Current Research Projects

Using online delivered therapy and brain imaging to better understand obsessive-compulsive disorder


Abstract: Obsessive-compulsive disorder (OCD) is a debilitating and prevalent anxiety with the exact pathophysiology unknown. By observing the effects of proven treatments on brain activation levels, the cause of OCD can be better understood. Currently, the gold standard treatment for OCD is cognitive CBT with exposure and response prevention. However, this is often temporally and geographically inaccessible, time-consuming, and costly. Fortunately, CBT can be effectively delivered using the internet (e-CBT) due to its structured nature thus addressing these barriers. This study will implement an e-CBT program for OCD and observe its effects on brain activation levels using magnetic resonance imaging (MRI). It is hypothesized that brain activation levels in the basal ganglia and frontal cortex will decrease following treatment. Individuals with OCD will be offered a 16-week e-CBT program with ERP mirroring in-person CBT content that will be administered through a secure online platform. Efficacy of treatment will bee valuated using clinically validated symptomology questionnaires at baseline, week 8, and post-treatment (week 16). Using MRI at baseline and post-treatment, brain activation levels will be assessed at resting state, and while exposed to simulating images. The effects of treatment on brain activation levels and the correlation between symptom changes and activation levels will be analyzed. The findings from this study can further our understanding of the causation of OCD, helping to develop more effective treatments for this disorder.

Developing and implementing an e-psychotherapy program for mental health challenges in oncology and palliative care


Abstract: The demand for mental health problems, particularly depression and anxiety, is three times greater in Oncology and Palliative Care Centres than in the general population. There are unique factors in this population that make them more susceptible to mental health challenges. The disease itself, the adjustment to a chronic/fatal diagnosis, and the treatment options can all perpetuate the development of mental illness. Despite the well-established association, there have been barriers to access suitable treatment for these patients. e-psychotherapy is an effective treatment option that may address many of these barriers. This modality has been proven effective in addressing depression and anxiety in other populations. To date, there has been no psychotherapy module developed specifically for oncology and palliative care patients to our knowledge. The aim is to establish the first academic e-psychotherapy treatment option to address mood and anxiety disorders in oncology and palliative care patients.The investigators will use the OPTT, a secure cloud-based platform for online delivery of e-psychotherapy. The proposed study aims to establish the feasibility and effectiveness of delivering e-psychotherapy to oncology and palliative care patients who have a comorbid depressive or anxiety disorder.The patients will be enrolled in an 8-week program with a combination of CBT and mindfulness techniques delivered via a series of modules. They will receive individualized feedback from a trained therapist weekly. It is hypothesized that delivering this psychotherapeutic intervention in this manner will have great adherence. The aim is to prove that it will improve the quality of life and decrease symptoms of depression and anxiety in this underserved patient population.

Delivering e-CBT to address mental health challenges in correctional officers and other public safety personnel


Abstract: Public safety personnel have regular and often intense exposure to potentially traumatic events at work and are at higher risk for developing mental health problems such as post traumatic stress disorder (PTSD). Studies have shown up to 4 times higher suicidal ideation, attempt and death among this population compared to the general population.Despite the high rate of mental health problems among PSPs, their willingness to receive mental healthcare support is low, mainly due to the stigma attached to these disorders. Those who are willing to seek help face unique barriers including their irregular shift hours, limiting their access to resources otherwise available to the public. Given these challenges and the critical contributions of public safety personnel, developing innovative solutions to address their mental health must be a healthcare priority. This study will evaluate the efficacy of using an innovative approach in delivering mental health online, to address mental health problems among correctional workers, who are especially prone to mental health problems given the high rate of workplace violence. It is hypothesized that e-CBT will lower the stigma of receiving care in a secure and confidential environment, easing the correctional workers concerns about stigma from co-workers. The content is delivered through interactive and engaging therapy modules, designed for specific groups of correctional workers, and customized by situational examples to make therapy more relatable. These online modules will provide correctional workers with 24/7 access to therapy content, solving the irregular work hour problem. The e-CBT modules developed in this study will provide high quality and clinically validated resources to address mental health problems of correctional workers across Canada. Knowledge acquired through this project could also be beneficial to using e-CBT in general for addressing mental health challenges among other public safety personnel.

E-psychotherapy, tailored to patients suffering from mental health problems due to COVID-19


Abstract: The recent COVID-19 pandemic has affected many aspects of individuals social life and its negative consequences on Canadian public health go far beyond the direct overload of the hospital care system. Self-isolation and financial uncertainty can significantly deteriorate individuals' mental health, which is only going to aggravate with prolonged physical distancing strategies. Adding to this is the personal and public trauma of lost lives and soon there will be an unprecedented epidemic of mental health problems with crushing effects on the public health sector and economy. To meet this huge new demand for an already strained health system, there is a need for innovative new approaches that significantly expand the capacity of care delivery. While it may not be possible in the short term to increase the number of mental healthcare providers or the number of hours they work, improving their time spent efficiently might be the solution. Virtual care and e-psychotherapy, shown to be clinically effective, efficient, and cost-effective, might be the perfect solution to address the high demand faced now. This study will establish the first academic online psychotherapy clinic to manage mental health problems secondary to COVID-19. The goal is to evaluate the feasibility and efficacy of treating COVID-19 related mental health issues in this clinic, offering a 10-week, diagnosis-specific, online psychotherapy program.OPTT, a secure cloud-based digital mental health platform, will be used.Potentially, this method of care delivery could increase care capacity by four-folds. The findings from this project have the potential to influence clinical practice and policy and increase accessibility to care during COVID-19pandemic, without sacrificing the quality of care.

Feasibility and effectiveness of delivering e-CBT through OPTT for depression


Abstract: Major Depressive Disorder (MDD) is a prevalent and debilitating mental health disorder. Among different therapeutic approaches(e.g., medication, psychotherapy), psychotherapy in the form of CBT is considered the gold standard treatment for MDD. However, while efficacious, CBTis not readily accessible to many patients in need due to hurdles like stigma, long wait times, high cost, the large time commitment for health care providers, and cultural/geographic barriers. e-CBT can effectively address many of these accessibility barriers. This study aims to investigate the efficacy and feasibility of implementing a digital e-psychotherapy clinic for the treatment of MDD. This non-randomized control trial intervention will provide e-CBT for MDD through OPTT, a secure, cloud-based, digital mental health platform. Participants (age 18-65 years) will be offered an e-CBT program tailored to MDD over 12 weeks to address their depressive symptoms.Participants will complete pre-designed modules and homework assignments while receiving personalized feedback and asynchronous interaction with a therapist through the platform. Using clinically validated symptomology questionnaires, the efficacy of the e-CBT program will be compared to a group receiving in-person CBT. Questionnaires will be completed at baseline, week 6, week 12, and at a 6-month follow-up. Inclusion criteria include diagnosis of MDD, competence to consent to participate, ability to speak and read English, and consistent and reliable access to the internet. Exclusion criteria include active psychosis, acute mania, severe alcohol or substance use disorder, and/or active suicidal or homicidal ideation. The results from this study can provide valuable information used to develop more accessible and scalable mental health interventions with increased care capacity for MDD, without sacrificing the quality of care.

Determining the efficacy of e-CBT for generalized anxiety disorder compared to pharmaceutical interventions


Abstract: Generalized anxiety disorder (GAD) is an extremely prevalent and debilitating mental health disorder. Currently, the gold standard treatment for GAD is CBT and/or pharmacotherapy. While CBT is a gold standard treatment for GAD, it is costly, time-consuming, and often inaccessible. Fortunately, e-CBT has emerged as a promising solution to address these barriers. E-CBT has shown to offer comparable results to in-person CBT while improving accessibility for patients and time efficiency for clinicians. The following project aims to investigate the treatment efficacy of e-CBT compared to, and in conjunction with pharmacotherapy for GAD. This study has been designed using a quasi-experimental design to allow patients the freedom to choose which treatment modality they would like to receive. Participants with a diagnosis ofGAD will be enrolled in 1 of 3 possible treatment arms: e-CBT, medication, or combination. The e-CBT program will include a 12-week psychotherapy program delivered through OPTT, a secure, cloud-based, digital mental health platform.The treatment efficacy of e-CBT will be compared to the treatment efficacy of the medication arm and the combination arm. If e-CBT is shown to either be comparable to medication or that the effects of both treatments are augmented when used in tandem, these findings could have major implications on the mental health care system. e-CBT is a more accessible, and affordable treatment that could increase mental health care capacity by four-folds if proven viable.

Delivering e-CBT to patients with bipolar disorder and residual depressive symptoms


Abstract: The lifetime prevalence of Bipolar II is 0.4% with the time spent with depressive symptoms outnumbering the time spent with hypomanic symptoms by 35 to 1. Regarding current treatment options, psychotherapy is effective for managing depressive symptoms, with CBT being particularly efficacious. Unfortunately, CBT is often not a feasible treatment option. e-CBTis more accessible for treating various mental illnesses with evidence suggesting it can increase treatment adherence and patient satisfaction.Moreover, e-CBT is suggested to have comparable outcomes to in-person CBT in the treatment of depression and anxiety. Typically, patient-clinician interactions of e-CBT are administered through email however, this is an insecure, unsustainable, and non-scalable treatment delivery method. The proposed study will use OPTT, a secure cloud-based platform for the delivery of e-CBT. The aim is to evaluate the feasibility and effectiveness of using OPTT for the treatment of Bipolar II with depressive symptoms, while also analyzing social, cultural, and personal factors affecting patients' experience.Participants (n = 80) diagnosed with Bipolar II in a depressive episode will be recruited from the Mood and Anxiety Clinic at Providence Care Hospital inKingston, Ontario, Canada. Eligible participants will then be randomly assigned to either the treatment group (e-CBT plus treatment as usual (n = 40) or the control group (n = 40) where they will complete the 12-week program.Participants in the treatment as usual group will be offered the e-CBT program after the first 12 weeks if they wish to take part. Participants in the e-CBT group will complete weekly modules mirroring in-person CBT content and complete homework assignments that will be evaluated by a clinician who will provide personalized feedback through OPTT. Progression/regression of participants will be analyzed using symptomology questionnaires administered at baseline, after week 6, and after week 12. Personal, social, and cultural factors impacting participant experience will be investigated through an in-depth interview utilizing focus groups. The findings from this study will be the first on the effectiveness of delivering e-CBT to patients with Bipolar II with residual depressive symptoms. This approach can provide an innovative method to address the barriers associated with in-person psychotherapy.

Investigating the effectiveness of incorporating a stepped care approach into e-CBT for depression


Abstract: This randomized trial intervention will provide e-CBT for MDD through OPTT, a secure, cloud-based, digital mental health platform. Participants (age: 18-65years) will be offered an e-CBT program tailored to MDD over 12 weeks to address their depressive symptoms. Participants will complete pre-designed modules and homework assignments while receiving personalized feedback and asynchronous interaction with a therapist through the platform. The content of the e-CBT modules is designed to mirror in-person standard CBT for MDD. There will be 12 weekly sessions that include approximately 30 slides each along with interactive content, delivered through OPTT. Using clinically validated symptomology questionnaires, the efficacy of the e-CBT program will be evaluated. Both groups will receive the 12-week e-CBT program with one group receiving the standard program. In the second arm, a stepped care approach can be implemented if deemed necessary by the care provider. This decision will be made if the participant has not shown improvement. Questionnaire data along with physiological data will be used to determine the decision.

Combined Ketamine and e-CBT Intervention for PTSD


Abstract: The study is an open label randomized control trial assessing the efficacy of a combined treatment of sub-anaesthetic IV Ketamine in conjunction with e-. In the study,20 participants with refractory PTSD will be randomly assigned either to an experimental group receiving a combination of Ketamine and e-CBT over 14 weeks, or they will be assigned to a 14-week waitlist-control group (at the end of which they will receive the experimental treatment). Both groups will be assessed for symptoms of PTSD and comorbid disorders before treatment, at the7-week halfway point, and at the end of the 14-week experimental period.Symptoms of PTSD and comorbid disorders for participants in the experimental group are expected to improve significantly more than participants in the waitlist-control.

Online Relapse Prevention Psychotherapy for Patients with Alcohol Use Disorder


Abstract: Alcohol consumption is associated with thousands of deaths annually. When alcohol consumption becomes a problematic pattern of alcohol use, accompanied by clinically significant distress, it is known as alcohol use disorder. Alcohol use disorder is highly disabling and is associated with a significant burden of disease.  Relapse rates remain high; one in five patients remain abstinent 12 months post-treatment. Craving is a major risk factor for relapse. It is useful to consider craving in treatment planning for alcohol use disorder. The experiences craving comprises physiological discomfort, intrusive substance-related cognitions, and affective distress.Traditional face-to-face psychotherapy resources have limited access due to factors such as high cost, long waitlists, living in remote areas where availability and accessibility could be barriers to receiving treatment. These experiences are recognized targets of cognitive and behavioural interventions; thus, this study will use a cognitive-behavioural relapse prevention intervention. This study will aim to establish the first academic e-relapse prevention psychotherapy treatment option to address alcohol use disorder in this population. 10 sessions of relapse prevention modules will be used, with the Online Psychotherapy Tool, a secure cloud-based platform for the e-psychotherapy.We will evaluate how patients’ mental status changes through this intervention as symptomology questionnaires and other behavioural variables. The findings will be the first on the effectiveness of delivering e-relapse prevention for patients with alcohol use disorder. This approach can provide an innovative method to address barriers to in-person psychotherapy.

Investigating the effectiveness of e-CBT compared to pharmaceutical interventions in treating Insomnia


Abstract: Insomnia is defined as the inability to fall asleep or stay asleep at night and it is one of the most prevalent sleep disorders that can have deleterious impacts on health and this population's quality of life. Currently, both pharmaceutical interventions (trazodone) and CBT are widely used to treat patients with insomnia. Although CBT has been efficacious in many patients, multitude of barriers for receiving treatment such as its limited availability of therapists, high costs and long wait times challenge its ability insufficiently meeting the population's health needs and demands. e-CBT has been developed as an accessible and effective alternative intervention for improving sleep outcomes in patients with insomnia. While evidence suggest that e-CBT is effective when compared to placebos/waitlist control, evidence comparing guide de-CBT to pharmaceutical interventions is still insufficient and needs further exploration.

Comparing the efficacy of an e-CBT program to a mental health coaching program for generalized anxiety disorder


Abstract: This study will compare the efficacy of an e-CBT program versus a mental health coaching program to treat generalized anxiety disorder (GAD). This randomized trial intervention will provide the e-CBT and mental health coaching for GAD through a secure, online platform. Participants will be between the ages of 18and 65 years with a confirmed diagnosis of GAD. Participants will either be offered an e-CBT program tailored to GAD or an online mental health coaching program over 12 weeks to address their anxiety symptoms. e-CBT participants will complete pre-designed modules and homework assignments while receiving personalized feedback and asynchronous interaction with a therapist through the platform. Participants in the coaching group will be contacted weekly through the online platform's chat feature. Therapists will ask the participants a series of pre-designed questions that revolve around a different theme each week to prompt conversation. Using clinically validated symptomology questionnaires, the efficacy of the e-CBT program will be compared to the coaching group. These questionnaires will be completed at baseline, week 6, week 12, and at a 6-month follow-up.