Making Inroads: Trial of an online early intervention to interrupt the cycle of anxiety and drinking in young Australians

The Inroads intervention is an online, youth-focused, therapist-supported transdiagnostic adaptation of our effective social anxiety and alcohol disorder CBT program for adults (Stapinski, Rapee, Sannibale, Teesson, Haber & Baillie, 2015). Participants are guided through five sequential online modules that focus on enhancing motivation to change and developing CBT strategies to manage anxiety and alcohol use problems. Each module should take approximately 30-60 minutes to complete, and to allow time for skill practice and consolidation, new modules will become available at a rate of 1 module each week, irrespective of whether the previous module has been completed. . The focus of online module content is as follows: 1) Understanding patterns of alcohol use, reasons for use, and setting drinking goals, psychoeducation about cognitive, physiological and behavioural aspects of anxiety, and the inter-relationship with drinking; 2) Understanding the ABC model, cognitive therapy targeting anxious thoughts, 3) Making Choices, setting limits, and handling group dynamics; 4) Understanding avoidance and anxiety, learning techniques to manage anxiety; 5) Finding support, goal-setting and relapse prevention. The content for each module is delivered via text, images/infographics, and interactive forms whereby participants are guided to identify their goals, cognitive/behavioural responses, and to practice CBT skills by working through personal examples. Additional online forms are provided for homework practice. In Modules 2,3 and 4, a brief 3-minute animated video illustrates the key skills introduced in the module (Module 2 - Realistic Thinking, Module 3 - Strategies to reduce or avoid drinking, Module 4 - Facing fears to overcome anxiety). In addition, as participants work through the program they follow the stories of two characters. This narrative is presented via audio segments (with accompanying text) to illustrate case examples aligned with the key concepts or skills in each module. A 5 item quiz at the end of each module provides the opportunity for participants to test their knowledge of the key points. Therapist support is provided via a weekly email with personalised feedback, trouble-shooting, and activity suggestions aligned to module content. In addition, telephone/text chat sessions following Module 1 (20-30 mins) and Module 4 (20-30 mins) will focus on motivational enhancement, developing an integrated anxiety-drinking problem formulation, trouble-shooting and tailoring behavioural experiments and cognitive therapy exercises. Participants will also have the opportunity to submit questions or request a brief trouble-shooting session (phone/chat) via a "Therapist link up" request form. In addition, they will receive an automated email notifying them when a new module becomes accessible, and a text reminder if they have not accessed the program for 7 days. To allow some flexibility in the rate of module completion, post intervention surveys will be administered at baseline plus 8 weeks to assess short-term intervention effects, as well as 6-months post-baseline in order to examine the durability of the intervention effects.