Mental health disorders are a leading cause of disability and mortality worldwide. Mental health services do not meet demand due to accessibility issues, financial burden, and increasing needs. Technology can provide affordable, accessible mental health care and some research suggests internet-delivered Cognitive Behavior Therapy (iCBT) may be an effective treatment. In iCBTs, participants typically complete Cognitive Behavior Therapy modules and videos and are supported by a therapist. Advantages of iCBT over face-to-face therapy include lower cost, no travel time, easy access, no waitlists, and trackable progress. To our knowledge there have been no naturalistic studies of iCBT programs. Therefore, this study will evaluate the usage and effectiveness of one iCBT program, SilverCloud, in a university counseling center. Participants (N=5568) were students at a large, private western university. Participants were either self-referred to the program, chose to enroll at intake as a standalone intervention, or were referred by their treating clinician as an adjunct to regular treatment. We compared the outcomes and usage of participants using SilverCloud concurrently with psychotherapy to participants using SilverCloud alone, and participants in psychotherapy alone.

Aim: Research on close relationships demonstrates that dyadic convergence, or two people becoming more concordant in their experiences and/or beliefs over time, is commonplace and adaptive. As psychotherapy involves a close relationship, patient–therapist convergence processes may influence treatment-specific outcomes. Although prior research supports that patients and therapists tend to converge on their alliance perspectives over time, which associates with subsequent patient improvement, no research has similarly examined belief convergence during therapy. Accordingly, this study focused on patient–therapist convergence in their outcome expectation (OE), a belief variable associated with patient improvement when measured from individual participant perspectives. I predicted both that significant OE convergence would occur and relate to better posttreatment outcome. Method: Data derived from a trial of naturalistic psychotherapy. Patients and therapists repeatedly rated their respective OE through treatment, and patients rated their symptom/functional outcomes at posttreatment. For dyads (N = 154) with the requisite OE data, I tested my questions using multilevel structural equation modeling. Results: There was no discernable OE convergence pattern over treatment (g100 = 0.02, SE = 0.04, p = .275) and OE convergence was unrelated to outcome at the between-dyad (b02k = 1.86, SD = 10.08, p = .406) and between-therapist (g002 = -0.06, SD = 3.54, p = .473) levels. However, higher early patient OE was significantly associated with better outcome at the between-dyad level (b05k = -0.04, SD = 0.01, p < .001). Discussion: Results suggest that OE may be more of a facilitative patient versus relational process factor.