An open, naturalistic trial of the Inroads program, an internet-delivered early intervention to reduce anxiety and alcohol use among young people

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 over a 5-week period, with automated email and text reminders to complete program modules and monitoring of drinking and anxiety. 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. In previous versions of the program, therapist support was provided via two phone sessions and a weekly email with personalised feedback, trouble-shooting, and activity suggestions aligned to module content. As recent evidence suggests that self-guided electronic health (eHealth) treatments can be just as effective as therapist-supported treatments, provided the intervention is carefully designed for self-guided delivery with features such as automatic emails (Dear et al., 2015; Carlbring et al., 2005; Berger et al., 2011; Mayo-Wilson & Montgomery 2013), we recently revised the effective Inroads program to be a fully self-guided program (i.e. without therapist support). The self-guided version of the program incorporates additional eHealth features to provide troubleshooting, accountability and motivational support via customised, responsive auto-messaging in place of therapist involvement.