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Understanding and Addressing Occupational Stressors in Internet-Delivered Therapy for Public Safety Personnel

Authors: Beahm, J.D., Landry, C.A., McCall, H.C., Carleton, R.N., & Hadjistavropoulos, H.D.

Topics: ICBT

PSP

Why Was the Study Done?

Public safety personnel (PSP) experience high rates of mental health concerns. Two types of occupational stressors that may contribute to the mental health concerns of PSP are operational stressors and organizational stressors. Operational stressors have to do with one’s job duties, such as fatigue from shift work, exposure to potentially psychologically traumatic events, and conflicts between work and personal life. Organizational stressors have to do with the context of one’s job, such as staff shortages, interpersonal issues, and a lack of resources leading to unmanageable workloads.

Internet-delivered Cognitive Behavioural Therapy (ICBT) effectively treats various mental health concerns and can help overcome barriers to care. The current study examined the occupational stressors that PSP describe when seeking and receiving ICBT and how PSP use skills learned in ICBT to manage those stressors.

 

What Was Done in the Study?

This study examined data from 126 Saskatchewan-based clients enrolled in the PSP Wellbeing Course with PSPNET between December 5th, 2019, and March 15th, 2021. Data included information PSP shared with their therapist before, during, and after ICBT. Researchers striped all data of personal information, and PSP provided consent for their data to be used as part of this research.

 

What Did We Find Out?

  • 96.8% of clients reported seeking ICBT for one or more occupational stressors.
  • 89.6% of clients reported operational stressors during the eligibility screen, and 45.2% reported organizational stressors.
  • 79.3% of clients reported being exposed to one or more potentially psychologically traumatic events (PPTEs). PPTEs were the most frequent type of occupational stressor mentioned by clients during the eligibility screen.
  • Most clients (69.5%) also reported seeking ICBT because of personal stressors outside of occupational stressors.
  • Clients noted that skills from the course helped them manage stress related to:
    • Being exposed to psychologically traumatic events
    • Dealing with demanding or combative clients/patients
    • Attending trial
    • Flashbacks or symptoms related to previous calls
    • Feelings of inadequacy related to their job
    • Becoming more social at work
    • Being more assertive when criticized by the public
  • Clients also described the skills as helpful for improving personal relationships impacted by their work (e.g., managing anger and outbursts towards family).
  • Thought challenging was the skill most frequently reported as helpful for managing occupational stressors.
  • Many clients found the PSP-specific case stories helpful.

 

Where Do We Go From Here?

This study shows that PSP seek and use ICBT to manage diverse occupational stressors, including both operational and organizational stressors. Overall, thought challenging was the skill most frequently reported as helpful by PSP. PSPNET is using the result from this study to continue to adapt and improve the PSP Wellbeing Course. For instance, the results have been used to make changes to PSP-specific case stories and to guide the development of new additional resources.

 

Original Story

Understanding and addressing occupational stressors in internet-delivered therapy for public safety personnel. Read publication here.

The original wording of the study was changed and condensed for the current research summary.

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Public Safety Personnel Insights Into Internet-Delivered Cognitive Behavioural Therapy

Authors: Beahm, J.D., McCall, H.C., Carleton, R.N., Titov, N., Dear, B., & Hadjistavropoulos, H.D.

Topics: ICBT

PSP

Why Was the Study Done?

Canadian public safety personnel (PSP) have high rates of mental health problems. Internet-delivered cognitive behavioural therapy (ICBT) is effective for treating various mental health concerns and can reduce barriers to care like time constraints and fear of stigma. The PSP Wellbeing Course is an ICBT course that has been tailored by PSPNET to the Canadian PSP experience. It includes five core lessons and resources on additional topics. Therapist support is provided weekly, biweekly, or as needed based on client choice over eight weeks with the option to extend to up to 16 weeks.

Tailoring of PSPNET courses is an ongoing process based on feedback from clients sought throughout their time in the courses. The current study looked at data collected from early users of the PSP Wellbeing Course that was used to continue the customization process. The research team wanted to determine the perceived impact of the course as well as what users liked and disliked.

 

What Was Done in the Study?

This study examined client communication and feedback from 82 clients who signed up for the PSP Wellbeing Course between December 2019 and June 2020.  The study looked at de-identified responses from client emails to therapists, optional weekly homework reflection questions, and a treatment satisfaction questionnaire (TSQ) administered at eight weeks post-enrollment. Of the 82 clients, 57 completed the TSQ.

 

What Did We Find Out?

  • Of the 57 clients who completed the TSQ, 97% indicated the course was worth their time, and 98% said they would recommend it to others.
  • A majority of clients who completed the TSQ also provided specific comments about benefiting from the course, including:
    • Increased skills and/or improved well-being;
    • normalization of mental health issues;
    • improved communications or relationships;
    • beneficial for PSP; and
    • good reminder of previously learned skills.
  • Less than 10% of clients who completed the TSQ reported the course had little or no impact on well-being.
    • 9% reported the program didn’t meet their specific needs.
  • Some clients (74%) reported difficultly with the eight-week timeline or technical difficulties logging in or using the course. However, these clients did not report that hindering events were detrimental to their overall experience in the course.
  • 25% of clients that completed the course indicated they had experienced an increase or novel symptoms from working on the course. However, they also indicated that the course skills helped them cope with these changes and the effects decreased as they progressed through the course.
  • Thought-challenging was the skill most frequently cited as helpful.
  • Clients reported several helpful aspects of the course including:
    • Therapist check-ins and communication;
    • course design and format;
    • DIY guides;
    • PSP stories;
    • additional resources beyond the core lessons ;and
    • flexibility and convenience of the course.
  • When asked to provide suggestions for improving the course, clients suggested:
    • Improving some aspects of the course design and materials;
    • improving some of the case stories;
    • including more topics in the additional resources;
    • including audio/video;
    • adjusting the course timelines;
    • addressing technical issues; and
    • increasing contact or accountability.

 

Where Do We Go From Here?

PSPNET has been designed to fill a need for tailored and easily accessible mental health treatment for PSP. Feedback from clients allows for continued program improvement. The feedback outlined in this study was used to make improvements to the PSP Wellbeing Course, including adding and improving additional resources and the inclusion of lesson audio. The course is now offered to all PSP in Saskatchewan, Quebec, New Brunswick, and Nova Scotia at no charge.

 

Original Story

Insights into internet-delivered cognitive behavioural therapy for public safety personnel: Exploration of client experiences during and after treatment. Read publication here.

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Why Do PSP Seek PSPNET’s Services?

Authors: McCall, H.C., Landry, C.A., Ogunade, A., Carleton, R.N., & Hadjistavropoulos

Topics: ICBT

PSP

Why Was the Study Done?

Public safety personnel (PSP) have elevated rates of mental health disorders. Because of the nature of their work, they can face barriers (stigma, access, cost) to getting mental health care. There is a growing interest amongst PSP about the use of internet-delivered cognitive behavioural therapy (ICBT). ICBT is effective in treating anxiety, mood, and trauma-related disorders. ICBT can be offered in a therapist-supported or self-guided format. ICBT is also private, accessible at any time or location, and cost-effective, eliminating many common barriers to treatment.

PSPNET has developed a tailored ICBT program for Canadian PSP with promising initial outcomes. However, little is known about why PSP seek ICBT. The current study will explore responses from prospective PSPNET clients to determine:

  • What occupational sectors do they come from? What personal characteristics (e.g., age, gender) do they report?
  • How did they hear about PSPNET?
  • How do they perceive ICBT?
  • What motivated them to seek ICBT?
  • What is the nature of their clinical concerns?
  • What previous treatments have they used?

 

What Was Done in the Study?

Participants were 259 PSP from Saskatchewan and Quebec who signed up for PSPNET from December 2019 to March 2021. Participants answered questions about their symptoms of mental health disorders, current functioning, expectations of ICBT, and previous mental health service usage. They were also asked how they heard about PSPNET and why they sought PSPNET’s ICBT services.

 

What Did We Find Out?

  • The average age of participants was 40.2 years, and the balance between men and women was fairly equal, with women making up 51.4% of participants.
  • Participants were from all sectors, but the bulk (74%) came from police, paramedics, and corrections.
  • 6% of participants indicated they had heard about PSPNET through an employer, union, work colleague, or professional association.
  • On average, participants expected a 55% improvement in symptoms with ICBT and reported feeling that ICBT would be “somewhat effective” to “very effective”.
  • The majority of participants (74.1%) reported multiple reasons for trying ICBT. The top three reasons were:
    • I heard about it and wanted to try it (49.8%)
    • Wanting to learn to manage symptoms independently (47.1%)
    • The convenience of ICBT (42.5%)
  • Most participants (52.5%) reported previously consulting a healthcare or mental health care professional.
  • The vast majority (84.7%) of participants screened positive for at least one mental health disorder, with 65.8% screening positive for two or more. The three most common types of symptoms in the clinically significant range were depression, anxiety, and PTSD.

 

Where Do We Go From Here?

This study has limitations, the most obvious being that feedback is limited to those that signed up for PSPNET. There were also only participants from the two provinces where PSPNET was offered during the study. However, there are some valuable insights. They include:

  • Partnerships with PSP organizations may be helpful to facilitate ICBT use;
  • prospective PSP clients wanted to learn to manage their problems, suggesting that skills-based or resilience-based treatment approaches are a good idea with PSP; and
  • most reported elevated symptoms of mental health disorders even with previous treatment, which means PSP may require specialized care.

 

Original Story

Why do public safety personnel seek tailored internet-delivered cognitive behavioural therapy? An observational study of treatment seekers. Read publication here.

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Initial Outcomes of PSPNET’s Wellbeing Course

Authors: Hajistavropoulous, H., McCall, H., Thiessen, D.L., Huang, Z. Carleton, R.N., Dear, B.F., & Titov, N

Topics: ICBT

PSP

Why Was the Study Done?

Canadian public safety personnel (PSP) experience high rates of mental health disorders. They also experience many barriers to accessing treatment, such as stigma, distance from services, and time constraints.

Internet-delivered cognitive behavioural therapy (ICBT) Internet-delivered cognitive behavioural therapy (ICBT) can help overcome these barriers because it can be accessed privately at any time and location Previous research has shown that ICBT is effective for treating various mental health disorders, including depression, anxiety, and PTSD.

The current study presents the outcomes, treatment satisfaction and program-usage patterns of the PSP Wellbeing Course for the first 83 clients in Saskatchewan.

 

What Was Done in the Study?

Clients completed an online screening questionnaire and phone screening interview before beginning the course. They were asked to complete questionnaires again after the course (8 weeks). The pre- and post-course questionnaires included measures of depression, anxiety, PTSD, and other mental health disorders.

 

What Did We Find Out?

  • Clients experienced a large improvement on measures of depression and anxiety.
  • Clients experienced a moderate improvement on measures of PTSD and other mental disorders.
  • 86% of clients who completed the satisfaction measure said the course had increased or greatly increased their confidence in their ability to manage their symptoms.
  • 98% of clients said the course was worth their time.
  • 89% of clients chose once-weekly therapist support.

Where Do We Go From Here?

Early results show that the PSP Wellbeing Course is a promising and effective method for treating depression, anxiety, and PTSD in PSP. PSPNET will continue to apply client feedback to improve the course. The team has already expanded services to Quebec. They will continue to share their findings as more PSP complete the course.

 

Original Study

Initial Outcomes of Transdiagnostic Internet-Delivered Cognitive Behavioral Therapy Tailored to Public Safety Personnel: Longitudinal Observational Study

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How Have Public Safety Personnel Seeking Help Been Affected by COVID-19?

Authors: Hugh C. McCall, M.A., Janine Beahm, M.A., Caeleigh Landry, B.A., Ziyin Huang, HBSc, R. Nick Carleton, Ph.D, Heather D. Hadjistavropoulos, Ph.D.

Topics: ICBT

PSP

Why Was the Study Done?

The COVID-19 pandemic is creating mental health problems worldwide as people adjust to limited personal interaction and the cancellation of numerous activities. Public safety personnel (PSP), who are at the front line of this pandemic, already display higher levels of mental health issues than the general public.

PSPNET is a free, internet-delivered cognitive behavioural therapy program designed specifically for PSP. Since the program launched just before COVID-19 arrived in Canada, the PSPNET team took the opportunity to explore the frequency and intensity of COVID-19 concerns in PSP seeking mental health help through the program.

 

What Was Done in the Study?

PSP that enroll in PSPNET must complete a set of screening questionnaires and a phone interview with a therapist. Therapists began to inquire about the impact of COVID-19 when it first reached the province of Saskatchewan. As cases increased, a separate COVID-19 screening questionnaire was added (April 13, 2020), which looked at the fears and impact of COVID-19. In total, 59 Saskatchewan PSP contributed to the study.

 

What Did We Find Out?

  • On average, participants were primarily white female, married without children, and lived in communities with less than 100,000 people.
  • The top two fears reported on the questionnaire were: 1) a family member getting COVID-19 (37%); and 2) the PSP giving someone else COVID-19 (22%).
  • Few participants reported severe fears related to COVID-19
  • When asked about the impacts of COVID-19, most reported a concern about maintaining distance at work (56%). However, the majority said they didn’t feel socially isolated by COVID-19 (63%), and fear of COVID-19 was not interfering with enjoyment in their life (59%).
  • The majority of participants that completed the phone interview indicated that COVID-19 was negatively impacting them to some extent. There were two major ways they were affected: 1) emotionally, and 2) by logistical complications.
  • Participants reported experiencing a range of negative emotions related to concerns about family becoming sick, fear of contracting the virus, isolation, or boredom.
  • Logistical complications included concerns about increased call volumes, the healthcare system’s inability to manage COVID-19 impact, management not taking the pandemic seriously, and not being provided adequate PPE.
  • 40% of those who completed a phone interview reported no negative impacts from COVID.

Where Do We Go From Here?

Most of the PSP who were seeking help from PSPNET reported that COVID-19 had negatively impacted their lives emotionally and logistically, but few reported severe impacts. These findings can inform programs and policies designed to help PSP cope with the COVID-19 pandemic. There are limitations to this study. It had a small sample from a province that has been less affected by the pandemic than other regions. It also relied on a more rural sample; the findings might be different in more urban areas. However, this study does support the idea that PSP may be impacted differently by COVID-19.

 

Original Study

How have public safety personnel seeking digital mental healthcare been affected by the COVID-19 pandemic? An exploratory mixed methods study. International Journal of Environmental Research and Public Health. 

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Exploring the Role of Persuasive Design in Self-Guided Internet-Delivered Cognitive Behavioural Therapy

Authors: Hugh C. McCall, M.A., Heather D. Hadjistavropoulos, Ph.D., Christopher Sundström, Ph.D.

Topics: ICBT

PSP

What Did We Do?

Internet-delivered cognitive behavioural therapy (ICBT) is an innovative treatment for common mental health problems like depression and anxiety. It is approximately as effective as face-to-face therapy when it is offered with therapist support by phone or secure email. It is not as effective when it is offered in a purely self-guided format, but it is easier to implement on a large scale. Various research groups have suggested that persuasive design—designing an intervention to be more engaging and stimulating for users (e.g., making treatment personalized, streamlined, and interactive)—can help improve the effectiveness of ICBT and other digital interventions for health and mental health problems.

The objective of this research was to review previously published studies to explore the relationship between persuasive design elements and effectiveness in unguided ICBT for depression and anxiety. A systematic search of five databases was conducted to identify relevant studies. A statistical procedure called meta-regression was used to determine whether the effectiveness of each unguided ICBT program was meaningfully related to the number of persuasive design elements it included.

What Did We Find?

A total of 41 studies were identified through the systematic search. The most common persuasive design elements were related to streamlining tasks of treatment and enabling users to monitor their treatment progress. The results of the meta-regressions showed that the number of persuasive design elements identified in each intervention was meaningfully related to the effectiveness of ICBT for depression but not ICBT for anxiety.

Where Do We Go From Here?

The results suggest that more persuasively designed ICBT interventions are more effective, at least for treating symptoms of depression. Since this research was conducted, PSPNET has begun incorporating new persuasive design elements (e.g., graphs to display to clients their symptom change over time) into its courses. Further research will be required to clarify the role of persuasive design in ICBT. In particular, it would be helpful to explore clients’ perspectives and experiences related to persuasive design elements and to conduct experimental studies that can directly test whether certain persuasive design elements improve the effectiveness of ICBT.

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Survey Results Examining Perceptions of ICBT Among Saskatchewan PSP

Authors: Angelo P. Sison, B.A. (Hons), Hugh C. McCall, M.A., Jody L. Burnett, Ph.D., Heather D. Hadjistavropoulos, Ph.D.

Topics: ICBT

PSP

What Did We Do?

In order to broadly understand perceptions of internet-delivered cognitive behaviour therapy (ICBT) among Public safety personnel (PSP), we informed PSP about ICBT through a simple poster or a poster plus a story. An online survey was then used to explore perceptions of ICBT among PSP. We received 132 responses from various PSP including those working for border services, corrections, dispatch, EMS, fire, and police.

What Did We Find?

Most PSP told us they would use ICBT if they needed help with mental health concerns.

Participants’ most preferred sources of treatment for mental health problems, out of 13 options, were as follows:

We found several other interesting tendencies:

Where Do We Go From Here?

The results of the survey indicated that PSP have favourable perceptions of ICBT, which suggests there will likely be broad interest in ICBT among PSP in Saskatchewan. PSP formulated these impressions based on a simple poster and a brief story. Ideas for improving the poster included clarifying patient privacy, duration of treatment, and number of sessions per week.

Stakeholders Surveyed

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PSPNET Stakeholder Interview Summary

Authors: Hugh C. McCall, M.A., Heather D. Hadjistavropoulos, Ph.D., Amélie K. Fournier, Ph.D., Jody L. Burnett, Ph.D., Janine D. Beahm, M.A., and R. Nicholas Carleton, Ph.D.

Topics: ICBT

PSP

What Did We Do?

Public safety personnel (PSP) work hard to keep Canadians safe. PSP have high rates of mental health problems and often struggle to access effective mental health care, such as cognitive behaviour therapy (CBT). The PSPNET team’s mission is to develop and evaluate Internet-delivered cognitive behaviour therapy (ICBT) that is tailored specifically to PSP. ICBT is more accessible than face-to-face CBT and is similarly effective. To inform the development of our program, we conducted and systematically analyzed interviews with PSP. We interviewed 126 PSP from across Saskatchewan and Quebec, including police, fire, EMS, corrections, dispatch, and border services.

 

What Did We Find?

PSP shared various reasons why they do not seek face-to-face mental health care. They also shared what they perceived to be the advantages and disadvantages of ICBT.

When asked about the content that should be included, stakeholders listed many options. The top six were:

  • Identifying and understanding symptoms
  • Relationships and Communication 5
  • Improving Sleep
  • Regulating Emotions
  • Substance misuse/dependency
  • Real case stories specific to PSP

When asked what PSP want ICBT therapists to know about them, the top six answers were:

  • They are frequently exposed to potentially traumatic events
  • They have a high frequency of mental and physical health issues with limited workplace support
  • There is an expectation of toughness
  • PSP become pessimistic/jaded over time
  • It is often difficult to talk to other people about their experiences
  • They often tend to have Type A personalities and a high need for control

Where Do We Go From Here?

The interviews indicated that there is strong support for ICBT among PSP. We have used the feedback from these interviews to help tailor ICBT for PSP. PSPNET is now being offered in Saskatchewan with plans underway to offer services in Quebec later in 2020

 

Stakeholders Interviewed

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Understanding and Addressing Occupational Stressors in Internet-Delivered Therapy for Public Safety Personnel: A Qualitative Analysis.

International Journal of Environmental Research and Public Health. 2022; 19(8):4744.

Authors: Beahm JD, Landry CA, McCall HC, Carleton RN, Hadjistavropoulos HD.

Topics: ICBT

PSP

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Why Do Public Safety Personnel Seek Tailored Internet-Delivered Cognitive Behavioural Therapy? An Observational Study of Treatment-Seekers.

2021. International Journal of Environmental Research and Public Health, 18(22), 1197

Authors: McCall, H. C., Landry, C. A., Ogunade, A., Carleton, R. N., & Hadjistavropoulos, H. D.

Topics: ICBT

PSP

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