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However, two TAU participants deteriorated at 2‐month follow‐up. The differences between iCBT and TAU were significant, Χ 2 (3, N = 30) = 8.66, p = 0.034. 3.7 | Treatment adherence and engagement Intervention adherence was acceptable. Out of 53 who signed up, 45 (84.9%) began the first module, and 28(52.8%) completed all mod- ules. The engagement was high; survivors approximately logged in 16 times (SD = 17.81; Min = 1, Max = 96). The average duration of each log‐in was 16 min. Each user spent approximately 4 h and 20 min. Carers' engagement with the programme was quite low. Three carers logged in only once, and one carer logged in five times. 4 | DISCUSSION To our knowledge, this is the first RCT of an iCBT addressing depression and anxiety in breast cancer survivors in Ireland and the UK. In line with the previous studies 18,21 and our hypothesis, re- ductions in overall distress were observed in the iCBT group at post‐intervention compared to TAU, which reached statistical significance at 2‐month follow‐up. These effects were achieved with weekly, asynchronous, and non‐clinician supporter feedback. Considering that 64% did not meet the criteria for clinical depres- sion and 19% for anxiety, these findings could have been improved if caseness was considered for inclusion. Although the degree of change was non‐significant, intervention participants had a trend indicating improvements in their quality of life and T A B L E 2 Between‐groups over time Baseline Post‐ intervention Follow‐up Effects of intervention post‐test between‐ groups Effect sizes [95% CI] Effects of intervention follow‐up between‐ groups Effect sizes [95% CI] Mean (SD) Mean (SD) Mean (SD) t(df) = , p Hedge's g t(df) = , p Hedge's g HADS‐total iCBT 17.12 (7.12) 12.79 (7.42) 11.00 (5.87) t(55) = −1.81, p = 0.075 −0.50 t(45) = −3.16, p = 0.003** −0.94 Control 16.09 (5.60) 16.42 (6.48) 17.00 (6.90) [−1.06, 0.06] [−1.57, −0.32] HADS‐anxiety iCBT 10.67 (4.22) 8.53 (4.60) 7.57 (3.85) t(55) = −1.82, p = 0.074 −0.50 t(45) = −2.54, p = 0.015* −0.76 Control 9.96 (3.15) 10.79 (4.01) 10.82 (4.82) [−1.06, 0.05] [−1.37, −0.14] HADS‐depression iCBT 6.45 (3.99) 4.26 (3.48) 3.43 (2.78) t(55) = −1.43, p = 0.158 −0.40 t(45) = −3.20, p = 0.002** −0.96 Control 6.13 (3.44) 5.63 (3.24) 6.18 (2.90) [−0.95, 0.16] [−1.58, −0.33] QOL iCBT 4.69 (1.39) 5.24 (1.00) 5.57 (0.94) t(55) = −0.48, p = 0.635 0.12 t(45) = 0.84, p = 0.403 0.26 Control 4.83 (1.30) 5.11 (1.29) 5.29 (1.26) [−0.43, 0.67] [−0.34, 0.86] CWC iCBT 16.82 (4.50) 14.66 (4.15) 14.30 (3.68) t(55) = 0.43 p = 0.672 −0.13 t(45) = −1.57, p = 0.123 −0.47 Control 15.91 (3.63) 15.21 (4.05) 16.29 (4.96) [−0.68, 0.42] [−1.07, 0.13] Active coping iCBT 2.60 (0.52) 2.83 (0.49) 2.96 (0.59) t(55) = 1.49, p = 0.141 0.42 t(45) = 1.90, p = 0.063 0.58 Control 2.72 (0.49) 2.61 (0.56) 2.64 (0.45) [−0.13, 0.98] [−0.03, 1.18] Avoidant coping iCBT 1.99 (0.44) 1.92 (0.44) 1.87 (3.34) t(55) = 0.30, p = 0.762 0.09 t(45) = −0.79, p = 0.434 −0.03 Control 1.97 (3.34) 1.88 (0.42) 1.96 (0.47) [−0.46, 0.64] [−0.63, 0.56] MOS‐SSS iCBT 3.35 (0.88) 3.40 (1.07) 3.45 (0.92) t(55) = 1.26, p = 0.213 0.35 t(45) = 2.08, p = 0.042* 0.63 Control 2.97 (0.97) 3.03 (0.94) 2.79 (1.22) [−0.20, 0.91] [0.02, 1.23] Note: Baseline N = 72 (N iCBT = 49 and N control = 23), Post‐test N = 57 (N iCBT = 38 and N control = 19), Follow‐up N = 47 (N iCBT = 30 and N control = 17). Abbreviations: CWC, Cancer Worry Scale; HADS, Hospital Anxiety and Depression Scale; iCBT, internet‐delivered cognitive behavioural therapy; MOS‐SSS, Medical Outcomes Study Social Support Survey; QOL, Quality of Life Scale. *p < 0.05; **p < 0.01. 452 - AKKOL‐SOLAKOGLU AND HEVEY 10991611, 2023, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/pon.6097, Wiley Online Library on [28/06/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License