Transdiagnostic internet cognitive-behavior therapy for mixed anxiety and depressive disorders in primary care: A dissemination and implementation study

Anxiety and depressive disorders are the most common mental disorders in Canada. COVID-19 is expected to put a strain on the already fragile mental health system, as early reports reveal depression and anxiety have been on the rise. Cognitive-behavior therapy (CBT) is the most evidence-based psychotherapy for anxiety and depressive disorders, but it is not widely available in Canada. The "This Way Up" virtual clinic in Australia created an innovative internet-based CBT (iCBT) program for mixed anxiety and depressive disorders. We developed a French adaptation of the iCBT program and conducted a feasibility study in Quebec and Ontario to examine the acceptability of the intervention for patients and family physicians. We now propose to conduct a dissemination and implementation study of the iCBT program to support the widespread uptake of this evidence-based intervention in the pandemic context. The study will be carried out in primary care settings in a large health region in Quebec. Participants with anxiety and depressive disorders in primary care will self-refer or be referred by a healthcare provider to iCBT. The implementation and evaluation of iCBT for settings, healthcare providers and patients will be guided by the five dimensions of the RE-AIM framework: reach, effectiveness, adoption, implementation and maintenance. Training sessions will be provided to clinicians to ensure competency in prescribing the program, monitoring patients' progress and symptoms from dashboard, and providing guided support. Quebec healthcare has not yet established a strategy to provide evidence-based iCBT, and this innovation offers a timely and appropriate response to this need. Our project will provide a rapidly accessible low-intensity iCBT intervention in French for anxiety and depression. The program's large-scale implementation could improve the effectiveness, efficiency, equity and access to a proven treatment for common mental disorders.