@article{bouchard_moderating_2023,

title = {The moderating and mediating role of telepresence and cognitive change in cognitive behaviour therapy delivered via videoconference},

author = {S. Bouchard and M. Berthiaume and G. Robillard and M. Allard and I. Green-Demers and S. Watts and A. Marchand and P. Gosselin and F. Langlois and G. Belleville and M. J. Dugas},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85139800809&doi=10.1002%2fcpp.2816&partnerID=40&md5=5eac58684326b5475037e1474aa932f7},

doi = {10.1002/cpp.2816},

issn = {10633995},

year  = {2023},

date = {2023-01-01},

journal = {Clinical Psychology and Psychotherapy},

volume = {30},

number = {3},

pages = {575–586},

abstract = {In this study, we combined the results of two controlled trials and examined the relationships between working alliance, telepresence, cognitive change and treatment outcome. Sixty-five participants with a primary diagnosis of generalized anxiety disorder (GAD) or panic disorder with agoraphobia (PDA) received cognitive behaviour therapy delivered via videoconference. Participants completed measures of working alliance and telepresence after three psychotherapy sessions. They also completed measures of treatment outcome and dysfunctional beliefs (cognitive change) specific to PDA and GAD at pretreatment and posttreatment. Results revealed that telepresence at the fifth session moderated the relationship between the working alliance at the first and fifth sessions. As telepresence increased, its impact on the working alliance diminished. Cognitive change mediated the relationship between the working alliance at the fifth session and treatment outcome. © 2022 John Wiley & Sons Ltd.},

note = {Publisher: John Wiley and Sons Ltd},

keywords = {agoraphobia, Anxiety disorder, Anxiety Disorders, cognition, cognitive behavioral therapy, human, Humans, procedures, treatment outcome, videoconferencing},

pubstate = {published},

tppubtype = {article}

}

@article{dugas_pain_2023,

title = {Pain catastrophizing and worry about health in generalized anxiety disorder},

author = {M. J. Dugas and K. Giguère Marchal and S. Cormier and S. Bouchard and J. -P. Gouin and R. Shafran},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85150514206&doi=10.1002%2fcpp.2843&partnerID=40&md5=2676de0f5a42bcdaea5f10aa5e8e3f55},

doi = {10.1002/cpp.2843},

issn = {10633995},

year  = {2023},

date = {2023-01-01},

journal = {Clinical Psychology and Psychotherapy},

volume = {30},

number = {4},

pages = {852–861},

abstract = {Because the diagnostic criteria of generalized anxiety disorder (GAD) are not tied to specific worry domains (worry is ‘generalized’), research on the content of worry in GAD is lacking. To our knowledge, no study has addressed vulnerability for specific worry topics in GAD. The goal of the current study, a secondary analysis of data from a clinical trial, is to explore the relationship between pain catastrophizing and worry about health in a sample of 60 adults with primary GAD. All data for this study were collected at pretest, prior to randomization to experimental condition in the larger trial. The hypotheses were that (1) pain catastrophizing would be positively related to the severity of GAD, (2) the relationship between pain catastrophizing and the severity of GAD would not be explained by intolerance of uncertainty and psychological rigidity, and (3) pain catastrophizing would be greater in participants reporting worry about health compared to those not reporting worry about health. All hypotheses were confirmed, suggesting that pain catastrophizing may be a threat-specific vulnerability for health-related worry in GAD. The implications of the current findings include a better understanding of the ideographic content of worry, which could help focus treatment interventions for individuals with GAD. © 2023 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd.},

note = {Publisher: John Wiley and Sons Ltd},

keywords = {adult, Anxiety, Anxiety disorder, Anxiety Disorders, Catastrophization, catastrophizing, human, Humans, Pain, psychology, uncertainty},

pubstate = {published},

tppubtype = {article}

}

@article{clemmensen_study_2023,

title = {Study protocol for virtual leisure investigating the effect of virtual reality-delivered stress reduction, entertainment and distraction on the use of coercion and need-based medication and patient satisfaction at a closed psychiatric intensive care unit - A mixed-methods pilot clinical trial},

author = {L. Clemmensen and G. Jørgensen and K. B. Gundersen and L. C. Smith and J. Midtgaard and S. Bouchard and C. P. Thomsen and L. Turgut and L. B. Glenthoj},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85172425765&doi=10.1136%2fbmjopen-2022-070566&partnerID=40&md5=87f1ee7c5b1f4d9245722d461eb9e6d2},

doi = {10.1136/bmjopen-2022-070566},

issn = {20446055},

year  = {2023},

date = {2023-01-01},

journal = {BMJ Open},

volume = {13},

number = {9},

abstract = {Introduction The environment at a psychiatric inpatient ward can lead to emotional distress and behavioural deviations in vulnerable individuals potentially resulting in conflicts, increased use of need-based medication and coercive actions, along with low satisfaction with treatment. To accommodate these challenges, recreational and entertaining interventions are recommended. The tested interventions have, however, shown varying effects and demand a high degree of planning and staff involvement while being difficult to adapt to individual needs. Virtual reality (VR) may help overcome these challenges. Methods and analysis The study is a mixed-methods clinical trial with a target sample of 124 patients hospitalised at a closed psychiatric ward in the capital region of Denmark. Outcomes (eg, coercion, need-based medication and perceived stress) for a 12-month period where all patients are offered VR-based recreational experiences during their hospitalisation will be compared with outcomes for a 12-month period where VR is not offered. Feasibility and acceptability will be explored with qualitative interviews supplemented with non-participant observations and focus groups. The study began on 1 January 2023, and we expect to complete data collection by 31 December 2024. Ethics and dissemination The study is registered at Danish Data Protection Agency (j.no P-2022-466) and is approved by the Committee on Health Research Ethics of the capital region of Denmark (j.no 22013313). All patients will be required to provide informed consent. Results from this study will be disseminated via peer-reviewed journals and congress/consortium presentations. Trial registration number NCT05654740. © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.},

note = {Publisher: BMJ Publishing Group},

keywords = {Anxiety disorder, article, Behavior Observation Techniques, behavioral observation, borderline state, clinical effectiveness, clinical outcome, clinical protocol, Coercion, cognitive behavioral therapy, comparative study, Denmark, Depression, feasibility study, health care need, hospital patient, human, Humans, intensive care unit, Intensive Care Units, interpersonal communication, leisure, Leisure Activities, major clinical study, neuroleptic agent, non participant observation, Patient Satisfaction, peer review, pilot study, psychiatric intensive care unit, qualitative analysis, quantitative analysis, schizophrenia spectrum disorder, semi structured interview, virtual reality, virtual reality delivered stress reduction},

pubstate = {published},

tppubtype = {article}

}

@article{scholten_baseline_2023,

title = {Baseline Severity as a Moderator of the Waiting List-Controlled Association of Cognitive Behavioral Therapy with Symptom Change in Social Anxiety Disorder: A Systematic Review and Individual Patient Data Meta-analysis},

author = {W. Scholten and A. Seldenrijk and A. Hoogendoorn and R. Bosman and A. Muntingh and E. Karyotaki and G. Andersson and T. Berger and P. Carlbring and T. Furmark and S. Bouchard and P. Goldin and I. Kampmann and N. Morina and N. Kocovski and E. Leibing and F. Leichsenring and T. Stolz and A. Van Balkom and N. Batelaan},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85166386036&doi=10.1001%2fjamapsychiatry.2023.1291&partnerID=40&md5=c279c8b0ff2d3b4558c6f8803cdda0af},

doi = {10.1001/jamapsychiatry.2023.1291},

issn = {2168622X (ISSN)},

year  = {2023},

date = {2023-01-01},

journal = {JAMA Psychiatry},

volume = {80},

number = {8},

pages = {822–831},

abstract = {Importance: Social anxiety disorder (SAD) can be adequately treated with cognitive behavioral therapy (CBT). However, there is a large gap in knowledge on factors associated with prognosis, and it is unclear whether symptom severity predicts response to CBT for SAD. Objective: To examine baseline SAD symptom severity as a moderator of the association between CBT and symptom change in patients with SAD. Data Sources: For this systematic review and individual patient data meta-analysis (IPDMA), PubMed, PsycInfo, Embase, and the Cochrane Library were searched from January 1, 1990, to January 13, 2023. Primary search topics were social anxiety disorder, cognitive behavior therapy, and randomized controlled trial. Study Selection: Inclusion criteria were randomized clinical trials comparing CBT with being on a waiting list and using the Liebowitz Social Anxiety Scale (LSAS) in adults with a primary clinical diagnosis of SAD. Data Extraction and Synthesis: Authors of included studies were approached to provide individual-level data. Data were extracted by pairs of authors following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline, and risk of bias was assessed using the Cochrane tool. An IPDMA was conducted using a 2-stage approach for the association of CBT with change in LSAS scores from baseline to posttreatment and for the interaction effect of baseline LSAS score by condition using random-effects models. Main Outcomes and Measures: The main outcome was the baseline to posttreatment change in symptom severity measured by the LSAS. Results: A total of 12 studies including 1246 patients with SAD (mean [SD] age, 35.3 [10.9] years; 738 [59.2%] female) were included in the meta-analysis. A waiting list-controlled association between CBT and pretreatment to posttreatment LSAS change was found (b = -20.3; 95% CI, -24.9 to -15.6; P <.001; Cohen d = -0.95; 95% CI, -1.16 to -0.73). Baseline LSAS scores moderated the differences between CBT and waiting list with respect to pretreatment to posttreatment symptom reductions (b = -0.22; 95% CI, -0.39 to -0.06; P =.009), indicating that individuals with severe symptoms had larger waiting list-controlled symptom reductions after CBT (Cohen d = -1.13 [95% CI, -1.39 to -0.88] for patients with very severe SAD; Cohen d = -0.54 [95% CI, -0.80 to -0.29] for patients with mild SAD). Conclusions and Relevance: In this systematic review and IPDMA, higher baseline SAD symptom severity was associated with greater (absolute but not relative) symptom reductions after CBT in patients with SAD. The findings contribute to personalized care by suggesting that clinicians can confidently offer CBT to individuals with severe SAD symptoms.. © 2023 American Medical Association. All rights reserved.},

note = {Publisher: American Medical Association},

keywords = {adult, antidepressant agent, Anxiety disorder, article, avoidant personality disorder, clinical outcome, cognitive behavioral therapy, comorbidity, cycloserine, Depression, disease severity, female, hospital admission, human, Humans, Liebowitz Social Anxiety Scale, male, meta analysis, paroxetine, phobia, Preferred Reporting Items for Systematic Reviews and Meta-Analyses, procedures, psychotropic agent, randomized controlled trial (topic), Randomized Controlled Trials as Topic, semi structured interview, Social, social anxiety, social phobia, Structured Clinical Interview for DSM Disorders, symptom, systematic review, treatment response, Waiting Lists},

pubstate = {published},

tppubtype = {article}

}

@article{orskov_cognitive_2022,

title = {Cognitive behavioral therapy with adaptive virtual reality exposure vs. cognitive behavioral therapy with in vivo exposure in the treatment of social anxiety disorder: A study protocol for a randomized controlled trial},

author = {P. T. Ørskov and M. B. Lichtenstein and M. T. Ernst and I. Fasterholdt and A. F. Matthiesen and M. Scirea and S. Bouchard and T. E. Andersen},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85140322564&doi=10.3389%2ffpsyt.2022.991755&partnerID=40&md5=1dacd4e05081f4790ccd5e0d7224e0ca},

doi = {10.3389/fpsyt.2022.991755},

issn = {16640640 (ISSN)},

year  = {2022},

date = {2022-01-01},

journal = {Frontiers in Psychiatry},

volume = {13},

abstract = {Background: Social anxiety disorder (SAD) has a high prevalence and an early onset with recovery taking decades to occur. Current evidence supports the efficacy of cognitive behavioral therapy (CBT) with virtual reality (VR) exposure. However, the evidence is based on a sparse number of studies with predominantly small sample sizes. There is a need for more trials investigating the optimal way of applying VR based exposure for SAD. In this trial, we will test the efficacy of CBT with adaptive VR exposure allowing adjustment of the exposure based on real-time monitoring of the participants's anxiety level. Methods: The trial is a randomized controlled, assessor-blinded, parallel-group superiority trail. The study has two arms: (1) CBT including exposure in vivo (CBT-Exp), (2) CBT including exposure therapy using individually tailored VR-content and a system to track anxiety levels (CBT-ExpVR). Treatment is individual, manual-based and consists of 10 weekly sessions with a duration of 60 min. The study includes 90 participants diagnosed with SAD. Assessments are carried out pre-treatment, mid-treatment and at follow-up (6 and 12 months). The primary outcome is the mean score on the Social Interaction Anxiety Scale (SIAS) with the primary endpoint being post-treatment. Discussion: The study adds to the existing knowledge by assessing the efficacy of CBT with adaptive VR exposure. The study has high methodological rigor using a randomized controlled trial with a large sample size that includes follow-up data and validated measures for social anxiety outcomes. Clinical trial registration: ClinicalTrials.gov, identifier: NCT05302518. Copyright © 2022 Ørskov, Lichtenstein, Ernst, Fasterholdt, Matthiesen, Scirea, Bouchard and Andersen.},

note = {Publisher: Frontiers Media S.A.},

keywords = {adult, aged, Alcohol Use Disorders Identification Test, anxiety assessment, Anxiety disorder, article, behavior disorder assessment, cognitive behavioral therapy, comparative effectiveness, controlled study, Depression, Drug Use Disorders Identification Test, electrodermal activity, exposure, Fear of Negative Evaluation, follow up, health economics, Heart Rate, human, Leibowitz Anxiety Scale, Machine learning, major clinical study, psychological distress assessment, psychophysiological measurements, randomized controlled trial, Simulator Sickness Questionnaire, social anxiety, Social Interaction Anxiety Scale, social phobia, Subjective Units of Distress Scale, therapy effect, treatment duration, treatment outcome, virtual reality, virtual reality exposure therapy, Working Alliance Inventory},

pubstate = {published},

tppubtype = {article}

}

@article{dugas_behavioral_2022,

title = {Behavioral Experiments for Intolerance of Uncertainty: A Randomized Clinical Trial for Adults With Generalized Anxiety Disorder},

author = {M. J. Dugas and K. A. Sexton and E. A. Hebert and S. Bouchard and J. -P. Gouin and R. Shafran},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85133178888&doi=10.1016%2fj.beth.2022.05.003&partnerID=40&md5=4dd15547cbef29c5f1adc84169176c53},

doi = {10.1016/j.beth.2022.05.003},

issn = {00057894 (ISSN)},

year  = {2022},

date = {2022-01-01},

journal = {Behavior Therapy},

volume = {53},

number = {6},

pages = {1147–1160},

abstract = {Sophisticated multicomponent treatments for adults with generalized anxiety disorder (GAD) have been developed over the past three decades. Although these comprehensive treatments have produced encouraging results, they appear to be less efficacious than treatments for other anxiety disorders. The goal of this randomized controlled trial is to test a newly developed, highly focused treatment for adults with GAD: Behavioral Experiments for Intolerance of Uncertainty. Sixty (60) participants (51 women, 9 men), with a mean age of 34.60 years (range: 19 to 67 years), were randomized to either treatment (n = 30) or wait-list control (n = 30). Treatment consisted of 12 weekly 1-hour sessions in which participants learned to use behavioral experiments to test their catastrophic beliefs about uncertainty. Assessments were conducted at pre-, mid- and postcondition, and at 6- and 12-month follow-up. The primary outcome was the severity of GAD, and secondary outcomes were worry, depression, somatic anxiety, and intolerance of uncertainty. Using growth curve modeling, we found that (1) the treatment group was superior to the wait-list group in terms of change from pre- to posttest on all outcomes; (2) the combined sample (once wait-listed participants received treatment) evidenced large and significant decreases on all outcomes; and (3) treatment gains were either maintained or increased over the 12-month follow-up period of the study. The new treatment is a promising treatment option for adults with GAD considering that it may be as efficacious as more comprehensive evidence-based psychological treatments for GAD. © 2022},

note = {Publisher: Elsevier Inc.},

keywords = {adult, aged, antidepressant agent, Anxiety, Anxiety disorder, Anxiety Disorders, anxiolytic agent, article, behavior assessment, behavioral experiments, benzodiazepine, cognitive behavioral therapy, cognitive vulnerability, Cognitive-behavioral treatment, confusion (uncertainty), controlled study, dependent variable, Depression, disease severity, female, follow up, generalized anxiety disorder, growth curve, human, Humans, intolerance of uncertainty, major clinical study, male, mental disease, outcome assessment, patient worry, procedures, psychology, randomized controlled trial, uncertainty},

pubstate = {published},

tppubtype = {article}

}

@article{ma_integrating_2021,

title = {Integrating virtual realities and psychotherapy: SWOT analysis on VR and MR based treatments of anxiety and stress-related disorders},

author = {L. Ma and S. Mor and P. L. Anderson and R. M. Baños and C. Botella and S. Bouchard and G. Cárdenas-López and T. Donker and J. Fernández-Álvarez and P. Lindner and A. Mühlberger and M. B. Powers and S. Quero and B. Rothbaum and B. K. Wiederhold and P. Carlbring},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85111974867&doi=10.1080%2f16506073.2021.1939410&partnerID=40&md5=37846f3bc3b9b7e260efba2709cb3c7b},

doi = {10.1080/16506073.2021.1939410},

issn = {16506073},

year  = {2021},

date = {2021-01-01},

journal = {Cognitive Behaviour Therapy},

volume = {50},

number = {6},

pages = {509–526},

abstract = {The use of virtual reality (VR) and mixed reality (MR) technology in clinical psychology is growing. Efficacious VR-based treatments for a variety of disorders have been developed. However, the field of technology-assisted psychotherapy is constantly changing with the advancement in technology. Factors such as interdisciplinary collaboration, consumer familiarity and adoption of VR products, and progress in clinical science all need to be taken into consideration when integrating virtual technologies into psychotherapies. We aim to present an overview of current expert opinions on the use of virtual technologies in the treatment of anxiety and stress-related disorders. An anonymous survey was distributed to a select group of researchers and clinicians, using an analytic framework known as Strengths, Weaknesses, Opportunities, and Threats (SWOT). Overall, the respondents had an optimistic outlook regarding the current use as well as future development and implementation of technology-assisted interventions. VR and MR psychotherapies offer distinct advantages that can overcome shortcomings associated with traditional therapy. The respondents acknowledged and discussed current limitations of VR and MR psychotherapies. They recommended consolidation of existing knowledge and encouraged standardisation in both theory and practice. Continued research is needed to leverage the strengths of VR and MR to develop better treatments. Abbreviations: AR: Augmented Reality; MR: Mixed Reality; RCT: Randomised Controlled Trial; SWOT: Strengths, Weaknesses, Opportunities, and Threats; VR: Virtual Reality; VR-EBT: Virtual Reality Exposure-Based Therapy. © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.},

note = {Publisher: Routledge},

keywords = {Anxiety, Anxiety disorder, Anxiety Disorders, augmented reality, health care survey, Health Care Surveys, human, Humans, mental stress, Psychological, psychology, Psychotherapists, psychotherapy, Stress, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{belleville_psychological_2021,

title = {Psychological Symptoms Among Evacuees From the 2016 Fort McMurray Wildfires: A Population-Based Survey One Year Later},

author = {G. Belleville and M. -C. Ouellet and J. Lebel and S. Ghosh and C. M. Morin and S. Bouchard and S. Guay and N. Bergeron and T. Campbell and F. P. MacMaster},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85105988601&doi=10.3389%2ffpubh.2021.655357&partnerID=40&md5=4971ac1ba23f88f8b6fa132caed4785d},

doi = {10.3389/fpubh.2021.655357},

issn = {22962565},

year  = {2021},

date = {2021-01-01},

journal = {Frontiers in Public Health},

volume = {9},

abstract = {Background: The 2016 wildfires in Fort McMurray (Alberta, Canada) led to a massive displacement of 88,000 people and destroyed 2,400 homes. Although no direct human fatality resulted, many individuals feared for their lives or those of their loved ones. Objectives: (1) To estimate the prevalence of post-traumatic stress, major depressive, insomnia, generalized anxiety, and substance use disorders in the adult population of Fort McMurray 1 year after the evacuation; (2) To identify pre-, peri-, and post-disaster correlates of mental health disorders. Methods: A phone survey using random digit sampling was used to survey evacuees. A total of 1,510 evacuees (response rate = 40.2%, 55.5% women, mean age = 44.11},

note = {Publisher: Frontiers Media S.A.},

keywords = {adult, Alberta, Anxiety disorder, Anxiety Disorders, Depressive Disorder, female, human, Humans, Major, major depression, male, Post-Traumatic, posttraumatic stress disorder, Stress Disorders, wildfire, Wildfires},

pubstate = {published},

tppubtype = {article}

}

@article{moise-richard_real_2021,

title = {Real and virtual classrooms can trigger the same levels of stuttering severity ratings and anxiety in school-age children and adolescents who stutter},

author = {A. Moïse-Richard and L. Ménard and S. Bouchard and A. -L. Leclercq},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85101691118&doi=10.1016%2fj.jfludis.2021.105830&partnerID=40&md5=e05dd193c76b1bad1d453aad4d87cc51},

doi = {10.1016/j.jfludis.2021.105830},

issn = {0094730X},

year  = {2021},

date = {2021-01-01},

journal = {Journal of Fluency Disorders},

volume = {68},

abstract = {Purpose: Many school-age children and adolescents who stutter experience the fear of public speaking. Treatment implications include the need to address this problem. However, it is not always possible to train repeatedly in front of a real audience. The present study aimed to assess the relevance of using a virtual classroom in clinical practice with school-age children and adolescents who stutter. Methods: Ten children and adolescents who stutter (aged 9–17 years old) had to speak in three different situations: in front of a real audience, in front of a virtual class and in an empty virtual apartment using a head-mounted display. We aimed to assess whether the self-rated levels of anxiety while speaking in front of a virtual audience reflect the levels of anxiety reported while speaking in front of a live audience, and if the stuttering level while speaking to a virtual class reflects the stuttering level while speaking in real conditions. Results: Results show that the real audience creates higher anticipatory anxiety than the virtual class. However, both the self-reported anxiety levels and the stuttering severity ratings when talking in front of a virtual class did not differ from those observed when talking to a real audience, and were significantly higher than when talking in an empty virtual apartment. Conclusion: Our results support the feasibility and relevance of using a virtual classroom to expose school-age children and adolescents who stutter to a feared situation during cognitive behavioral therapy targeting the fear of public speaking. © 2021 Elsevier Inc.},

note = {Publisher: Elsevier Inc.},

keywords = {Adolescent, anticipatory anxiety, Anxiety, anxiety assessment, Anxiety disorder, Anxiety Disorders, article, Child, clinical article, controlled study, disease severity, female, human, Humans, male, psychological rating scale, Public speaking, school, school child, Schools, self report, software, speech, Stuttering, virtual learning environment},

pubstate = {published},

tppubtype = {article}

}

@article{savard_efficacy_2021,

title = {Efficacy of a stepped care approach to deliver cognitive-behavioral therapy for insomnia in cancer patients: A noninferiority randomized controlled trial},

author = {J. Savard and H. Ivers and M. -H. Savard and C. M. Morin and A. Caplette-Gingras and S. Bouchard and G. Lacroix},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85121217599&doi=10.1093%2fsleep%2fzsab166&partnerID=40&md5=8c3390082d345b725c47465f96bb8e44},

doi = {10.1093/sleep/zsab166},

issn = {01618105 (ISSN)},

year  = {2021},

date = {2021-01-01},

journal = {Sleep},

volume = {44},

number = {11},

abstract = {Study Objectives: Cognitive-behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for cancer-related insomnia, but its accessibility is very limited in routine care. A stepped care approach has been recommended as a cost-effective way to make CBT-I more widely accessible. However, no controlled study has yet been published about the efficacy of this approach. The goal of this noninferiority randomized controlled trial (RCT) was to compare the short and long-term efficacy of a stepped care CBT-I (StepCBT-I) to a standard face-to-face CBT-I (StanCBT-I). Methods: A total of 177 cancer patients were randomized to: (1) StanCBT-I (6 face-to-face CBT-I sessions; n = 59) or (2) StepCBT-I (n = 118). In the StepCBT-I group, patients with less severe insomnia first received a web-based CBT-I (n = 65), while those with more severe insomnia received 6 face-to-face CBT-I sessions (n = 53). In both cases, patients could receive up to three booster sessions of CBT-I if they still had insomnia symptoms following this first step. Results: Results indicated that the Step-CBT-I group showed an Insomnia Severity Index score reduction and a sleep efficiency (on a sleep diary) increase that was not significantly inferior to that of StanCBT-I at all post-treatment time points. Analyses of secondary outcomes indicated significant time effects (ps <. 001) and no significant group-by-time interactions (ps from. 07 to. 91) on other sleep diary parameters, sleep medication use, depression, anxiety, fatigue, and quality of life scores. Conclusion(s): The efficacy of stepped care CBT-I is not inferior to that of a standard face-to-face intervention and is a valuable approach to making this treatment more widely accessible to cancer patients. Trial registration: ClinicalTrials.gov Identifier: NCT01864720 (https://clinicaltrials.gov/ct2/show/NCT01864720?term=Savard&draw=2&rank=6; Stepped Care Model for the Wider Dissemination of Cognitive-Behavioural Therapy for Insomnia Among Cancer Patients). © 2021 Sleep Research Society 2021. Published by Oxford University Press on behalf of the Sleep Research Society.},

note = {Publisher: Oxford University Press},

keywords = {adult, Anxiety, Anxiety disorder, cancer, cancer diagnosis, cancer patient, cognitive behavioral therapy, Cognitive-behavioral therapy, comparative study, complication, controlled study, cost effectiveness analysis, Depression, disease severity, drug use, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, fatigue, female, Hospital Anxiety and Depression Scale, human, Humans, insomnia, Insomnia Severity Index, long term care, major clinical study, male, malignant neoplasm, Middle Aged, Montreal cognitive assessment, neoplasm, Neoplasms, outcome assessment, procedures, psychotropic agent, quality of life, randomized controlled trial, remission, review, Self Care, short course therapy, sleep, sleep efficiency, Sleep Initiation and Maintenance Disorders, sleep pattern, stepped care, stepped care approach, Structured Clinical Interview for DSM Disorders, therapy effect, treatment outcome, web-based intervention},

pubstate = {published},

tppubtype = {article}

}