Optimization of Internet-Delivered Cognitive Behavioral Therapy for Canadian Leaders Within Public Safety: Qualitative Study
Bibliographic record
Abstract
BACKGROUND: Canadian public safety personnel (PSP) report high rates of mental health concerns and barriers to treatment. PSPNET is a clinical research unit that offers internet-delivered cognitive behavioral therapy (ICBT) that is free, confidential, and developed with and for PSP. Treatment outcomes are promising with clinically significant symptom improvement (eg, anxiety, depression, and posttraumatic stress) and favorable treatment satisfaction. While these results are promising, research has yet to explore ways to optimize therapist-guided ICBT for leaders within public safety. Optimizing ICBT for leaders is particularly important given their widespread organizational impact. OBJECTIVE: This study aims to investigate (1) the perceived mental health stressors of Canadian leaders within public safety, (2) the degree to which leaders perceived existing therapist-guided ICBT courses tailored for PSP (ie, PSP Wellbeing Course and PSP PTSD Course) as suitable for their needs, and (3) ways to further optimize therapist-guided ICBT for public safety leaders. METHODS: This study included 10 clients who self-identified as being in a supervisory or leadership position within their public safety organization and completed either the therapist-guided PSP Wellbeing Course or PSP PTSD Course. We used descriptive statistics to analyze demographics, mental health symptoms, treatment engagement, and treatment satisfaction. We also used a reflexive thematic analysis of semistructured interview transcripts to assess leaders' course perceptions and feedback. RESULTS: Canadian leaders within public safety reported occupational and nonoccupational stressors and enrolled in ICBT to support their own or colleagues' mental health. Most clients enrolled in the PSP Wellbeing Course, accessed 4 of 5 lessons (n=7, 70%), engaged with therapist support (n=7, 70%), and identified as employed (n=8, 80%), White (n=8, 80%), and men (n=7, 70%) with an average age of 45 years. At pretreatment, 80% of clients endorsed clinically significant symptoms of one or more disorders; most often depression (n=7, 70%) and anger (n=6, 60%). Clients reported favorable attitudes toward the ICBT courses with most reporting that they were satisfied with the course (n=9, 90%). Feedback to further optimize ICBT content for leaders included the development of a leader case story (n=6, 60%) and new resources to help leaders apply skills learned in ICBT within the context of their leadership roles (n=4, 40%). Leaders also recommended optimizing ICBT delivery by improving the platform technology and incorporating more multimedia. CONCLUSIONS: Canadian leaders within public safety perceived therapist-guided ICBT developed with and for PSP as a suitable treatment option for their needs and identified ways to further optimize its content and delivery. Future research should investigate the impacts of these efforts and explore optimizing ICBT for other groups of clients. TRIAL REGISTRATION: ClinicalTrials.gov NCT04127032, https://www.clinicaltrials.gov/study/NCT04127032; ClinicalTrials.gov NCT04335487, https://clinicaltrials.gov/study/NCT04335487.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.014 | 0.005 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".