Background: Despite alcohol misuse representing a significant public health concern, treatment seeking behavior remains disproportionately low (<15%). Traditional face-to-face interventions are often associated with barriers that include cost, time, distance, stigma, low expectations of improvement, and treatment credibility. Internet-Delivered Cognitive Behavioural Therapy (ICBT) offers a flexible, cost effective, and accessible alternative to care that works to overcome these barriers. Several studies investigating the effectiveness of face-to-face therapy compared to ICBT found equivalent ratings in successful outcomes for a variety of mental health conditions.
Methods: In this mixed-methods study, expectations and perceptions of treatment credibility were examined in 81 participants enrolled in the Alcohol Change Course Enhanced (ACCE), an 8-week, evidenced based ICBT aimed at reducing alcohol consumption. All measurements were administered at pre-, mid-, and post-treatment. Changes in credibility, expectancy, and alcohol consumption levels were captured using a Linear-fixed effects model, while correlational measures examined associations between participant characteristics, baseline measures, and alcohol outcomes. In addition, 10 Qualitative interviews were conducted to identify themes and patterns that influence credibility and expectancy in ICBT.
Results: The results obtained from the study showed that credibility and expectancy reduced across treatment, with relationship status emerging as the strongest predictor that drives these perceptions. Individuals who scored higher on the Credibility and Expectancy Questionnaire at pre-treatment were associated with greater levels of post-treatment satisfaction. Exploratory and qualitative findings revealed that participants reported significant reductions in alcohol consumption and mental health symptoms. Although clinical improvements were not associated with changes in credibility and expectancy across time, these variables were influenced by baseline symptom severity, expectations of behavior change, internal shifts such as increased motivation, and external shifts such as perceived relevance and relatability of treatment content and material.
Conclusion: The findings from this study, along with the existing literature on ICBT for alcohol misuse highlights how digital mental health services are an innovative approach that support clinical outcomes. Moreover, patient perspectives and testimonials shared during the interview process provided clinicians with valuable feedback that can be utilized to improve future ICBT interventions for alcohol misuse.