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Background: The Wellbeing Course is a transdiagnostic online program designed to treat anxiety and depression. The five lesson course teaches patients skills for managing anxiety and depression based on principals of cognitive behavioural therapy and includes weekly therapist contact via telephone or secure message. The program has been shown to reduce symptoms in patients overall and, on average, patients report a high degree of satisfaction. Although the program is effective overall, only 75% of patients complete the program and only 50% of patients complete the program and report a reliable reduction in either anxiety or depression. The aim of this research was therefore to examine patient outcomes further and look for relationships with patient characteristics that might allow us to predict which patients are most likely to benefit from online therapy.
Method: Patient case records from 1201 patients who enrolled in the Wellbeing Course were compiled and analyzed to look for relationships between patient characteristics at intake and patient outcomes. Autoregressive latent trajectory modeling was used to look for relationships between patient characteristics and patient symptom change over time. Classification trees were created to predict treatment dropout and overall treatment success.
Results: Younger people were found to be at greater risk of dropping out from online therapy. Higher initial severity of anxiety or depression was related to greater improvement over the course of therapy. Age and relationship status were related to anxiety symptom trajectories, while education and initial psychological distress and disability scores were related to depressive symptom trajectories.
Conclusions: Although some groups were identified as being at higher risk of dropout or not improving, none of these effects were strong enough to suggest that exclusion criteria for the program should be changed. Instead, future research should look at how the program can be modified to improve outcomes for at-risk groups.