Why was the study done?

Public safety personnel (PSP) face high rates of mental health problems including, but not limited to, posttraumatic stress disorder (PTSD). Internet-delivered cognitive behavioural therapy (ICBT) shows promising outcomes for improving PSP mental health, but previous research has not yet evaluated PTSD-specific ICBT among Canadian PSP. There was also a need for research comparing PTSD-specific ICBT with ICBT designed to treat symptoms of multiple mental health concerns (known as transdiagnostic ICBT).

What was done in the study?

This study was designed to evaluate two ICBT programs tailored for PSP and offered via PSPNET—the PSP Wellbeing Course and the PSP PTSD Course—among 150 Canadian PSP who reported clinically significant symptoms of PTSD.

Content in the PSP Wellbeing Course focused on symptoms of depression, anxiety, and PTSD, while content in the PSP PTSD Course focused specifically on symptoms of PTSD. Both courses are 8 weeks long and included five lessons with weekly questionnaires, homework assignments, downloadable resources, and illustrative course vignettes. Optional therapist guidance by phone or secure email was also available up to twice a week for up 16 weeks. PSP were free to choose either course.

What did we find out?

Course preference:

• Approximately half the sample selected the PSP Wellbeing Course (57%), and approximately half selected the PSP PTSD Course (43%)
• PSP were more likely to enroll in the PSP Wellbeing Course if they had greater symptoms of depression

Course experience:

• PSP in both courses reported similar and favourable treatment satisfaction (e.g., 98% would recommend the course to a friend), treatment engagement (i.e., 69% access at least four of the five lessons), and feedback

Course effectiveness:

• The PSP Wellbeing Course resulted in greater reductions in panic disorder symptoms than the PSP PTSD Course
• PSP in both courses reported large reductions in depression, generalized anxiety, and PTSD
• PSP in both courses reported moderate reductions in anger
• PSP in both courses reported small reductions in social anxiety

Overall:

• The PSP Wellbeing Course and the PSP PTSD Course showed relatively similar outcomes
• This study builds on growing evidence that transdiagnostic ICBT (e.g., PSP Wellbeing Course) is at least as effective as disorder-specific ICBT (e.g., PSP PTSD Couse) for treating symptoms of various emotional disorders

Where do we go from here?

• This study builds on prior evidence that ICBT is an effective, acceptable, accessible, and useful treatment for PSP
• Future research should identify if and when disorder-specific ICBT is preferable to transdiagnostic ICBT

Original Story

Internet-delivered cognitive behavioural therapy for symptoms of PTSD among public safety personnel: Initial outcomes of an open cohort preference trial of transdiagnostic and disorder-specific therapy. Read publication here.

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Why was the study done?

PSPNET has tailored internet-delivered cognitive behavioural therapy (ICBT) to public safety personnel (PSP) to help address increased rates of mental health challenges within this population and overcome barriers to care. ICBT refers to a form of cognitive behavioural therapy that is delivered online in the form of a course and has shown to be as effective as face-to-face therapy. PSPNET offers both therapist-assisted and self-guided ICBT. PSPNET has previously used user feedback to evaluate and make iterative changes to ICBT. The current study was created to seek feedback from PSP leaders to further evaluate and optimize PSPNET.

What was done in the study?

PSP leaders from Saskatchewan (­n = 10) completed an interview on their perceptions of PSPNET. PSP leaders were asked to identify strengths and weaknesses of the program, including areas for improvement.

What did we find out?

Reach/Adoption:

• PSP leaders reported that information about PSPNET is reaching PSP within their organizations
• Factors that helped reach PSP included PSPNET building trust and relationships with PSP and support from PSP leaders and organizations
• Challenges for reaching PSP include:
  • general barriers to mental health care (e.g., stigma, time, confidentiality),
  • information overload (PSP receive too many emails),
  • and organization specific barriers (e.g., decentralized organizations)

Effectiveness:

• PSP leaders reported believing PSPNET is beneficial for individual PSP as well as PSP organizations
• PSP leaders reported that PSPNET is helping to improve awareness about posttraumatic stress injuries within their organization

Implementation:

• PSP leaders identified the characteristics of PSPNET’s ICBT (e.g., no cost, knowledgeable therapist support, accessibility) and promotional activities of PSPNET as factors that have made PSPNET successful
• Some ideas for improving PSPNET included:
  • Creating more promotional videos
  • Emphasizing the preventative aspects of PSPNET
  • Increasing the availability of PSPNET (e.g., access to therapist support across Canada)

Maintenance:

• PSP leaders are willing to continue to support and promote PSPNET and believe losing PSPNET would negatively affect their organization

Where do we go from here?

The results show that ICBT is viewed as valuable by PSP leaders and provide insight into best practices for promoting tailored ICBT (e.g., building relationships). The PSPNET team is using the feedback from PSP leaders to further improve services. For instance, the team is working on expanding therapist-assisted PSPNET to other provinces and is continuing to build relationships with PSP organizations.

Original Story

Optimizing internet-delivered cognitive therapy for public safety personnel using leaders’ feedback. Read publication here.

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Why Was the Study Done?

Public Safety Personnel (PSP) have an elevated risk of developing mental health problems and face barriers to accessing mental health treatments.

This study investigated:

• How PSP across Canada perceive internet-delivered cognitive behaviour therapy (ICBT) tailored to meet their needs.
• The level of organizational support for tailored ICBT within PSP organizations.
• Perceived facilitators and barriers to funding tailored ICBT.

The overarching purpose of the study was to develop strategies to provide ICBT to a greater number of PSP.

What was Done in the Study?

524 PSP across Canada participated in an online survey. They were asked to view a short video and brochure about PSPNET. Then, they answered questions about the advantages and disadvantages of tailored ICBT and factors that could help or hinder the implementation of PSPNET. 262 participants who self-identified as leaders were asked some additional questions about their perceptions of PSPNET. The survey was completed between November 2021 and March 2022.

What Did We Find Out?

• 72% of participants indicated that they had not heard about PSPNET before the survey, and 97% reported never having used PSPNET or any other form of online therapy.
• On average, PSP agreed or strongly agreed that mental health problems are common within their occupations and that PSPNET should be easily and freely accessible to them.
• PSP identified the following characteristics as PSPNET’s greatest advantages:
  • Accessibility at any time and location
  • Minimal wait time
  • Free service
  • Therapist guidance for 16 weeks

• When asked about potential disadvantages of PSPNET, PSP identified the following as mild concerns about PSPNET:
  • Absence of face-to-face interaction
  • ICBT may require more motivation than face-to-face therapy
  • Reading material could be fatiguing

• PSP leaders, on average, agreed or strongly agreed that:
  • PSPNET should be available and prioritized within their organizations
  • PSPNET would be an effective treatment option for PSP in their organizations
  • They would personally advocate for PSPNET to be made available within their organizations

• 3% of participants who self-identified as leaders indicated that PSPNET should be funded by the government, and 38% indicated that greater evidence of the success of ICBT would help facilitate funding.

Where Do We Go From Here?

• A key limitation of this study is that the PSP who decided to participate might be more responsive to the mental health needs of PSP and more supportive of PSPNET than the PSP who heard about the study and decided not to participate. As a result, our findings may overestimate the degree to which Canadian PSP have favorable attitudes towards PSPNET
• Some key insights that were gained from this study are:
  • PSP believe ICBT is valuable and needed, and they are willing to support its implementation
  • PSP believe that there is an increased need for funding, especially from the government, to address mental health services

Original Story

Sustaining and expanding internet-delivered cognitive behavioural therapy (ICBT) for public safety personnel across Canada: A survey of stakeholder perspectives. Read publication here.

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

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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 5^th, 2019, and March 15^th, 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.

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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 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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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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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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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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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.

We found several other interesting tendencies:

Stakeholders Surveyed

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