Internet-Based Cognitive Behavioral Therapy with Layperson Support: A mixed-Methods Evaluation of Empower@Home.

Objectives: This study evaluates Empower@Home, an older adult-centered, layperson-supported internet-based cognitive behavioral therapy (iCBT) program for depression using a concurrent mixed-methods design.

Methods: Adults aged 50+ with at least mild depressive symptoms enrolled in the program and were assessed pre- and post-treatment (N = 224). A subset participated in qualitative interviews post-treatment (N = 148). Paired t-tests and mixed-effects modeling assessed quantitative program effects, while qualitative data identified key themes of impact.

Results: Program completion was 90%. Depression symptoms significantly decreased (Cohen's d = 0.9 overall; d = 1.4 for those with moderate depression at baseline). Anxiety and social isolation also declined significantly. Moderation analyses showed that participants with lower education, antidepressant use, and more childhood adversities experienced faster symptom reduction. Qualitative findings aligned with quantitative results, highlighting acquisition and application of CBT skills and improved emotional well-being. Additional themes included increased insight and self-awareness, improved social relationships, empowerment, self-worth, and self-care.

Conclusions: Older adult-centered, layperson-supported iCBT shows promise in reducing depression and improving mental well-being in older adults.

Clinical implications: Findings offer insights for improving mental health treatment and outcomes for older adults.