title: A Mixed-Methods Study Using a Nonclinical Sample to Measure Feasibility of Ostrich Community: A Web-Based Cognitive Behavioral Therapy Program for Individuals With Debt and Associated Stress.
abstract: BACKGROUND
  There are increasing concerns about the health and well-being of individuals facing financial troubles. For instance, in the United Kingdom, the relationship between debt and mental health difficulties is becoming more evident due to the economic downturn and welfare reform. Access to debt counseling services is limited and individuals may be reluctant to access services due to stigma. In addition, most of these services may not be appropriately resourced to address the psychological impact of debt. This study describes outcomes from an Internet-based cognitive behavioral therapy (ICBT) program, Ostrich Community (OC), which was developed to provide support to those struggling with debt and associated psychological distress.
  
  
  OBJECTIVE
  The aim of this feasibility study was to assess the suitability and acceptability of the OC program in a nonclinical sample and examine mental health and well-being outcomes from using the program.
  
  
  METHODS
  A total of 15 participants (who were not suffering from severe financial difficulty) were assisted in working through the 8-week ICBT program. Participants rated usability and satisfaction with the program, and after completion 7 participants took part in a semistructured interview to provide further feedback. Before the first session and after the final session all participants completed questionnaires to measure well-being and levels of depression, stress, and anxiety and pre- and postscores were compared.
  
  
  RESULTS
  Satisfaction was high and themes emerging from the interviews indicate that the program has the potential to promote effective financial behaviors and improve financial and global psychosocial well-being. When postcompletion scores were compared with those taken before the program, significant improvements were identified on psychometric measures of well-being, stress, and anxiety.
  
  
  CONCLUSIONS
  The OC program is the first ICBT program that targets poor mental health associated with financial difficulty. This feasibility study indicates that OC may be an effective intervention for increasing financial resilience, supporting individuals to become financially independent, and promoting positive financial and global well-being. Further work with individuals suffering from debt and associated emotional difficulties will help to examine clinical effectiveness more closely.
authors.affiliation: Ostrich Community, Manchester, United Kingdom.
authors.forename: Dawn
authors.identifier: http://orcid.org/0000-0003-3861-3892
authors.initials: D
authors.lastname: Smail
authors.affiliation: Breaking Free Group, Manchester, United Kingdom.
authors.forename: Sarah
authors.identifier: http://orcid.org/0000-0002-5649-640X
authors.initials: S
authors.lastname: Elison
authors.affiliation: School of Health Sciences, University of Salford, Salford, United Kingdom.
authors.forename: Linda
authors.identifier: http://orcid.org/0000-0003-4092-6599
authors.initials: L
authors.lastname: Dubrow-Marshall
authors.affiliation: School of Health Sciences, University of Salford, Salford, United Kingdom.
authors.forename: Catherine
authors.identifier: http://orcid.org/0000-0002-7967-7019
authors.initials: C
authors.lastname: Thompson
keywords: cognitive behavioral therapy; computer-assisted therapy; economic recession; mental health; psychological stress