and two subscales (credibility and expectancy). Total scores can range from 3 to 27, with higher scores representing greater perceptions of ICBT credibility. | Baseline and week 9 | 
| Therapeutic alliance | Measured by the Working Alliance Inventory-Short Revised (WAI-SR). Scores are summed into three sub-total scores, which respectively assess various domains of the therapeutic relationship (i.e., goal, task, and bond). Sub-total scores each range between 5 and 20, with higher scores representing better therapeutic relationship in each of the three domains assessed. | 9 weeks following baseline | 
| Treatment satisfaction | Measured by the Treatment Satisfaction Questionnaire (TSQ). 6 items are scored using various scales. Descriptive statistics are produced for each item. | 9 weeks following baseline | 
| Adverse effects | Measured by questions assessing whether participants encountered any adverse effects of treatment, developed any new psychological symptoms, or experienced any unexpected events over the course of treatment | 9 weeks following baseline | 
| Service utilization | Measured by a series of questions asking participants whether they accessed additional services or support | Weeks 9, 13, and 37 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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postpartum, depression, anxiety, internet-delivered cognitive behaviour therapy, randomized controlled trial, therapist-assistance