Selin Akkol-Solakoglu

Breast cancer survivors often lack post-treatment psychological care options. Internet-delivered cognitive behavioural therapy (iCBT) has proven effective for depression and anxiety among survivors. Involving carers in iCBT can further encourage survivors and enhance the benefits they receive. This study explored survivors’ experiences with iCBT and their perspectives on carer involvement. Fifteen participants were interviewed. Data were analysed using thematic content analysis. Most survivors found iCBT helpful, mentioning evidence-based approach, reminders, readiness for change, recognising benefits, and contributing to research as engagement facilitators. Suggestions included widespread availability of the programme and additional guidance on some tools. Reluctance to involve carers resulted from survivors’ unwillingness to discuss cancer, desire not to burden others, and the need for ownership over their recovery. Findings support iCBT’s acceptability in addressing post-treatment depression and anxiety among survivors. Future research could explore alternative ways to involve carers, such as dedicated programmes, optional joint exercises, or brief interventions.

Background: In recent years, exponential growth in digital innovations and internet access has provided opportunities to deliver health services at a much greater scale than previously possible. Evidence-based technology-enabled interventions can provide cost-effective, accessible, and resource-efficient solutions for addressing mental health issues. This study evaluated the first year of a supported digital cognitive behavioral therapy (CBT) service provided by the national health service in Ireland, which has been accessible to individuals who receive a referral from one of five referring groups: General Practitioners, Primary Care Psychology, Counselling Primary Care, Community Mental Health, and Jigsaw (a nationwide youth mental health service). Methods: A retrospective, observational study examining data from the service between April 2021 to April 2022 was conducted. Descriptive statistics on referrals, account activations, user demographics, program usage, and user satisfaction were extracted, and pre-to-post clinical outcomes for depression measured by the Patient Health Questionnaire-9 and for anxiety measured by the Generalised Anxiety Disorder-7 were analysed using linear mixed effect models. Results: There were 5,298 referrals and 3,236 (61%) account activations within the year. Most users were female (72.9%) and aged between 18 and 44 years (75.4%). The CBT programs were associated with significant reductions in both depression (β = 3.34, 95% CI [3.03, 3.65], p < 0.001) and anxiety (β = 3.64, 95% CI [3.36, 3.93], p < 0.001), with large effect sizes (Cohen’s d > 0.8). Time spent using the programs was also found to be a predictor of the variability in these clinical outcomes (p < 0.001), and accounting for this resulted in significantly better model fits (p < 0.001). User satisfaction ratings were also very high, exceeding 94%. Conclusions: Efforts to improve the representation of male and older adult users are warranted. However, overall, the results demonstrate how digital CBT can be provided at scale and lead to symptom reductions with large effect sizes for patients seeking help for depression and anxiety. The findings substantiate the continued use and expansion of this service in Ireland and the more widespread implementation of similar services in other international public healthcare settings.

Objective: Depression and anxiety symptoms are common among breast cancer survivors. Access to evidence‐based psychological therapy remains a major challenge. Despite the proven effectiveness of internet‐delivered cognitive behavioural therapy (iCBT) in reducing depression and anxiety, the research with cancer survivors is still limited. This study evaluated the effectiveness of an iCBT intervention on depression and anxiety, quality of life, fear of recurrence, active and avoidant coping, and perceived social support in breast cancer survivors.Methods: Seventy‐two participants were randomised to a 7‐module guided iCBT intervention or treatment‐as‐usual (TAU). Depression and anxiety symptoms were measured using the Hospital Anxiety and Depression Scale total score (HADS‐T). The secondary measures included the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC‐QLQ), Breast Cancer Worry Scale (CWC), Brief Coping Orientation to Problems Encountered (Brief COPE), Medical Outcomes Study Social Support Survey (MOS‐SSS). All were completed at baseline, post‐intervention, and 2‐month follow‐up. Groups were compared using linear mixed models.Results: Although non‐significant, iCBT group had lower HADS‐T scores than TAU at post‐intervention. This difference was statistically significant at 2‐month follow‐up (Hedge's g = −0.94). No significant group‐by‐time interaction effects were found for quality of life, fear of recurrence, active coping, avoidant coping, and perceived social support. The intervention adherence was acceptable; 52.8% (n = 28) completed all seven modules.Conclusions: iCBT intervention demonstrated its preliminary effectiveness in reducing distress in breast cancer survivors.