Table 3 Overview of ICBT Delivery Process

Screening conducted by OTU

Online screening assessed patients for basic eligibility:(1) 18 years or older; (2) residents of Saskatchewan, Canada; (3) self-reporting symptoms of depression and or anxiety; (4) able to access and comfortable using computers and the Internet; (5) reporting no past history of psychotic symptoms; (6) available to participate in ICBT for 8 weeks; and (7) willing to provide a physician as an emergency contact. Eligible patients then completed additional online questions about their background and psychological symptoms/distress. A follow-up telephone interview was conducted by the OTU to ensure patients’ consented to ICBT and were not at high risk of suicide, needing help with a different disorder (e.g., alcohol or drugs, psychosis, bipolar), or in receipt of regular therapy.

Coordination

Patients were assigned to the first available registered therapist in one of the participating community clinics. If unavailable, the patient was offered treatment by a supervised graduate student or a registered provider working in the OTU.

Website

ICBT was available through a single secure server managed by the OTU. All patients and therapists used login credentials to access the course and communicated through this server.

ICBT Program

All patients were offered an ICBT course, called the Wellbeing Course [see 7 for details]. This is a transdiagnostic cognitive behavioural intervention targeting symptoms of depression and anxiety. It comprises 5 online lessons (text-based with visual images) released over 8 weeks that provide psychoeducation and instructions about: 1) symptom identification and the cognitive behavioral model; 2) thought monitoring and challenging; 3) de-arousal strategies and pleasant activity scheduling; 4) graduated exposure; and 5) relapse prevention. Patients are assigned homework to facilitate acquisition of skills.

Therapist-assistance

Patients were able to contact therapists by secure email for 8 weeks. Therapists responded to patient emails once a week, with a message that:1) highlighted the lesson content; 2) answered questions and assisted patients in applying skills; 3) reinforced progress, completion of the lessons, and practice of skills; and 4) provided support and normalized patient challenges. Therapists had the option to phone patients or send additional messages if they deemed this would facilitate treatment. Therapists were instructed to spend ~15 to 20 min on therapist-assistance per week.

Outcome monitoring

Patients completed brief measures of depression and anxiety [see 7 for details on measures] prior to each lesson to assist therapists in systematically assessing patient progress.