Exploring the utility of transdiagnostic internet-delivered cognitive behavioral therapy for symptoms of adjustment disorder: A longitudinal observational study in a routine online care setting in Western Canada
Bibliographic record
Abstract
Disorder-specific Internet-delivered cognitive behavioral therapy (ICBT) for Adjustment Disorder (AD) has shown moderate effect sizes but may lack scalability in routine care, where clients present with diverse concerns. Transdiagnostic ICBT, which targets common emotional and behavioral difficulties regardless of diagnosis, may offer a more scalable solution. This study explored the utility of a transdiagnostic ICBT course for individuals with high AD symptoms. Between June 15th, 2022, and June 19th, 2023, 585 participants (72.1% women; 83.2% White) who completed a therapist-guided, transdiagnostic ICBT course and met the inclusion criteria for the present study were included in the analysis. AD symptoms were assessed at pre-treatment, post-treatment, and 3-month follow-up using the Adjustment Disorder–New Module 8 (ADNM-8). At pre-treatment, 356 (60.9%) of participants scored above the clinical cut-off (>23) on the ADNM-8. Large within-group reductions in AD symptoms were observed from pre- to post-treatment (Cohen’s d = 1.31, 95% CI [1.13, 1.48]) and pre-treatment to follow-up ( d = 1.61, 95% CI [1.41, 1.81]). Approximately 70% of participants with high AD symptoms scored below the cut-off at post-treatment, increasing to 75% at follow-up. Treatment engagement and satisfaction were high across groups, with 76.9% completing four or more lessons and 81.5% reporting overall satisfaction. Transdiagnostic ICBT appears to be a useful and acceptable treatment for individuals with high AD symptoms. Symptom improvement was comparable to those from disorder-specific interventions. The high number of self-reported AD symptoms highlights the need for early identification and scalable treatment options in routine care. • Transdiagnostic ICBT led to large reductions in AD symptoms over time • 70% no longer met criteria for high AD symptoms after treatment • Outcomes were comparable to AD-specific ICBT interventions • High engagement and satisfaction across participants • Results support scalable ICBT for AD in routine care settings
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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 | 0.003 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.006 | 0.002 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 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".