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Peer-reviewedCC BY 4.0Frontiers in Psychiatry

Delivering online cognitive behavioral therapy to address mental health challenges in correctional workers: a randomized controlled trial

  • Christina Holmes1,2
  • Gilmar Gutierrez1,3
  • Callum Stephenson1
  • Elnaz Moghimi1,4,5
  • Niloufar Malakouti1
  • Jasleen Jagayat1,6
  • Charmy Patel1
  • Alexander Simpson5,7
  • Cory Gerritsen5,8
  • Michael Martin9,10,11
  • Mark Fitzpatrick12
  • Jazmin Eadie1
7 more authors
  • Anika Agrawal1
  • Vineeth Jarabana1
  • Kimia Asadpour1
  • Ferwa Khan1
  • Dianne Groll1
  • Mohsen Omrani1,7,12
  • Nazanin Alavi1,6,12,13,14,15
15 affiliations
  1. 1Department of Psychiatry, Faculty of Health Sciences, Queen’s University
  2. 2Department of Clinical Psychology, School of Health in Social Sciences, The University of Edinburgh
  3. 3Department of Psychiatry, University of Alberta
  4. 4Waypoint Research Institute, Waypoint Centre for Mental Health Care
  5. 5Department of Psychiatry, University of Toronto
  6. 6Centre for Neuroscience Studies, Faculty of Health Sciences, Queen’s University
  7. 7Department of Forensic Psychiatry, Center for Addiction and Mental Health
  8. 8Graduate Department of Psychological Clinical Sciences, University of Toronto
  9. 9Health Services Sector, Correctional Service of Canada
  10. 10School of Epidemiology and Public Health, University of Ottawa
  11. 11Department of Psychology, Carleton University
  12. 12OPTT Inc.
  13. 13Faculty of Medicine and Health Sciences, McGill University
  14. 14Centre for Neuroscience Studies, Kingston Health Sciences Centre
  15. 15Centre for Digital Health Research (CDHR), Providence Care Hospital
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Abstract

Background: Correctional workers (CWs), are frequently exposed to traumatic workplace events, placing them at higher risk of experiencing mental health disorders, including major depressive disorder (MDD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD). Despite high prevalence of mental health challenges, CWs underutilize mental health services due to stigma, irregular work schedules, and accessibility issues. While cognitive behavioral therapy (CBT) is effective, it poses accessibility challenges. Electronic CBT (eCBT) offers a scalable, accessible alternative, but use among CWs remains underexplored.

Objective: This study aimed to evaluate the efficacy of diagnosis-specific eCBT programs designed for CWs in reducing symptoms of MDD, GAD, and PTSD compared to treatment as usual (TAU).

Methods: A randomized controlled trial (RCT) was conducted with 84 CWs in Ontario, assigned to either eCBT (n=40) or TAU (n=44). The eCBT program provided diagnosis-specific modules with synchronous personalized feedback from care providers over 12-weeks via the Online Psychotherapy Tool (OPTT). Symptom severity was measured at baseline, week-6, and post-treatment using validated scales for depression, anxiety, PTSD, and quality-of-life. Data analysis included paired samples t-tests, mixed linear models, and effect size calculations (Cohen’s d).

Results: The eCBT group exhibited significant reductions in symptom severity for depression, anxiety, and PTSD from baseline to post-treatment compared to TAU (p<0.01), with a moderate effect size (Cohen’s d=0.68). Symptom severity decreased by 61.37% for eCBT versus 23.29% in TAU. Mixed linear models confirmed a significant treatment-by-time interaction, favoring eCBT (p<0.01). However, no significant differences in quality-of-life improvements were observed between groups.

Conclusions: Diagnosis-specific eCBT programs are effective in reducing symptoms of depression, anxiety, and PTSD for CWs. The asynchronous, accessible format of eCBT addresses current key barriers. Future research should explore strategies to improve adherence and increase the accessibility of services for CWs.

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Cite

BibTeXRIS
BibTeX
@article{holmes2026delivering,
  title = {{Delivering online cognitive behavioral therapy to address mental health challenges in correctional workers: a randomized controlled trial}},
  author = {Christina Holmes and Gilmar Gutierrez and Callum Stephenson and Elnaz Moghimi and Niloufar Malakouti and Jasleen Jagayat and Charmy Patel and Alexander Simpson and Cory Gerritsen and Michael Martin and Mark Fitzpatrick and Jazmin Eadie and Anika Agrawal and Vineeth Jarabana and Kimia Asadpour and Ferwa Khan and Dianne Groll and Mohsen Omrani and Nazanin Alavi},
  journal = {Frontiers in Psychiatry},
  year = {2026},
  month = oct,
  doi = {10.3389/fpsyt.2026.1922912},
  url = {https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1922912/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Delivering online cognitive behavioral therapy to address mental health challenges in correctional workers: a randomized controlled trial
AU  - Christina Holmes
AU  - Gilmar Gutierrez
AU  - Callum Stephenson
AU  - Elnaz Moghimi
AU  - Niloufar Malakouti
AU  - Jasleen Jagayat
AU  - Charmy Patel
AU  - Alexander Simpson
AU  - Cory Gerritsen
AU  - Michael Martin
AU  - Mark Fitzpatrick
AU  - Jazmin Eadie
AU  - Anika Agrawal
AU  - Vineeth Jarabana
AU  - Kimia Asadpour
AU  - Ferwa Khan
AU  - Dianne Groll
AU  - Mohsen Omrani
AU  - Nazanin Alavi
PY  - 2026
DA  - 2026/10/16
JO  - Frontiers in Psychiatry
DO  - 10.3389/fpsyt.2026.1922912
UR  - https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1922912/full
AB  - Background: Correctional workers (CWs), are frequently exposed to traumatic workplace events, placing them at higher risk of experiencing mental health disorders, including major depressive disorder (MDD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD). Despite high prevalence of mental health challenges, CWs underutilize mental health services due to stigma, irregular work schedules, and accessibility issues. While cognitive behavioral therapy (CBT) is effective, it poses accessibility challenges. Electronic CBT (eCBT) offers a scalable, accessible alternative, but use among CWs remains underexplored.  Objective: This study aimed to evaluate the efficacy of diagnosis-specific eCBT programs designed for CWs in reducing symptoms of MDD, GAD, and PTSD compared to treatment as usual (TAU).  Methods: A randomized controlled trial (RCT) was conducted with 84 CWs in Ontario, assigned to either eCBT (n=40) or TAU (n=44). The eCBT program provided diagnosis-specific modules with synchronous personalized feedback from care providers over 12-weeks via the Online Psychotherapy Tool (OPTT). Symptom severity was measured at baseline, week-6, and post-treatment using validated scales for depression, anxiety, PTSD, and quality-of-life. Data analysis included paired samples t-tests, mixed linear models, and effect size calculations (Cohen’s d).  Results: The eCBT group exhibited significant reductions in symptom severity for depression, anxiety, and PTSD from baseline to post-treatment compared to TAU (p<0.01), with a moderate effect size (Cohen’s d=0.68). Symptom severity decreased by 61.37% for eCBT versus 23.29% in TAU. Mixed linear models confirmed a significant treatment-by-time interaction, favoring eCBT (p<0.01). However, no significant differences in quality-of-life improvements were observed between groups.  Conclusions: Diagnosis-specific eCBT programs are effective in reducing symptoms of depression, anxiety, and PTSD for CWs. The asynchronous, accessible format of eCBT addresses current key barriers. Future research should explore strategies to improve adherence and increase the accessibility of services for CWs.
SN  - 1664-0640
ER  -