Electronic Thesis and Dissertation Repository

Thesis Format



Master of Science


Health and Rehabilitation Sciences


Loh, Eldon

2nd Supervisor

Mehta, Swati



Individuals with mild traumatic brain injury (mTBI) can experience high levels of emotional distress, leading to decreased quality of life and increased health care costs. Bowen's feasibility framework was used to examine the feasibility, acceptability, and limited efficacy of an innovative clinician-guided internet-delivered cognitive behavioural therapy program (ICBT) specialized for people with mTBI to improve their wellbeing. The data illustrated strong adherence and program satisfaction from participants. Likewise, statistically and clinically significant changes in symptoms of unhappiness and anxiety were found, along with improved self-efficacy and quality of life. The findings of this study contribute new knowledge to the emerging literature on ICBT and its effectiveness on those with neurological conditions (i.e., mTBI). The data will be used to guide more extensive studies that will evaluate the program's effectiveness in a community setting to improve patients' overall wellbeing and access to mental health care services.

Summary for Lay Audience

People with mild traumatic brain injury (mTBI) are highly susceptible to experiencing depression and anxiety after their injury. Although these mental health problems are prevalent and disabling, they often go untreated for various reasons (i.e., cost, time, stigma). Unfortunately, untreated and persistent psychological symptoms increase pain, health care costs and risk of suicide and decrease quality of life. Thus, this thesis explores the feasibility of a 10-week clinician-guided internet-delivered Cognitive Behavioural Therapy (ICBT) program for people with mTBI by examining the program’s acceptability and effectiveness. The ICBT program was developed to improve the wellbeing of people with mTBI by teaching them skills to manage their symptoms of depression and anxiety. The program includes clinician support once per week intended to strengthen participants’ understanding of the program content and provide personalization within the online program. Twenty participants enrolled in the ICBT program. Information on their experiences of depression, anxiety, self-efficacy, and quality of life was collected before and after the program. After completing the program, participants provided information on their satisfaction with the treatment, ICBT content, platform, and clinician support. The results revealed a decrease in participants’ experience of depression and anxiety, suggesting that they learned to better manage their mental health by applying the skills learned from the program. Furthermore, all participants were satisfied with the ICBT platform, the treatment, and the support received from the clinician. The impact seen in this study is noteworthy, as access to mental health services for people with mTBI is still limited due to several factors, including cost, stigma, and accessibility. The ICBT program potentially addresses these barriers and provides services on a safe and secure platform from the comfort of the participant’s home. Although not evaluated in this study, past research has suggested that online CBT-based programs are equally effective as traditional face-to-face Cognitive Behavioural Therapy. This may be the potential for the current ICBT program. Given the limited research on ICBT for people with mTBI, this study will contribute to the literature and lead as an example for further clinical trials with improved versions of the ICBT program.