Suitability of therapist-guided internet-delivered cognitive behavioural therapy for public safety personnel with subthreshold symptoms

Public safety personnel (PSP) report high rates of mental health challenges due to frequent exposure to potentially psychologically traumatic events and increased barriers to support. Internet-delivered cognitive behavioural therapy (ICBT) is an accessible and effective option for PSP with clinical symptoms. This mixed-methods study uniquely explored treatment engagement, outcomes, and satisfaction among 174 archived clients (quantitative data) and 10 recent clients (quantitative and qualitative data) with subthreshold symptoms of anxiety, depression, and posttraumatic stress who enrolled in a therapist-guided ICBT program. Most participants reported mental health concerns related to their subthreshold symptoms, meaningfully engaged in the course materials and therapist support, displayed statistically significant reductions in anxiety, depression, and posttraumatic stress symptoms from pre-treatment to 8-weeks post-enrollment ( ps < 0.001; Hedges’ g = 0.40–0.50), and reported good treatment satisfaction. Recommendations to further optimize ICBT focused on new content topics (e.g., resiliency, responding to events involving family and friends, workplace bullying) and improving delivery (e.g., navigation between lessons, playbook summarizing key information and skills). Overall, the current study provides initial findings supporting the suitability of therapist-guided ICBT for PSP with subthreshold symptoms while emphasizing the importance of early ICBT awareness to address mental health concerns of all levels of severity and limit escalation of subthreshold symptoms.