With the growing demand for internet-delivered cognitive behavioural therapy (iCBT), this pragmatic factorial (2 X 2 X 2) randomized controlled trial evaluated strategies for facilitating iCBT engagement and outcomes in routine care. Specifically, the benefits to patients and therapists, of using homework reflection questionnaires and offering patients twice-weekly therapist support were examined. Patients (n = 632) accepted into iCBT for depression and/or anxiety were randomly assigned to complete homework reflection questionnaires or not (factor 1), receive once- or twice-weekly support (factor 2), and to receive care from therapists employed in one of two settings (iCBT clinic or a community mental health clinic; factor 3). Outcomes were measured at pre-treatment, and 8, 12, and 24-weeks post-enrollment. Therapist time was tracked and a focus group was conducted to examine therapist experiences. No differences in patient outcomes were found between therapists employed in the two settings; as such, these two groups were combined for further analyses. In terms of engagement, homework reflection questionnaires were associated with fewer website log-ins and days accessing iCBT; twice-weekly support was associated with more patient emails sent to therapists. Despite engagement differences, homework reflection questionnaires and twice-weekly support did not significantly impact primary outcomes; all groups showed large improvements in depression and anxiety that were maintained at 24-week follow-up. Therapists perceived a number of benefits and challenges associated with responding to homework reflection questionnaires and offering twice-weekly support; most notably the strategies did not benefit all patients. Twice-weekly support was associated with increased therapist time and organizational challenges. It is concluded that neither completion of homework questionnaires nor offering twice-weekly support significantly improve iCBT in routine care.

随着对互联网交付的认知行为疗法（iCBT）的需求不断增长，该实用的阶乘（2 X 2 X 2）随机对照试验评估了促进iCBT参与常规护理和改善结局的策略。具体而言，研究了使用作业反思问卷并为患者提供每周两次的治疗师支持对患者和治疗师的益处。患者（n= 632）因抑郁和/或焦虑而被接受入iCBT的患者被随机分配到是否完成家庭作业反映问卷中（因子1），每周接受一次或两次支持（因子2）以及接受以下任一种治疗师的护理两种设置（iCBT诊所或社区心理健康诊所；因子3）。在治疗前，入组后第8、12和24周测量结局。跟踪治疗师的时间，并召开焦点小组检查治疗师的经历。在两种情况下聘用的治疗师之间，患者的预后没有差异。因此，将这两组进行了进一步的分析。在参与度方面，作业反思问卷与网站登录次数减少和访问iCBT的天数相关；每周两次的支持与发送给治疗师的更多患者电子邮件相关。尽管参与度存在差异，但作业反思问卷和每周两次的支持并没有显着影响主要结局。所有组在抑郁和焦虑方面均表现出很大的改善，并在24周的随访中得以维持。治疗师认为，回答作业反思问卷和每周提供两次支持会带来许多好处和挑战；最值得注意的是，该策略并未使所有患者受益。每周两次的支持与治疗师时间的增加和组织方面的挑战有关。结论是，完成家庭作业调查表或提供每周两次的支持都不会显着改善常规护理中的iCBT。家庭作业反思问卷和每周两次的支持并没有显着影响主要结果；所有组在抑郁和焦虑方面均表现出很大的改善，并在24周的随访中得以维持。治疗师意识到回应作业反思问卷并每周提供两次支持会带来许多好处和挑战；最值得注意的是，该策略并未使所有患者受益。每周两次的支持与治疗师时间的增加和组织方面的挑战有关。结论是，完成家庭作业调查表或提供每周两次的支持都不会显着改善常规护理中的iCBT。家庭作业反思问卷和每周两次的支持并没有显着影响主要结果；所有组在抑郁和焦虑方面均表现出很大的改善，并在24周的随访中得以维持。治疗师认为，回答作业反思问卷和每周提供两次支持会带来许多好处和挑战；最值得注意的是，该策略并未使所有患者受益。每周两次的支持与治疗师时间的增加和组织方面的挑战有关。结论是，完成家庭作业调查表或提供每周两次的支持都不会显着改善常规护理中的iCBT。治疗师认为，回答作业反思问卷和每周提供两次支持会带来许多好处和挑战；最值得注意的是，该策略并未使所有患者受益。每周两次的支持与治疗师时间的增加和组织方面的挑战有关。结论是，完成家庭作业调查表或提供每周两次的支持都不会显着改善常规护理中的iCBT。治疗师认为，回答作业反思问卷和每周提供两次支持会带来许多好处和挑战；最值得注意的是，该策略并未使所有患者受益。每周两次的支持与治疗师时间的增加和组织方面的挑战有关。结论是，完成家庭作业调查表或提供每周两次的支持都不会显着改善常规护理中的iCBT。