Experiences of non-adherence to Internet-delivered cognitive behavior therapy: A qualitative study

Johansson, Olof; Michel, Teresa; Andersson, Gerhard; Paxling, Björn

doi:10.1016/j.invent.2015.02.006

Cited by 96 publications

(143 citation statements)

References 37 publications

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“…However, some participants do not benefit from internet interventions and a large group drop out of treatment at an early stage. The reasons these participants are terminating the intervention is unclear but may be due to a mismatch between expectations and treatment realities or practical issues in everyday life (Johansson et al, 2015). Based on the results from this study, it is not evident that finding ways of keeping these participants in treatment is the most beneficiary action but rather to better inform participants of how internet interventions work and the demands not only through written information but through practical exercises or examples.…”

Section: Discussionmentioning

confidence: 85%

The effects of therapist support and treatment presentation on the clinical outcomes of an Internet based applied relaxation program

Alfonsson

Olsson

Hursti

2015

Internet Interventions

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Symptoms of stress are common in the general population and associated with health risks and economic costs. Applied relaxation training has shown to be effective for reducing stress and worry both as a self-help treatment and as an internet-based intervention with therapist support. However, what factors may affect the outcome of internet based relaxation training is unclear. The aims of the present study were to investigate the effect of a brief internet based relaxation program for people with symptoms of stress or worry and to assess whether enhancing the quality of intervention presentation or therapist support had an impact on outcomes. Participants were randomized in a full factorial design to either Normal or Enhanced treatment Presentation and either Normal or Enhanced therapist Support in a four-week online program with applied relaxation. The main outcome measures were self-report instruments of stress and worry. A total of 162 participants were included in the study and 94 and 84 participants completed the post and followup measurements respectively. Participants in all conditions improved significantly on the main outcome measures, and the different levels of Presentation or therapist Support did not significantly affect treatment outcome. Registered number of completed exercises was a predictor of better treatment outcome, but this effect was independent of treatment condition. Enhancing internet based interventions by improving presentations and the quality of support may thus not be the best way to further improve the effect of internet based interventions. More specific knowledge of the mechanisms that affect outcomes in online psychotherapy is needed.

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Section: Discussionmentioning

confidence: 85%

The effects of therapist support and treatment presentation on the clinical outcomes of an Internet based applied relaxation program

Alfonsson

Olsson

Hursti

2015

Internet Interventions

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“…However, drop-out rates have been known to increase progressively with program length . This is also true for high volumes of treatment content and high demands for reading and writing (Johansson, Michel, Andersson, & Paxling, 2015). The text material for the ICBT program in Study IV was condensed in comparison to the two preceding studies which potentially is a factor that further promoted treatment adherence.…”

Section: The Influence Of the Treatment Formatsmentioning

confidence: 99%

A Randomized Controlled Study of Group-Administered Cognitive Behavioral Therapy for Hypersexual Disorder in Men

Hallberg

Kaldo

Arver

et al. 2019

The Journal of Sexual Medicine

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Background Hypersexual disorder (HD) is defined as a condition in which the individual loses control over engagement in sexual behaviors, leading to distress and negative effects on key life areas. Cognitive behavioral therapy (CBT) has been proven to reduce symptoms of hypersexual behavior; however, no randomized controlled study of CBT interventions for HD has been reported previously. Aim To investigate the efficacy of group-administered CBT for HD. Methods Male participants (n = 137) diagnosed with HD, were randomized between 7 weeks of group-administered CBT (n = 70) and a waitlist control receiving the intervention after 8 weeks (n = 67). Measurements were administered at pre-, mid-, and posttreatment, with follow-up after 3 and 6 months. Outcomes The primary outcome was the Hypersexual Disorder: Current Assessment Scale (HD:CAS), and secondary outcomes were the Sexual Compulsivity Scale (SCS) and measures of depression (Montgomery–Åsberg Depression Rating Scale (MADRS-S), psychological distress (Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), and treatment satisfaction (CSQ-8). Results A significantly greater decrease in HD symptoms and sexual compulsivity, as well as significantly greater improvements in psychiatric well-being, were found for the treatment condition compared with the waitlist. These effects remained stable at 3 and 6 months after treatment. Clinical Implications CBT can ameliorate HD symptoms and psychiatric distress, suggesting that the CBT program may serve as a first-line treatment in clinical settings. Strengths & Limitations This is the first randomized controlled study evaluating the efficacy of a CBT program in a rather large sample of HD-specific diagnosed men. The long-term treatment effects are vague due to the low response rate on follow-up measurements, and the efficacy of this program for hypersexual women remains unknown. Conclusion This study supports the efficacy of a group-administered CBT program as a treatment option for HD; however, future studies should include women, comprise dismantling analysis of the constituting interventions, and evaluate other treatment formats, for example, administration via the Internet.

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“…For some, deadlines brought on a structure that promoted autonomy which has been seen in another patient group in ICBT [9]. For some, deadlines were found stressful, also previously seen [34] and led to negative emotions of guilt, nevertheless motivating them to complete. Deadlines gave a structure that compensated for cognitive difficulties for some.…”

Section: Autonomymentioning

confidence: 85%

“…Participants have previously mentioned that additional therapist guidance could improve their engagement [7,34]. This has however to date not been shown to be more effective than regular therapist contact in ICBT [20].…”

Section: Therapist Guidancementioning

confidence: 99%

Patients’ experiences of internet-based Acceptance and commitment therapy for chronic pain: a qualitative study

Bendelin

Björkdahl

Risell

et al. 2020

BMC Musculoskelet Disord

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Background: Chronic pain is a globally widespread condition with complex clusters of symptoms within a heterogeneous patient group. Internet-delivered Acceptance and Commitment Therapy (IACT) has shown promising results in the treatment of chronic pain. How IACT is experienced by patients is less well known. Qualitative studies of patients' experiences are needed to further understand factors behind both engagement and negative effects. The aim of this study was to explore how IACT was experienced by chronic pain patients who had participated in a controlled trial. Methods:Through an open and exploratory approach this study aimed to investigate how IACT was experienced when delivered as a guided self-help program to persons with chronic pain. Eleven participants were interviewed over telephone after completing IACT.Results: Qualitative analysis based on grounded theory resulted in 2 core categories and 8 subcategories. In treatment: Physical and cognitive restraints, Time and deadline, Therapist contact, and Self-confrontation. After treatment: Attitude to pain, Image of pain, Control or Command, and Acting with pain. Individual differences as well as specific conditions of the treatment may explain variations in how the treatment was approached, experienced and what consequences it led to. Therapist guidance and deadlines for homework play complex roles in relation to autonomy and change.Conclusions: Adjusting treatment content and format based on participants' characteristics, such as expectations, motivation and restraints, might positively affect engagement, autonomy and change. Further research on attrition and negative effects of treatment might clarify what enables chronic pain patients to benefit from IACT.Trial registration: clinicaltrials.gov (NCT01603797). Registered 22 May 2012. Retrospectively registered.

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Experiences of non-adherence to Internet-delivered cognitive behavior therapy: A qualitative study

Cited by 96 publications

References 37 publications

The effects of therapist support and treatment presentation on the clinical outcomes of an Internet based applied relaxation program

The effects of therapist support and treatment presentation on the clinical outcomes of an Internet based applied relaxation program

A Randomized Controlled Study of Group-Administered Cognitive Behavioral Therapy for Hypersexual Disorder in Men

Patients’ experiences of internet-based Acceptance and commitment therapy for chronic pain: a qualitative study

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