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Research Summaries

Stakeholder perspectives on Internet-delivered CBT

Keywords: ICBT, Mental Health Disorders, Stigma

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Why was the study done?

Public safety personnel (PSP) are regularly exposed to potentially traumatic events. This exposure likely contributes to the high rates of mental health disorders observed in PSP. Therapies, including cognitive behavioural therapy (CBT), have been shown to successfully treat mental health disorders, but recent studies show that there may be logistical and attitudinal barriers to PSP seeking mental health help. Internet-delivered CBT (ICBT) has been proven to be effective and may help overcome many common barriers to seeking mental health help.

The goals of the current study are:

  • to determine how PSP view an ICBT program tailored for PSP;
  • to collect information on barriers that PSP face in getting mental health care; and
  • to determine how PSP believe ICBT should be tailored to meet their unique needs.

What was done in the study?

Participants were recruited in Saskatchewan and Quebec from all sectors of PSP. The 126 participants included those on the frontline, union managers, executive managers, and civilian employees. Participants completed a semi-structured interview of 19 questions covering the need for ICBT, the feasibility of ICBT for PSP, tailoring of ICBT for PSP, recruitment strategies, and coordination of ICBT with other services. Transcripts of the taped interviews were entered into computer software to help with the analysis of themes in the participants’ answers.

What did we find out?

Analysis of the interviews showed six main themes:

  • Barriers to treatment for PSP. The barriers to treatment can be divided into two categories: First, there are logistical barriers, such as distance, time constraints, costs, and limited service options. Second, there is a lack of awareness of treatment options and attitudinal barriers, which includes stigma, discomfort with being vulnerable, service provider lack of PSP understanding, distrust of service providers, and expectations of services.
  • Need for ICBT and expected uptake. Almost all of the participants felt that there was a need for tailored ICBT for PSP. The majority (62%) reported that PSP would be likely to use a tailored ICBT program, but many (36%) reported feeling unsure about the uptake of ICBT in PSP.
  • Advantages and Disadvantages of ICBT. The top three advantages identified were greater privacy, ability to access at any time, and access from any location with Internet. The top three disadvantages noted were that therapists can’t always view non-verbal cues, technical issues, and that PSP may feel less accountable for completing treatment.
  • Ideas for tailoring ICBT to PSP. The participants made numerous suggestions for tailoring an ICBT program to PSP, including providing education and content on topics such as mental health signs and symptoms, intimate relationships and communications, sleep, emotional regulation, substance abuse, and social isolation.
  • Treatment delivery preferences. The majority of participants felt the time frame for completing the ICBT program should be flexible. Participants also thought that the mode of therapist support (phone, email, text, video conference) should be flexible.
  • Differences in PSP culture and personality. Participants identified several ways that PSP are different from the general population. They felt that differences such as frequent exposure to trauma, mental health issues with limited support, expectations of toughness, an attitude of jadedness or pessimism, and the use of dark humour to cope with stress were all considerations when looking to create an ICBT program for PSP.

Where do we go from here?

Though this was a small sample limited to two provinces, the participants reported numerous possible barriers that PSP experience in getting mental health care. Nearly all participants believed there was a need for ICBT tailored to PSP. They also provided valuable feedback on the content and delivery of such a program. This study highlights the unique challenges that must be considered when adapting treatment for PSP. This study’s feedback has been incorporated into the current version of the PSP Wellbeing Course, which is currently available for free to PSP in Saskatchewan and Quebec.


The original wording of the study was changed and condensed for the current research summary.

Original Study

McCall, H.C., Beahm, J.D., Fournier, A.K., Burnett, J.L., Carleton, R.N., & Hadjistavropoulos, H.D. (2020). Stakeholder perspectives on internet-delivered cognitive behavioural therapy for public safety personnel: A qualitative analysis. Canadian Journal of Behavioural Science/ Revue canadienne des sciences du comportement.

Summary Prepared by Kossick, E.  Edited & reviewed by Barootes, B. & McCall, H.

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