Making Internet-delivered cognitive behaviour therapy scalable for cancer survivors: a randomized non-inferiority trial of self-guided and technician-guided therapy

  • D. DirkseEmail author
  • H.D. Hadjistavropoulos
  • N. A. Alberts
  • E. Karin
  • L.H. Schneider
  • N. Titov
  • B.F. Dear



To compare the effectiveness and acceptability of two low-intensity methods of offering a transdiagnostic Internet-delivered cognitive behaviour therapy (ICBT) intervention for treating symptoms of anxiety and depression among cancer survivors.


Cancer survivors with symptoms of anxiety or depression (n = 86) were randomly assigned to receive a transdiagnostic ICBT programme (Wellbeing After Cancer) that was either guided by a technician (n = 42) or self-guided (n = 44). Measures of anxiety, depression, fear of cancer recurrence, and quality of life were completed at pre-treatment, post-treatment, and 4 weeks following treatment completion.


Large within-group effect sizes were observed on measures of depression, anxiety, and mental health-related quality of life (d range, 0.98–1.86) at post-treatment. Medium effects were found for reductions in fear of cancer recurrence (d range, 0.65–0.78). Non-inferiority was established for the primary outcome measures of anxiety and depression. All participants reported high satisfaction ratings of the programme; however, technician-guided participants were slightly more satisfied with their level of support (d = 0.57, p = .014).


The Wellbeing After Cancer Course was associated with improved levels of anxiety, depression, fear of cancer recurrence, and quality of life, regardless of how ICBT was offered.

Implications for Cancer Survivors

ICBT is emerging as an accessible and effective treatment for depression, anxiety, and fear of cancer recurrence in cancer survivors. The success of non-therapist-guided options increases the potential scalability of ICBT, which is particularly valuable for cancer survivors from rural areas who have less access to mental health services.


Internet Cognitive behaviour therapy Anxiety Depression Cancer survivor Randomized trial 



This work was made possible in part as a result of funding provided by the Canadian Institutes of Health Research (reference numbers 293379, 152917), Saskatchewan Health Research Foundation, Rx & D Health Research Foundation, and the University of Regina Faculty of Graduate Studies and Research.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegCanada
  2. 2.Department of PsychologyUniversity of ReginaReginaCanada
  3. 3.Department of PsychologySt. Jude Children’s Research HospitalMemphisUSA
  4. 4.eCentreClinic, Department of PsychologyMacquarie UniversitySydneyAustralia

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