4 - (SYM 1) High Intensity Service Outcomes: Towards Meaningful Change

The Ontario Structured Psychotherapy Program provides free cognitive-behavioural therapy (CBT) to adults in Ontario for anxiety, mood, obsessive-compulsive, and post-traumatic stress symptoms. CBT is delivered individually and in groups, either in-person or virtually, depending on the needs of the client. The most common format is individual virtual therapy since the covid-19 pandemic. Clinicians are predominantly masters level therapists from professional backgrounds including occupational therapy, psychotherapy, social work, and nursing. Clinicians receive ongoing consultation and support from clinical psychologists.

Clients receive 12-20 sessions of free structured CBT for a specific problem, delivered on a weekly basis. Clinicians follow evidence-based treatment protocols for each disorder (e.g., Mind Over Mood for Depression, Cognitive Processing Therapy for post-traumatic stress), but have flexibility over the length of treatment and whether additional CBT skills are integrated into treatment. Clients complete symptom measures at each session.

Outcome data from 2021 to 2023 are presented using hierarchical linear modelling, modelling change over the course of treatment. HLM accounts for the violation of independence of data that arises with repeated measurement. Clients with at least two data points were included in the analyses to provide the most conservative estimates (individuals who dropped out are included).

Analyses showed that across all problem-descriptors and service delivery types (individual/group, virtual/in-person), the Generalized Anxiety Disorder-7 Item (GAD-7) and Patient Health Questionnaire -9 Item (PHQ-9) scores decreased significantly (B = -.25, p < .001 for both). Results were even more promising when looking at disorder-specific scales for each problem area. Depression (B = -.29), generalized anxiety (B = -.31), health anxiety (B = -.53), obsessive-compulsive (B = -.83), post-traumatic stress (B = -1.26), and social anxiety (B = -.92) symptoms all significantly decreased on their corresponding validated symptom measures (all ps < .001). Generalized anxiety scores and post-traumatic stress scores were below the threshold for clinically significant symptoms at the end of treatment. These data are promising given that drop-outs are included and the treatment is delivered in a real-world setting, outside the context of a rigorous clinical trial with strict fidelity. More fine-tuned analyses will also be presented (e.g., demographic data, differences in service delivery type).