Developing and implementing a web-based psychotherapy program to address anxiety and depression among patients receiving oncological and palliative care: An open-label, mixed-methods randomized controlled pilot trial (Preprint)

BACKGROUND Cancer is a prevalent disease that commonly leads to comorbid mental health conditions that are often undertreated due to barriers to traditional psychotherapy. Online cognitive behavioural therapy (e-CBT) could be an effective way to reduce these barriers since it demonstrates efficacy in reducing depression and anxiety symptoms, but its effectiveness is understudied in oncological and palliative populations. OBJECTIVE This study aimed to develop a web-based psychotherapy clinic for individuals receiving oncological and palliative care to examine whether this program is an effective psychotherapy to address this population's needs. METHODS Sixty participants diagnosed with depressive disorder and/or anxiety disorder in the context of oncological and/or palliative care conditions were recruited in Kingston, Canada. Participants were randomly assigned to either 8 weeks of a Mindfulness-Enhanced e-CBT (MECBT) program plus treatment as usual (TAU; n=32) or TAU alone (n=28). Participants in the MECBT condition completed weekly pre-designed modules, homework, and were sent personalized feedback. Additionally, a survey was sent out to all MECBT participants to conduct a thematic analysis of their experiences with the program. RESULTS Both conditions demonstrated reductions in anxiety and depression symptoms over time, and a statistically significant difference in depression scores occurred when comparing treatments. Six main themes were identified during the thematic analysis. CONCLUSIONS Findings support the effectiveness of MECBT in reducing depression severity. Qualitative benefits included providing structure, flexibility, and accessibility. Constructive feedback included problems with time restraints, the need for continuity of care, technical challenges, and the need for human contact. CLINICALTRIAL NCT04666974 INTERNATIONAL REGISTERED REPORT RR2-10.2196/30735