Table 4.
Reliable Change, Program Engagement, Working Alliance, and Treatment Ratings by Year and Overall.
| 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | Total | Significance | |
|---|---|---|---|---|---|---|---|---|---|
| Reliable change | |||||||||
| PHQ-9 post-treatment recovery | 42.0% | 39.4% | 36.8% | 35.9% | 37.1% | 35.2% | 35.7% | 36.3% | F (6, 2609) = 0.33, P = 0.92 |
| PHQ-9 post-treatment deterioration | 4.7% | 1.3% | 1.8% | 1.4% | 1.9% | 2.0% | 1.4% | 1.7% | F (6,1434) = 0.36, P = 0.90 |
| GAD-7 post-treatment recovery | 50.7% | 43.7% | 39.5% | 44.3% | 47.5% | 45.5% | 45.5% | 45.0% | F (6, 2252) = 1.00, P = 0.43 |
| GAD-7 post-treatment deterioration | 0.8% | 1.3% | 3.7% | 2.1% | 2.0% | 1.6% | 1.7% | 2.0% | F (6,1117) = 0.76, P = 0.60 |
| Program engagement | |||||||||
| Accessed > 4 lessons | 85.7% (24/28) | 85.8% (236/275) | 79.4% (323/407) | 79.3% (453/571) | 78.0% (558/715) | 81.8% (664/812) | 80.3% (959/1,195) | 80.4% (3,217/4,003) | χ2 (1, N = 4,003) = .48, P = 0.49 |
| Accessed 5 lessons | 75.0% (21/28) | 78.9% (217/275) | 70.3% (286/407) | 70.6% (403/571) | 66.4% (475/715) | 71.1% (577/812) | 71.3% (852/1,195) | 70.7% (2,831/4,003) | χ2 (1, N = 4,003) = 1.21, P = 0.27 |
| Mean number of therapist emails to patient (SD) | 9.68 (2.98) | 9.44 (2.29) | 8.33 (1.98) | 7.07 (2.70) | 8.15 (2.94) | 10.01 (3.14) | 11.29 (3.97) | 9.43 (3.52) | F (6, 3996) = 152.29, P < 0.001a |
| Mean number of emails from patient to therapist (SD) | 6.93 (8.02) | 4.78 (3.30) | 4.13 (3.70) | 3.34 (3.44) | 3.53 (3.20) | 4.09 (3.76) | 4.14 (3.57) | 3.97 (3.60) | F (6, 3996) = 11.04, P < 0.001a |
| Mean number of phone calls (SD) | 1.21 (1.69) | 0.77 (1.23) | 0.88 (1.29) | 0.54 (0.89) | 0.68 (1.04) | 0.96 (1.32) | 0.98 (1.21) | 0.84 (1.19) | F (6, 3996) = 18.00, P < 0.001a |
| Working alliance | |||||||||
| WAI-SR total score | — | — | — | 43.67 (11.92) | 45.36 (10.89) | 46.30 (10.56) | 47.22 (10.01) | 46.19 (10.62) | F (3, 1973) = 7.81, P < 0.001b |
| WAI-SR bond score | — | — | — | 15.80 (4.76) | 16.58 (3.91) | 16.88 (3.79) | 17.14 (3.47) | 16.80 (3.84) | F (3, 1966) = 8.14, P < 0.001b |
| WAI-SR task score | — | — | — | 14.78 (3.73) | 14.89 (3.66) | 15.08 (3.58) | 15.34 (3.40) | 15.11 (3.55) | F (3, 1966) = 2.25, P = 0.08 |
| WAI-SR goal score | — | — | — | 13.09 (5.03) | 13.84 (4.99) | 14.30 (4.57) | 14.73 (4.45) | 14.25 (4.68) | F (63, 1966) = 8.69, P < 0.001b |
| Treatment ratings | |||||||||
| Satisfied/very satisfied overall | 90.9% (20/22) | 84.7% (171/202) | 81.3% (222/273) | 80.4% (300/373) | 86.3% (402/466) | 84.4% (487,576) | 88.6% (675/762) | 85.2% (2,277/2,674) | χ2 (1, N = 2,674) = 3.23, P = 0.07 |
| Satisfied/very satisfied with materials | 95.5% (21/22) | 93.1% (188/202) | 89.0% (243/273) | 86.9% (324/373) | 90.8% (423/466) | 88.7% (511/576) | 90.4% (689/762) | 89.7% (2,399/2,674) | χ2 (1, N = 2,674) = 0, P = 0.99 |
| Satisfied/very satisfied with telephone calls | 71.4% (5/7) | 77.3% (85/110) | 71.9% (110/153) | 67.9% (133/196) | 71.2% (183/257) | 75.0% (252/336) | 74.8% (357/477) | 73.2% (1,125/1,536) | χ2 (1, N = 1,536) = 4.93, P = 0.03 |
| Satisfied/very satisfied with emails | 90.9% (10/11) | 83.7% (169/202) | 78.0% (213/273) | 74.0% (276/373) | 77.0% (359/466) | 83.8% (482/575) | 84.1% (641/762) | 80.7% (2,150/2,662) | χ2 (1, N = 2,622) = 8.344, P = 0.004 |
| Increased/greatly increased confidence | 95.5% (21/22) | 91.0% (184/202) | 86.4% (236/273) | 87.9% (328/373) | 93.6% (436/466) | 90.1% (519/576) | 93.0% (709/762) | 91.0% (2,433/2,674) | χ2 (1, N = 2,674) = 2.78, P = 0.10 |
| Increased/greatly increased motivation for other treatment | 77.3% (17/22) | 79.2% (160/202) | 75.8% (207/273) | 77.2% (288/373) | 81.5% (380/466) | 83.5% (481/576) | 86.9% (636/732) | 81.1% (2,169/2,674) | χ2 (1, N = 2,674) = 4.90, P = 0.03 |
| Course was worth the time (%) | 100% (22/22) | 98.0% (198/202) | 94.5% (258/273) | 94.6% (353/373) | 96.8% (451/466) | 95.8% (552/576) | 97.2% (741/762) | 96.3% (2,575/2,674) | χ2 (1, N = 2,674) = 0.77, P = 0.38 |
| Would recommend course to a friend (%) | 100% (22/22) | 97.5% (197/202) | 93.8% (256/273) | 94.9% (354/373) | 97.2% (453/466) | 97.0% (559/576) | 97.2% (741/762) | 96.6% (2,582/2,674) | χ 2 (1, N = 2,674) = 2.78, P = 0.10 |
Note. PHQ-9 = Patient Health Questionnaire-9-item; GAD-7 = Generalized Anxiety Disorder-7-item; WAI-SR = Working Alliance Inventory-Short Report. Bonferroni correction p < .002.
aPost-hoc comparisons revealed some year-to-year differences in emails sent, emails received, and phone contact. These differences are attributed to trial designs investigating different levels of therapist support. For detailed comparisons by trial, see Supplementary Materials.
bPost-hoc comparisons revealed the WAI-SR Total, Bond subscale, and Goal subscale were lower in 2016 (year patients offered optional support) than in 2018 or 2019 (years offered once-weekly or greater support). For detailed comparisons by trial, see Supplementary Materials.