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Currently submitted to: JMIR Mental Health

Date Submitted: Aug 7, 2019
Open Peer Review Period: Aug 7, 2019 - Aug 29, 2019
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Examining the usage, user experience and perceived impact of an Internet-based cognitive behavioural therapy program for adolescents with anxiety: Results from a randomized controlled trial

  • Ashley Dawn Radomski; 
  • Alexa Bagnell; 
  • Sarah Curtis; 
  • Lisa Hartling; 
  • Amanda S Newton; 



Internet-based cognitive behavioural therapy (iCBT) increases access to treatment for adolescents with anxiety; typically, many participants do not complete these programs. Understanding adolescents’ program experiences may help explain and improve iCBT use and effectiveness based on program features and changes in anxiety (minimal clinically important difference; MCID) that are meaningful to users.


Within a randomized controlled trial comparing a 6-session iCBT program for adolescent anxiety (‘Breathe’) to anxiety-based resource webpages, we aimed to: describe Breathe and webpage usage; describe and compare Breathe and webpage user experiences; calculate a user-defined MCID for anxiety symptoms; and among Breathe users, explore relationships between usage, experiences, and perceived changes in anxiety.


Enrolled adolescents, aged 13-19 years with mild-to-moderate anxiety, were randomly allocated to the interventions. Adolescents reported demographics and anxiety symptoms (Multidimensional Anxiety Scale for Children-2nd edition [MASC-2]) prior to intervention use. After intervention use, they reported symptoms, experiences (User Experience Questionnaire for Internet-based Interventions: satisfaction, acceptability, credibility, impact, adherence and usage), perceived change in anxiety (global ratings of change scale [GRCS]), and intervention use (number of Breathe sessions completed, webpages visited). We used descriptive statistics to summarize usage and experience outcomes, and independent sample t-tests, Pearson, Spearman or point-biserial correlations to test relationships between them. To calculate the MCID, we used MASC-2 mean change scores among adolescents reporting “somewhat better” anxiety on the GRCS.


Adolescents (n=530) were mostly female (71.3%), aged 16.6 years (standard deviation [SD] 1.7) with ‘very elevated’ anxiety symptoms (Mean 92.2, SD 18.1). Intervention usage was low for adolescents allocated to Breathe (Mean 2.2 sessions, SD 2.3; n=258) and webpages (Mean 2.1 visits, SD 2.7; n=278). Breathe use was higher among the adolescents who reported their user experience after intervention use (Breathe: Median 6.0, Range 1-6, n=81/258; webpages: Median 2.0, Range 1-9, n=148/278) and the total user experience was more positive for Breathe users than the webpage users (P<.001). Adolescents who used Breathe reported time constraints and program delivery factors (exposure activities, program support) as challenges to use. Program design features (surveys, graphs, videos) and learning activities (self-management skills) contributed to adolescents’ enjoyment of Breathe. The MCID was determined to be a mean MASC-2 change score of 13.8 (SD 18.1). Using the MCID, 43% (n=35/81) of Breathe users were considered ‘treatment responders’. Treatment response was not correlated with user experience scores or Breathe use (P’s>0.05).


Breathe users reported positive experiences and changes in anxiety unrelated to their program use. Users identified program design, activity and delivery factors that may influence their iCBT experience and use. Future studies can apply our measures to compare user experiences between Internet-based interventions, interpret treatment outcomes, optimize program development, and improve treatment decision-making for adolescents with anxiety. Clinical Trial: NCT02970734


Please cite as:

Radomski AD, Bagnell A, Curtis S, Hartling L, Newton AS

Examining the usage, user experience and perceived impact of an Internet-based cognitive behavioural therapy program for adolescents with anxiety: Results from a randomized controlled trial

JMIR Preprints. 07/08/2019:15795

DOI: 10.2196/preprints.15795


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