Abstract
Introduction
Transdiagnostic self-help cognitive behavioral therapy (CBT) approaches may help ease the burden of untreated symptoms of internalizing distress, especially in geographic areas with relatively small numbers of mental health providers.
Methods
Over the course of 12 months, we conducted a six-week randomized controlled trial (N = 275) across Indiana, a state with high unmet need for mental health care. All participants were given immediate access to a single-session intervention (SSI) followed by randomization to either guided or unguided CBT-based bibliotherapy. We used mixed models to model change over time in distress, well-being, and emotion regulation as a piecewise function of study week.
Results
The sample was in their early 30s (M = 34.10, SD = 11.68), mostly female (75.64%, n = 208) and, consistent with the demographics of the state, mostly Non-Hispanic White (80.36%, n = 221). Less than half of participants accessed the SSI (39.27%, n = 108). There was no evidence that completing the SSI was associated with improved outcomes, though it improved study engagement. Participants randomized to the guided (vs. unguided) condition experienced greater overall improvements in internalizing distress (SMD=-0.44, 95% CI: -0.74, -0.13) and cognitive reappraisal (SMD = 0.32, 95% CI: 0.06, 0.58). The differences between groups in improvements in well-being (SMD = 0.25, 95% CI: -0.13, 0.63) and expressive suppression (SMD=-0.24, 95% CI: -0.55, 0.07) were smaller and not statistically significant. Virtually all participants expressed some interest in more therapy via telehealth (89.74%, n = 140). Findings were sensitive to multiple imputation using random forests as well as propensity score matching.
Discussion
Self-help approaches are scalable interventions for individuals in under-served states. As in previous work, guided self-help was more effective than unguided self-help. More work should focus on adding additional treatment steps past self-help.
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Funding
This research was funded by: the Indiana University Center for Rural Engagement, the National Institute of Mental Health grant T32 MH103213-06 which provided support for Peipert, De Jesús-Romero, Buss, and Starvaggi) and grant numbers KL2TR002530 and UL1TR002529 (A. Shekhar, PI) from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award which provided support for Prof. Lorenzo-Luaces.
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Conceptualization: LL-L, JH. Data curation: LL-L. Formal Analysis: LL-L. Funding acquisition: LL-L. Investigation: LL-L, JH, RDJ-R, AP, JB, CL, IS. Methodology: LL-L. Project administration: LL-L, JH, CD. Resources: LL-L. Software: LL-L. Supervision: LL-L. Validation: LL-L. Visualization: LL-L. Writing ? original draft: LL-L. Writing review & editing: LL-L, JH, RDJ-R, AP, JB, CL, IS, RF, CD, SA, IR.
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Prof. Lorenzo-Luaces and Robert Fite have received consulting fees from Syra Health, inc. who had no role in the current research. The other authors declare no conflict of interest.
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Lorenzo-Luaces, L., Dierckman, C., Lind, C. et al. A Pragmatic Randomized Controlled Trial of Stepped Care Cognitive-behavioral Therapy for Internalizing Distress in Adults. Cogn Ther Res (2024). https://doi.org/10.1007/s10608-024-10489-7
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DOI: https://doi.org/10.1007/s10608-024-10489-7