A Web-Based Group Cognitive Behavioral Therapy Intervention for Symptoms of Anxiety and Depression Among University Students: Open-Label, Pragmatic Trial

Jason Bantjes, Alan E Kazdin, Pim Cuijpers, Elsie Breet, Munita Dunn-Coetzee, Charl Davids, Dan J Stein, Ronald C Kessler, Jason Bantjes, Alan E Kazdin, Pim Cuijpers, Elsie Breet, Munita Dunn-Coetzee, Charl Davids, Dan J Stein, Ronald C Kessler

Abstract

Background: Anxiety and depression are common among university students, and university counseling centers are under pressure to develop effective, novel, and sustainable interventions that engage and retain students. Group interventions delivered via the internet could be a novel and effective way to promote student mental health.

Objective: We conducted a pragmatic open trial to investigate the uptake, retention, treatment response, and level of satisfaction with a remote group cognitive behavioral therapy intervention designed to reduce symptoms of anxiety and depression delivered on the web to university students during the COVID-19 pandemic.

Methods: Preintervention and postintervention self-reported data on anxiety and depression were collected using the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9. Satisfaction was assessed postintervention using the Client Satisfaction with Treatment Questionnaire.

Results: A total of 175 students were enrolled, 158 (90.3%) of whom initiated treatment. Among those initiating treatment, 86.1% (135/158) identified as female, and the mean age was 22.4 (SD 4.9) years. The mean number of sessions attended was 6.4 (SD 2.8) out of 10. Among participants with clinically significant symptoms at baseline, mean symptom scores decreased significantly for anxiety (t56=11.6; P<.001), depression (t61=7.8; P<.001), and composite anxiety and depression (t60=10.7; P<.001), with large effect sizes (d=1-1.5). Remission rates among participants with clinically significant baseline symptoms were 67.7%-78.9% and were not associated with baseline symptom severity. High overall levels of satisfaction with treatment were reported.

Conclusions: The results of this study serve as a proof of concept for the use of web-based group cognitive behavioral therapy to promote the mental health of university students.

Keywords: South Africa; anxiety; cognitive behavioral therapy; depression; e-intervention; group therapy; university students; web-based.

Conflict of interest statement

Conflicts of Interest: DJS has received research grants and/or consultancy honoraria from Johnson & Johnson, Lundbeck, Servier, and Takeda. In the past 3 years, RCK was a consultant for Datastat, Inc; RallyPoint Networks, Inc; Sage Pharmaceuticals; and Takeda. The other authors have no conflicts of interest to declare.

©Jason Bantjes, Alan E Kazdin, Pim Cuijpers, Elsie Breet, Munita Dunn-Coetzee, Charl Davids, Dan J Stein, Ronald C Kessler. Originally published in JMIR Mental Health (https://mental.jmir.org), 27.05.2021.

Figures

Figure 1
Figure 1
Flowchart of recruitment and assessment process.

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