Madelyne A. Bisby

Objectives: To evaluate the efficacy of the online cognitive-behavioral therapy (CBT)-based Pain Course on levels of pain, disability, and psychological well-being in adults with chronic pain living in Ireland, with a 2-year follow-up. Methods: One hundred thirty-three people were randomly assigned (ISRCTN 11292570) to either the Pain Course (n=66), comprising 5 lessons delivered over 8 weeks with clinician support, or to delayed access with usual care in the interim (n=67). The primary outcome was pain-related disability while secondary outcomes were depression, anxiety and average pain, and tertiary outcomes were pain self-efficacy, fear of movement, and pain acceptance. Outcomes were collected at post-treatment, and for the treatment group at 3-month follow-up (n=55 [83% retention]) and 2-year follow-up (n=29 [44% retention]). Results: Course completion rate was 80%. Improvements were significantly greater for Treatment Group participants compared with Control Group on measures of disability, anxiety, depression, and average pain at post-treatment (Cohen d =.48-1.00). Improvements in outcomes were in the range 12% to 44% and benefits were maintained or improved at 3-month follow-up. All tertiary outcomes also improved in the treatment group. There was substantial attrition at 2-year follow-up, but for those who responded, treatment effects were largely maintained. High treatment satisfaction ratings were expressed by over 80% of participants. Average clinician contact, per participant, was 81.06 minutes. Discussion: The findings of the current study in an Irish sample corroborate those of previous Pain Course efficacy trials and highlight the potential benefits of internet-based interventions for adults with chronic pain, with treatment effects maintained for up to 2 years in those who responded.

A meaningful proportion of adults with anxiety and depression symptoms do not seek out psychological therapy. Studies show that higher treatment credibility (how logical therapy seems) and outcome expectations (perceptions of therapy effectiveness) are associated with greater treatment uptake. Most research has included individuals in therapy, who may perceive therapy as more logical and effective than those not seeking treatment. No studies have investigated these constructs in detail in the general community. This study examined perceptions of psychological therapy for anxiety and depression symptoms, and its relationship to treatment willingness in a community sample of Australian adults. Participant factors associated with credibility and expectations were explored. Participants (n = 911) completed an online survey covering demographic information, anxiety and depression symptoms, credibility and expectations, coping self-efficacy, and therapy willingness. Results indicated that participants held positive beliefs about therapy. Credibility and expectations uniquely predicted willingness to engage in therapy. Participant characteristics explained little variance in credibility and expectations. The findings have important implications for improving treatment uptake: credibility and expectations should be considered and could be targeted via public health interventions and in primary care settings. Research exploring optimal approaches for increasing credibility and expectations would be a valuable future direction.

Depression and anxiety are common but most adults experiencing these symptoms do not receive psychological treatment. Ultra-brief psychological treatments are a time-limited and potentially lower cost option for those who would otherwise not receive treatment. This prospectively registered review examined the acceptability and efficacy of ultra-brief psychological treatments for adults with depression or anxiety symptoms. A systematic search was undertaken up to April 2025. All clinical trials examining an ultra-brief psychological treatment for adults with depression or anxiety symptoms were included. This review returned 16,670 results and included 34 studies (N = 3,679). High rates of uptake (91% [95% CI 86, 94]) and completion (96% [95% CI 90, 98]) were reported. Compared to control, treatment resulted in small to moderate reductions in depression g = 0.35 (k = 20, 95% CI 0.13, 0.56) and moderate reductions in anxiety g = 0.51 (k = 14, 95% CI 0.40, 0.61) at post-treatment. Within-group effects appear to be maintained at follow-up. Overall heterogeneity was high; several moderators of between-group and within-group effects were identified. Control groups and follow-up periods varied greatly. Ultra-brief treatments appear to be acceptable and associated with significant symptom improvements. Larger clinical trials with longer follow-up periods are needed.

Objective: Ultra‐brief treatments (i.e., three or fewer sessions/modules) are associated with reductions in depression and anxiety symptoms, though the mechanisms underlying their effects are unclear. Research has yet to compare how perceptions of treatment credibility and outcome expectancy (i.e., how suitable and effective the treatment will be) may differ between ultra‐brief and standard‐length digital treatments. Methods: In a secondary analysis of a randomized controlled trial ( N = 152), the current study examined the distribution of credibility and expectancy prior to receiving either an ultra‐brief or standard‐length digital transdiagnostic treatment based on cognitive behaviour therapy and explored whether these variables predicted improvement in anxiety or depression symptoms. Results: There were no differences in how credible and effective participants perceived the two treatment options. In binary logistic regressions, higher credibility and expectancy were associated with greater odds of experiencing a clinically meaningful improvement (≥ 30% reduction) in anxiety (credibility OR = 1.68 [95% CI 1.15, 2.44]; expectancy OR = 1.50 [95% CI 1.11, 2.02]) and depression symptoms (credibility OR = 1.45 [95% CI 1.02, 2.05]; expectancy OR = 1.34 [95% CI 1.03, 1.76]) for the standard‐length treatment only. The predictive value of these two variables diminished when they were entered into the models together, highlighting their conceptual overlap. Findings also indicated a potential moderating role for treatment preference. Conclusion: Credibility and expectancy predict treatment outcomes for standard‐length digital treatment. Their influence on outcomes in ultra‐brief digital treatment is unclear and further research with larger samples is warranted.

BACKGROUND Depressive and anxiety disorders contribute substantially to the global burden of disease. Many patients wait a long time for outpatient psychotherapy, during which symptoms may persist or worsen. Digital interventions may help bridge this gap, and ultra-brief treatments (UBTs) are especially promising because they are scalable, low-threshold, and require few resources. However, it remains unclear how such interventions should be constructed to maximize reductions in symptoms of depression and anxiety and meet the needs of patients waiting for face-to-face (f2f) psychotherapy. OBJECTIVE This study aims to optimize a digital UBT for patients waiting for outpatient psychotherapy by testing three intervention components: therapeutic content (resource-focused vs. problem-focused), guidance (with vs without human support), and expectation-optimization elements (with vs without). The primary goal is to identify the most promising UBT configuration for reducing anxiety and depressive symptoms. The study will also examine patient experiences with the UBT to gain knowledge on how a UBT should be constructed to best suit their needs. METHODS This randomized, balanced 2 × 2 × 2 factorial trial includes eight conditions. A total of 312 participants waiting for outpatient f2f-psychotherapy who meet diagnostic criteria for a depressive disorder, anxiety disorder, or both will be randomized. The primary endpoint is anxiety and depressive symptom severity 2 weeks after randomization, measured with the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS). Secondary outcomes include depression symptoms, quality of life, anxiety symptoms, treatment satisfaction, negative effects, treatment expectations, perceived resource activation and problem mastery, and working alliance. Assessments will be conducted at baseline and 2, 5, 9, and 24 weeks after randomization. Qualitative interviews on patient experiences with the UBT will be conducted with a subsample (N = 40) following the 9-week assessment. RESULTS Recruitment started in September 2025. As of the date of manuscript submission in May 2026, 108 participants have been randomized and recruitment is ongoing. First results are expected in late 2027. CONCLUSIONS This trial examines how a digital UBT should be constructed to reduce depression and anxiety symptoms in patients waiting for face-to-face therapy. The factorial design will help identify which components contribute to symptom improvement. Findings are expected to guide the development of an optimized, scalable digital intervention for future testing and potential integration into routine care. CLINICALTRIAL ClinicalTrials.gov, NCT07167849.

Sudden gains are rapid, substantial, and lasting symptom reductions between sessions which have been associated with better treatment outcomes. Frequent symptom measurements in treatment change research can be burdensome; ultra-brief scales can reduce this burden, increase completion rates, and enable the examination of a broader range of constructs. This study compared the timing, prevalence, and treatment outcomes associated with sudden gains during an internet-delivered treatment using standard and ultra-brief self-report measures of depression and anxiety. Existing data (N = 937) from a five-week internet-delivered treatment for depression and anxiety in university students was analysed. Anxiety symptoms were measured using the Generalized Anxiety Disorder 7-item Scale (GAD-7) and its brief version the GAD-2, and depression symptoms were measured using the Patient Health Questionnaire 9-item Scale (PHQ-9) and its brief version the PHQ-2. More sudden gains were identified by the PHQ-9 than the PHQ-2, and more by the GAD-2 than the GAD-7. Critically, the standard and ultra-brief measures identified different individuals as having experienced a sudden gain. Sudden gains were associated with higher baseline symptom severity. These results seem to raise important questions about the detection of sudden gains, and the comparability of findings across studies using different measures.