Transdiagnostic internet-delivered cognitive behavioural therapy for university students with symptoms of anxiety and depression

Anxiety and mood disorders are prevalent among university students, but many do not seek treatment. The first two studies of the present thesis aimed to evaluate whether a transdiagnostic internet-delivered cognitive behavioural therapy intervention (iCBT), the UniWellbeing Course, is efficacious and acceptable to students with symptoms of anxiety and depression. Study III evaluated the implementation of iCBT in a student counselling service (SCS). In Study I university students (n = 52) with symptoms of anxiety or depression were randomly allocated to receive therapist-guided iCBT or to a waitlist-control group. At post-treatment mixed models analyses revealed outcomes for the treatment group were statistically and clinically superior to those of the waitlist-control group on the primary outcome measures, the Patient Health Questionnaire 9-Item (PHQ-9) and the Generalized Anxiety Disorder 7-Item (GAD-7), with gains sustained at 3-month follow-up. Clinically significant reductions in the number of diagnoses of anxiety and depression were also found, with a mean total of 27 minutes of clinician time required per participant during the program. In Study II, the waitlist-control group from Study I received a self-guided version of the UniWellbeing Course, using an open trial design. Outcomes were consistent with those from the treatment group in Study I. In Study III, the UniWellbeing Course was offered to students attending a SCS as an alternative to treatment as usual. This small open trial (n = 6) found no statistically significant improvements as measured by the primary outcome measures, the PHQ-9 and GAD-7. Study III also explored the implementation of iCBT at the SCS using a structured methodology which identified several barriers to implementation including clinician attitudes and student treatment preferences. Notwithstanding these challenges, students, as well as managers and clinicians of the SCS who used the intervention rated it as highly acceptable. The results provide preliminary support that transdiagnostic iCBT for university students has the potential to be clinically effective, and acceptable to consumers, therapists, and service managers.