@article{pmid40075340,

title = {Transdiagnostic internet cognitive behavioural therapy for anxiety and depressive symptoms in postnatal women: protocol of a randomized controlled trial},

author = {Pasquale Roberge and Helen-Maria Vasiliadis and Alexandra Chapdelaine and Marie-Claude Battista and Marie-Claude Beaulieu and Marie-Hélène Chomienne and Annabelle Cumyn and Martin Drapeau and Camila Durand and Ariane Girard and Dominique Gosselin and Jean Grenier and Isabelle Hardy and Catherine Hudon and Diana Koszycki and Réal Labelle and Alain Lesage and Marie-Thérèse Lussier and Alison Mahoney and Martin D Provencher and Christine T Shiner},

doi = {10.1186/s12888-025-06636-3},

issn = {1471-244X},

year  = {2025},

date = {2025-03-01},

journal = {BMC Psychiatry},

volume = {25},

number = {1},

pages = {237},

abstract = {BACKGROUND: Nearly 20% of women will be confronted with anxiety or depressive disorders during the perinatal period and this may lead to adverse outcomes for both mother and child. Cognitive behavioural therapy (CBT) is the psychological intervention with the most empirical support for the clinical management of anxiety and depressive disorders. Anxiety and depression frequently occur in women during the perinatal period, and there is growing evidence that internet-delivered CBT (iCBT) could be an acceptable and effective intervention. THIS WAY UP, an Australian digital mental health service, has developed a program for postnatal anxiety and depression. This study protocol aims to examine the acceptability and efficacy of a French-Canadian adaptation of the program.nnMETHODS/DESIGN: The research team propose to conduct a mixed hybrid type 1 pragmatic randomized clinical trial and implementation study to replicate the findings of the trial conducted in Australia by Loughnan et al. (2019), as well as explore barriers and facilitators to potential large-scale implementation. TREATMENT AND CONTROL CONDITIONS: a) postnatal anxiety and depression iCBT program with three lessons to complete in a six-week period, added to treatment-as-usual (TAU); b) TAU. Participants will include French-speaking women with probable postnatal depression or anxiety as per the Generalized Anxiety Disorder-7 (GAD-7) or the Edinburgh Postnatal Depression Scale (EPDS). The primary outcome measures will be the GAD-7 and the EPDS. Secondary outcome measures will comprise self-reported instruments to evaluate psychological distress, quality of life, mother-child experience, and treatment experience. Qualitative interviews with participants and health professionals will provide insights on acceptability and delivery of the iCBT program.nnSTATISTICAL ANALYSIS: Statistical analysis will follow intent-to-treat principles. A mixed model regression approach will be used to account for between- and within-subject variations in the analysis of the effects of iCBT compared to TAU only intervention.nnDISCUSSION: The study will generate important data of efficacy and acceptability to patients, clinicians, and decision-makers to inform the scaling-up of the postnatal iCBT intervention in Canada.nnTRIAL REGISTRATION: ClinicalTrials.gov: NCT06778096, prospectively registered on 2025/01/16.},

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pubstate = {published},

tppubtype = {article}

}

@article{pmid39961344,

title = {Psychometric Assessment of the Mental Health Self-Management Questionnaire in a Clinical Sample With Anxiety Disorders},

author = {Natalia Muñoz Gómez and Simon Coulombe and Janie Houle and Nathalie Carrier and Martin D Provencher and Peter J Norton and Pasquale Roberge},

doi = {10.1177/00332941251320305},

issn = {1558-691X},

year  = {2025},

date = {2025-02-01},

journal = {Psychol Rep},

pages = {332941251320305},

abstract = {The development of self-management strategies plays an active role in the recovery process of individuals suffering from mental disorders. The Mental Health Self-Management Questionnaire (MHSQ) was developed to give empirical insight into the construct of self-management. This study aimed to assess the psychometric properties of this recent instrument in a sample of patients meeting DSM-5 criteria for anxiety disorders. Data were drawn from a randomized controlled trial examining transdiagnostic group cognitive-behavioural therapy compared to treatment-as-usual for anxiety disorders. Participants ( = 231) completed a structured interview for anxiety disorders and several self-reported measures, including the MHSQ. Confirmatory factor analysis for the initial three-factor structure showed adequate fit after adding covariances between certain items. The MHSQ had acceptable reliability for the  (α = .73, ω = .78),  (α = .80, ω = .80) and  (α = .71, ω = .71) subscales. Results showed high correlations with measures of well-being and moderate correlations with measures of disability and depression, especially on the empowerment and vitality subscales. Lower correlations were found between the MHSQ and anxiety symptoms. The linear mixed model examining sensitivity to change showed that the MHSQ score at post-treatment was significantly greater for the experimental condition compared to the control condition for the clinical and empowerment subscales. The MHSQ is a promising measure, and research with other clinical populations and long-term follow-up is warranted to gather further evidence on the validity and fidelity of the instrument.},

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pubstate = {published},

tppubtype = {article}

}

@article{pmid39379845,

title = {A digital iCBT intervention for social anxiety disorder in Quebec and Ontario: protocol for a multi-phase effectiveness-implementation study},

author = {Helen-Maria Vasiliadis and Pasquale Roberge and Jessica Spagnolo and Catherine Lamoureux-Lamarche and Alexandra Chapdelaine and Magaly Brodeur and Jean Grenier and Alison Mahoney and Diana Koszycki and Marie-Hélène Chomienne and Martin Drapeau and Réal Labelle and Martin D Provencher and Marie-Claire Ishimo and John A Naslund and Alain Lesage},

doi = {10.1186/s12888-024-06082-7},

issn = {1471-244X},

year  = {2024},

date = {2024-10-01},

journal = {BMC Psychiatry},

volume = {24},

number = {1},

pages = {662},

abstract = {BACKGROUND: Social anxiety disorder (SAD) is one of the most prevalent anxiety disorders in Canada. Viable therapy options for the treatment of SAD include CBT being delivered virtually. In Australia, an innovative internet-delivered cognitive-behavioral therapy (iCBT) program for social anxiety has been developed, implemented, and demonstrated as effective. To make available high-quality and real-time evidence in response to the crucial need to access psychological services to meet population mental health needs, we propose to conduct a Canadian adaptation of the iCBT Shyness Program and to examine the program's effectiveness, and implementation in two Canadian provinces (Quebec and Ontario).nnMETHODS: The overall study design is a hybrid effectiveness-implementation study of a quasi-experimental parallel group trial. Prior to implementing the iCBT Shyness Program, it will undergo an initial adaptation to the Canadian context and focus groups will be conducted with key actor groups to discuss the adaptations to the graphics, narration of the lessons, and this to better reflect varying socio-cultural context among Canadian French- and English-speaking populations. We will evaluate the effectiveness of the program in three parallel pathways reflecting real-world pathways: (1) self-refer to the intervention; (2) recommended by a health professional without guidance; and (3) recommended by a health professional, with low-intensity guidance. Data collection will be carried out at baseline, at the beginning of each lesson, 12-week and 6-month follow-up. Outcomes measured will include anxiety and depressive symptoms, psychological distress, disability, as well as health service utilization and satisfaction. Semi-structured interviews will then be conducted with study participants and health care providers to explore facilitating factors and barriers to the implementation of the iCBT adapted program.nnDISCUSSION: This study will provide evidence on the effectiveness, barriers and facilitating factors to implementing a low-intensity iCBT in the Canadian context for SAD, which will bridge an important care gap for undeserved populations in Canada with SAD. Findings will inform the eventual scaling up of the program in community-based primary care across Canada. This would improve equity of the health care system by helping a large number of Canadians to timely access to mental health services.nnTRIAL REGISTRATION: clinicaltrials.gov NCT06403995. Prospectively registered on 05/03/2024.},

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pubstate = {published},

tppubtype = {article}

}

@article{pmid37934006,

title = {The effectiveness of transdiagnostic cognitive behavioural therapy for anxiety disorders: the role of and impact of comorbid depression},

author = {Megan G George and Pasquale Roberge and Martin D Provencher and Peter J Norton},

doi = {10.1080/16506073.2023.2274290},

issn = {1651-2316},

year  = {2024},

date = {2024-01-01},

journal = {Cogn Behav Ther},

volume = {53},

number = {1},

pages = {105--118},

abstract = {Transdiagnostic Cognitive Behaviour Therapy (tCBT), an intervention designed to be applicable across multiple diagnoses, was introduced to improve limitations in traditional therapy such as cost and access to trained therapists. It has been established as an effective and efficacious treatment for anxiety disorders, though there has been little research focussed on the role of depression. The current study investigated the role of comorbid depression during tCBT for anxiety disorders in primary care settings as an outcome and a moderator of anxiety outcomes. Results of multi-level ANOVAs indicated no significant difference in anxiety outcomes regardless of whether there was a comorbid depression diagnosis in the tCBT condition, and that individuals with a comorbid depression diagnosis experienced significantly greater reduction in anxiety severity than those without. Depression symptom severity decreased to a significantly greater extent in the tCBT condition than in TAU when the outcome measure of Patient Health Questionnaire was utilised as the outcome measure, but this was not mirrored when the Clinician Severity Rating was utilised as the outcome measure. This study provides preliminary support for the effectiveness of Transdiagnostic Cognitive Behaviour therapy for those with both a principal anxiety disorder and comorbid depression in symptom reduction.},

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pubstate = {published},

tppubtype = {article}

}

@article{pmid37461378,

title = {Cost-Effectiveness of Group Transdiagnostic Cognitive Behavioural Therapy for Anxiety Disorders in Primary Care Settings: Economic Evaluation From the Healthcare System Perspective Over a 1-Year Time Horizon},

author = {Helen-Maria Vasiliadis and Catherine Lamoureux-Lamarche and Alexandra Chapdelaine and Martin D Provencher and Peter J Norton and Djamal Berbiche and Pasquale Roberge},

doi = {10.1177/07067437231187459},

issn = {1497-0015},

year  = {2024},

date = {2024-01-01},

journal = {Can J Psychiatry},

volume = {69},

number = {1},

pages = {43--53},

abstract = {AIM: To assess the incremental cost-effectiveness ratio (ICER) of group transdiagnostic cognitive-behavioural therapy (tCBT) added to treatment as usual (TAU) for anxiety disorders compared to TAU only from the healthcare system perspective over a 1-year time horizon.nnMETHODS: Data from a pragmatic multisite randomized controlled trial where adults (18-65 years) with an anxiety disorder were randomized to tCBT + TAU ( = 117) or TAU ( = 114). Group tCBT is a 12-week (2h weekly sessions) community-based intervention. Health service utilization and related costs were captured from medico-administrative data and included those for the intervention, ambulatory visits, hospitalizations and medications. Effectiveness was based on quality-adjusted life years (QALYs). The study included measures at baseline, 4, 8, and 12 months. Intention-to-treat and complete case analyses were carried out. Missing data were imputed using multiple imputation analyses. Seemingly unrelated regression analyses were used to assess the effect of the intervention on total costs and QALYs while also adjusting for baseline confounders. The probability of cost-effectiveness of the intervention was assessed according to different willingness-to-pay (WTP) thresholds using the net benefit regression method.nnRESULTS: The ICER of tCBT + TAU as compared to TAU in the intention-to-treat analysis was $6,581/QALY. Complete case analyses showed a similar ICER of $6,642/QALY. The probability at a WTP threshold of $20,000 and $40,000 that tCBT + TAU as compared to TAU is cost-effective is 93.0% and 99.9%.nnCONCLUSION: tCBT added to TAU appears to be cost-effective from the healthcare system perspective for treating adult patients with anxiety disorders. Larger trials including young and older adults as well as a range of anxiety disorders are needed to further investigate the cost-effectiveness of tCBT in different patient populations.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid39208221,

title = {[Professionals' Perceptions Regarding the Implementation of Guided Self-help in the context of the Programme québécois pour les troubles mentaux]},

author = {Quentin Bet and Alexane Gilbert and Juliette Bergeron and Isabelle Fournel and Josée Savard and Guillaume Foldes-Busque and Martin D Provencher},

issn = {1708-3923},

year  = {2024},

date = {2024-01-01},

journal = {Sante Ment Que},

volume = {49},

number = {1},

pages = {99--122},

abstract = {Objective Common mental disorders, such as anxiety and depression, have many individual and societal consequences. Various treatments are available for people with these diagnoses, including medication and cognitive behavioral therapy. When these disorders are mild or moderate, psychotherapy is the recommended first-line treatment, given its greater long-term efficacy than pharmacotherapy. However, this is not what is observed in practice: medication is much more widely used than psychotherapy, the latter's accessibility being greatly reduced by long waiting lists. An alternative to these accessibility difficulties is the stepped-care model, which includes guided self-help. These are low-intensity interventions that enable more people to be treated with fewer resources (e.g., fewer meetings with a professional). The Programme québécois pour les troubles mentaux (PQPTM; Quebec Program for Mental Disorders) is a stepped-care model recently implemented in some settings in Quebec. The aim of this study is to gather the perceptions of social workers (SWs) in a Centre intégré (universitaire) de santé et de services sociaux (CI[U]SSS; Community mental health center) on the implementation of the PQPTM guided self-help. Methods To this end, three focus groups of approximately 1h30 were conducted with 13 SWs. The data were coded and analyzed using a thematic qualitative inductive-deductive approach, based on the Consolidated Framework for Implementing Research (CFIR) and the participants' responses obtained during the focus groups. Results The barriers and facilitators to PQPTM guided self-help implementation identified relate to different CFIR constructs: intervention characteristics (e.g., monitoring, type of self-help), internal implementation parameters (e.g., training, organizational pressures), caregiver characteristics (e.g., experience, appropriation time), user characteristics (e.g., age, personality) and process (e.g., treatment integrity, supervision). The results of this qualitative study show that SWs have varied perceptions and opinions of the PQPTM guided self-help: 64% of the themes discussed were nuanced, while 25% were considered exclusively as barriers and 11% exclusively as facilitators. Conclusion These results shed light on the factors that can contribute to the successful implementation of the PQPTM guided self-help in Quebec, with a view to improving it at the heart of the specific CI(U)SSS of the current study and in other mental health centers in Quebec. Several recommendations are made in this respect: for example, to increase upstream planning for future implementations, to maintain access to training and supervision, and to guarantee the availability and printing of self-help guides.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37291599,

title = {Moderators of the cost-effectiveness of transdiagnostic CBT for anxiety disorders over an 8-month time horizon using a net-benefit regression framework},

author = {Alexandra Chapdelaine and Helen-Maria Vasiliadis and Martin D Provencher and Peter J Norton and Pasquale Roberge},

doi = {10.1186/s12913-023-09468-7},

issn = {1472-6963},

year  = {2023},

date = {2023-06-01},

journal = {BMC Health Serv Res},

volume = {23},

number = {1},

pages = {596},

abstract = {BACKGROUND: Access to evidence-based psychological treatment is a concern in many parts of the globe due to government-level financial constraints and patient-level barriers. Transdiagnostic cognitive behavioural therapy (tCBT) is an effective treatment approach that uses a single protocol for anxiety disorders which could enhance the dissemination of evidence-based psychotherapy. In a context of limited resources, the study of treatment moderators can allow to identify subgroups for which the cost-effectiveness of an intervention differs, information that could impact decision-making. So far, there has been no economic evaluation of tCBT for different subpopulations. The objectives of this study, using the net-benefit regression framework, were to explore clinical and sociodemographic factors as potential moderators of the cost-effectiveness of tCBT compared to treatment-as-usual (TAU).nnMETHODS: This is a secondary data analysis of a pragmatic randomized controlled trial opposing tCBT added to TAU (n = 117) to TAU only (n = 114). Data on costs from the health system and the limited societal perspectives, as well as anxiety-free days, an effectiveness measure based on the Beck Anxiety Inventory, were collected over an 8-month time horizon and used to derive individual net-benefits. The net-benefit regression framework was used to assess moderators of the cost-effectiveness of tCBT + TAU as opposed to TAU alone. Variables of sociodemographic and clinical nature were assessed.nnRESULTS: Results showed that the number of comorbid anxiety disorders significantly moderated the cost-effectiveness of tCBT + TAU compared to TAU from the limited societal perspective.nnCONCLUSIONS: The number of comorbid anxiety disorders was identified as a moderator affecting the cost-effectiveness of tCBT + TAU compared to TAU from the limited societal perspective. More research is needed to strengthen the case of tCBT from an economic standpoint for large-scale dissemination.nnTRIAL REGISTRATION: ClinicalTrials.gov: NCT02811458, 23/06/2016.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36840371,

title = {An analysis of differential improvement by diagnosis in group transdiagnostic cognitive behaviour therapy for anxiety disorders},

author = {Mehrnaz Rostami and Martin D Provencher and Pasquale Roberge and Peter J Norton},

doi = {10.1080/09638237.2023.2182419},

issn = {1360-0567},

year  = {2023},

date = {2023-06-01},

journal = {J Ment Health},

volume = {32},

number = {3},

pages = {619--624},

abstract = {INTRODUCTION: Anxiety disorders are the most prevalent among the mental health disorders and have a negative impact on an individual's life. Cognitive behaviour therapy (CBT) is documented as the most effective treatment for anxiety disorders. However, challenges associated with implementing diagnosis-specific CBT have led to transdiagnostic approaches of CBT (tCBT). tCBT uses a single protocol with core elements of CBT for treatment of anxiety disorders broadly. The aim of the current study is to examine whether participants with different principal anxiety diagnoses demonstrate similar anxiety reduction.nnMETHODS: The current study involved a secondary analysis of 117 participants randomly allocated to receive tCBT for anxiety disorders in a pragmatic randomised effectiveness trial. Beck Anxiety Inventory (BAI) and Clinician Severity Ratings (CSR) scales were administered at pre- and post-treatment and one-year follow-up, while the Anxiety Disorder Diagnostic Questionnaire - Weekly (ADDQ-W) was administered each session.nnRESULTS: Mixed-factorial analyses of variance (ANOVAs) indicated that participants with GAD, SAD and PD/A improved to post-treatment and maintained to follow-up, with no differential improvement across principal diagnoses. Mixed effect regression modelling of session by session measures indicated non-differential negative slopes across principal diagnoses of GAD, SAD and PD/A.nnCONCLUSION: Overall, results indicate that group tCBT for anxiety disorders shows equal effectiveness for GAD, PD/A, and SAD in real-world conditions.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36921511,

title = {An examination of sudden gain prevalence across cognitive-behavioural therapy for anxiety and depressive disorders: A quantitative analysis and meta-analytic review},

author = {Ursula R Silverstone and Pasquale Roberge and Martin D Provencher and Peter J Norton},

doi = {10.1016/j.janxdis.2023.102697},

issn = {1873-7897},

year  = {2023},

date = {2023-04-01},

journal = {J Anxiety Disord},

volume = {95},

pages = {102697},

abstract = {Sudden gains, incidences of unexpectedly large and stable session to session symptom reductions during psychotherapy, have been shown in samples of individuals receiving treatment for both anxiety and depressive disorders, although seemingly more frequently in sample receiving treatment for depressive disorders. This may suggest that sudden gains are a function of depression, but the high comorbidity between anxiety and depressive disorders makes this difficult to assess. Study One utilised a sample of 117 adults undergoing CBT for a principal anxiety disorder to explore the effect of comorbid depression on sudden gain prevalence. Results indicated that sudden gains were not more prevalent in the comorbid depression group; however, the frequency of sudden gains was significantly related to comorbid depressive disorder severity. Study Two involved a meta-analysis of 48 studies to compare sudden gain prevalence between trials of CBT for depressive disorders versus anxiety-related disorders. The results of the meta-analysis indicated significantly higher rates of sudden gains in samples with a principal depressive disorder diagnosis, compared to a principal anxiety disorder diagnosis. Sudden gains may therefore be driven by depression, but only at the more severe level.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36695038,

title = {Cost-effectiveness of transdiagnostic group cognitive behavioural therapy for anxiety disorders  treatment as usual: economic evaluation of a pragmatic randomized controlled trial over an 8-month time horizon using self-reported data},

author = {Alexandra Chapdelaine and Helen-Maria Vasiliadis and Martin D Provencher and Peter J Norton and Pasquale Roberge},

doi = {10.1017/S0033291722003920},

issn = {1469-8978},

year  = {2023},

date = {2023-01-01},

journal = {Psychol Med},

pages = {1--13},

abstract = {BACKGROUND: This economic evaluation supplements a pragmatic randomized controlled trial conducted in community care settings, which showed superior improvement in the symptoms of adults with anxiety disorders who received 12 sessions of transdiagnostic cognitive-behavioural group therapy in addition to treatment as usual (tCBT + TAU) compared to TAU alone.nnMETHODS: This study evaluates the cost-utility and cost-effectiveness of tCBT + TAU over an 8-month time horizon. For the reference case, quality-adjusted life years (QALYs) obtained using the EQ-5D-5L, and the health system perspective were chosen. Alternatively, anxiety-free days (AFDs), derived from the Beck Anxiety Inventory, and the limited societal perspective were considered. Unadjusted incremental cost-effectiveness/utility ratios were calculated. Net-benefit regressions were done for a willingness-to-pay (WTP) thresholds range to build cost-effectiveness acceptability curves (CEAC). Sensitivity analyses were included.nnRESULTS: Compared to TAU ( = 114), tCBT + TAU ( = 117) generated additional QALYs, AFDs, and higher mental health care costs from the health system perspective. From the health system and the limited societal perspectives, at a WTP of Can$ 50 000/QALY, the CEACs showed that the probability of tCBT + TAU v. TAU being cost-effective was 97 and 89%. Promising cost-effectiveness results using AFDs are also presented. The participation of therapists from the public health sector could increase cost-effectiveness.nnCONCLUSIONS: From the limited societal and health system perspectives, this first economic evaluation of tCBT shows favourable cost-effectiveness results at a WTP threshold of Can$ 50 000/QALY. Future research is needed to replicate findings in longer follow-up studies and different health system contexts to better inform decision-makers for a full-scale implementation.},

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pubstate = {published},

tppubtype = {article}

}