Implementation trial II: Clinical outcomes and acceptability of an internet-delivered intervention for anxiety and depression delivered as part of routine care for university students in Australia

Background: University students report high levels of psychological distress, which is a contributor to poorer academic, social and health outcomes. There is increasing interest in the use of internet-delivered psychological treatments in student counselling services as a strategy improving access to psychological care at scale. However, to date, few large-scale prospective effectiveness trials of internet-delivered psychological treatment have been conducted in “real world” settings with university student populations. Aim: To investigate the effectiveness and acceptability of a brief transdiagnostic internet-delivered cognitive behavioural therapy (iCBT) intervention for anxiety and depression when delivered as part of routine care by the counselling service of an Australian university. Design: A large, prospective, single-group Phase IV clinical trial. Method: Students engaging with the university counselling service between 2018 and 2023 (N = 845; 8.5% of those presenting to the service) were given the option to receive the intervention based on their clinical needs and preferences. Students completed standardised measures of depression and anxiety severity at pre-treatment, each week of the intervention, and post-treatment. A subsample (n = 426) also completed the measures at 3-month follow-up. Results: Over a 5-year period, 700 students participated in the intervention and 489 provided data at post-treatment. Significant reductions in depression symptoms (% reduction = 27%, Hedges' g = 0.35) and anxiety (% reduction = 37%, Hedges' g = 0.61) were observed, alongside high levels of satisfaction (>70%) and adherence (68%). Over 50% of students had clinically significant improvements in symptom severity, and symptom deterioration was observed in <15% of students. Conclusion: The results of the current trial provide support for the effectiveness and acceptability of internet-delivered psychological interventions provided as part of routine care to university students with symptoms of anxiety and depression.