From August to September 2017, by simply putting up posters on a few busy streets in the city of Halifax, and on Saint Mary’s and Dalhousie campuses, we had 130 people sign-up to take part in our Pilot Study.

There were a few things we wanted to test.  First off, and most importantly, we wanted to know if the program that we created would help people decrease their levels of anxiety.  With that said, we also wanted to see how different coaching models would perform. We already knew that adherence rates for self-directed programs are very low and that coaching can make a big difference, but we also wanted to test group sessions, to see how well that would work.

We’re excited to be able to share with you the results!

Executive Summary

Previous research has shown that internet-based CBT (iCBT) works in treating anxiety disorders (Olthuis et al., 2015). Studies have also demonstrated that having some contact with a coach or therapist decreases drop-out rates and improves outcomes (Hadjistavropoulos et al., 2017; Stallman et al., 2016).

In our pilot study, we found that the more modules someone completed the better the outcome; and, that coaching leads to more modules completed. Furthermore, for participants who completed the program, their anxiety went from being in the clinically significant range to the non-clinical range. Therefore, completing Tranquility with the help of a coach leads to meaningful change in people’s anxiety.

Findings from Pilot Study

We conducted a pilot program evaluation study with 27 people who all met fairly strict criteria on having significant levels of anxiety and no clinically significant symptoms of depression. The participants were split up into 3 groups: self-help only (n=9), 1:1 coaching (n=9), and group based coaching (n=9). Due to this small sample size, along with some participants dropping out, participants were grouped together to describe the outcome data. This service was provided to participants free of charge.

Number of sessions completed

Overall, groups that received one-on-one or group coaching completed more modules than those in the self-help group.

Average number of modules completed per group

Symptom improvement trends

Overall, participants in the pilot study who completed at least the first three modules tended to see improvements in their anxiety and mood symptoms by the end of the program, as shown by their decreasing scores on the Generalized Anxiety Disorder- 7 item (GAD-7; Spitzer et al., 2006) and Patient Health Questionnaire- 9 item (PHQ-9; Kroenke et al., 2001). Similar decreases were all seen on the Anxiety and Depression subscales of the Depression Anxiety Stress Scales- 21 item (DASS-21; Lovibond & Lovibond, 1995). In addition to these primary symptoms of interest, the participants also saw decreases in symptoms of general stress, as shown by their decreasing scores on the Stress subscale of the DASS-21. These improvements are demonstrated in the following figures.

*PHQ-9 graph can be found at the end of this document.

Subjective Improvements and Attitudes Towards Program

Subjective Improvement

We asked participants about their improvement and the helpfulness of the program. Of those who completed at least 3 modules, most indicated the program was helpful overall. Additionally, most also indicated some level of improvement in anxiety symptoms and learning new skills to deal with anxiety when it happens. The percentage of participants indicating these kinds of improvements were even higher when you look at those who completed all nine modules. The answers to these questions are pictured in the figures below:

The majority of participants also believed the program helped specifically with providing new ways to deal with anxious thoughts and reducing avoidance behaviours (i.e., the main targets of CBT).

What Participants Learned

In the final survey, participants were asked how they will try to manage their anxiety differently after completing our program. They reported a range of things related to the skills they were taught. Some things they report doing differently are:

-       Checking in with themselves more.

-       Telling themselves they can do things even when they are anxious about it.

-       Being more kind to themselves at times they feel they can’t do something.

-       Mindfulness techniques.

-       Recognizing automatic thoughts and challenging them.

-       Working to better understand the root of their anxiety so they can manage it without adding additional fuel to it.

-       Observing the anxiety happening to them rather than being consumed by it.

-       Understanding and working on how behaviours affect their anxiety.

-       How they can talk more about their anxiety, and feel more comfortable about that.

Satisfaction Rating

In our final survey we asked participants how Tranquility Online lived up to their expectations. Of the 15 participants that filled the survey out, 1 said it did not meet their expectations, 9 said that the program met their expectations, and 5 said that it exceeded their expectations.

In our final survey we asked participants if they would recommend Tranquility Online. Of the 15 participants that filled the survey out, 13 said yes and 2 said maybe, that it depended on the cost/person.

Testimonials

“I’m super grateful — it’s been really hard, but life changing. I feel like it’s pushing me forward in a place I didn’t think I would ever be - before Tranquility, I didn’t know how to get here”

“I felt like I was drowning. Now I'm fighting. I feel like a winner."

"Having a coach to talk to, and get feedback from, helped me get the most out of the program".  

"I'm very grateful for Tranquility Online and my coach - I highly recommend this for people.”  

Patient Health Questionnaire - 9 item

References

Hadjistavropoulosa, H.D., Schneidera, L.H., Edmondsa, M., Karinb, E., Nugenta, M.N., Dirksea, D., Dearb, B.F., & Titovc, N. (2017). Randomized controlled trial of internet-delivered cognitive behaviour therapy comparing standard weekly versus optional weekly therapist support. Journal of Anxiety Disorders, 52, 15–24

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression

severity measure. Journal of General Internal Medicine, 16, 606-613.

Lovibond, P. F., &  Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour  Research and Therapy, 33, 335-343.

Olthuis, J. V., Watt, M. C., Bailey, K., Hayden, J. A., & Stewart, S. H. (2015). Therapist supported Internet cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database of Systematic Reviews, 3.

Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Lowe, B. (2006). A brief measure for assessing

generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166, 1092-1097.

Stallman, H. M., Kavanagh, D. J., Arklay, A. R., & Bennett-Levy, J. (2016). Randomised control

trial of a low-intensity cognitive-behaviour therapy intervention to improve mental health in university students. Australian Psychologist, 51, 145-153.