Motivation and Treatment Credibility Predicts Dropout, Treatment Adherence, and Clinical Outcomes in an Internet-Based Cognitive Behavioral Relaxation Program: A Randomized Controlled Trial

Abstract

BackgroundIn previous research, variables such as age, education, treatment credibility, and therapeutic alliance have shown to affect patients’ treatment adherence and outcome in Internet-based psychotherapy. A more detailed understanding of how such variables are associated with different measures of adherence and clinical outcomes may help in designing more effective online therapy.ObjectiveThe aims of this study were to investigate demographical, psychological, and treatment-specific variables that could predict dropout, treatment adherence, and treatment outcomes in a study of online relaxation for mild to moderate stress symptoms.MethodsParticipant dropout and attrition as well as data from self-report instruments completed before, during, and after the online relaxation program were analyzed. Multiple linear and logistical regression analyses were conducted to predict early dropout, overall attrition, online treatment progress, number of registered relaxation exercises, posttreatment symptom levels, and reliable improvement.ResultsDropout was significantly predicted by treatment credibility, whereas overall attrition was associated with reporting a focus on immediate consequences and experiencing a low level of intrinsic motivation for the treatment. Treatment progress was predicted by education level and treatment credibility, whereas number of registered relaxation exercises was associated with experiencing intrinsic motivation for the treatment. Posttreatment stress symptoms were positively predicted by feeling external pressure to participate in the treatment and negatively predicted by treatment credibility. Reporting reliable symptom improvement after treatment was predicted by treatment credibility and therapeutic bond.ConclusionsThis study confirmed that treatment credibility and a good working alliance are factors associated with successful Internet-based psychotherapy. Further, the study showed that measuring adherence in different ways provides somewhat different results, which underscore the importance of carefully defining treatment adherence in psychotherapy research. Lastly, the results suggest that finding the treatment interesting and engaging may help patients carry through with the intervention and complete prescribed assignments, a result that may help guide the design of future interventions.Trial RegistrationClinicaltrials.gov NCT02535598; http://clinicaltrials.gov/ct2/show/NCT02535598 (Archived by WebCite at http://www.webcitation.org/6fl38ms7y).

Childbirth experiences among women with fear of birth randomized to internet-based cognitive therapy or midwife counseling

“…One reason for dropout from the study could have been technical problems with the online portal, which was available only via computers, not smartphones or tablets. Similar findings of internetbased treatments and large dropout rates have also been reported elsewhere [47]. Since the response rate increased when the questionnaires were mailed, receiving a questionnaire by mail should have been an option offered earlier.…”

Evaluation of an online self‐help version of the REACH forgiveness program: Outcomes and predictors of persistence in a community sample

“…Treatment credibility, on the other hand, predicted patient adherence and symptom improvement after treatment. Alfonsson et al (2016) suggested that if people find a treatment interesting and engaging, they tend to carry through with the intervention and complete prescribed assignments.…”

“…Typically, characteristics of the intervention and therapeutic relationship have accounted for variance in persistence. Alfonsson, Olsson, and Hursti () found applying external pressure to participate in treatment resulted in lower efficacy due to dropout and less responsiveness even if the participant continued. Treatment credibility, on the other hand, predicted patient adherence and symptom improvement after treatment.…”

“…Alfonsson et al. () suggested that if people find a treatment interesting and engaging, they tend to carry through with the intervention and complete prescribed assignments.…”

Evidenze preliminari dalla piattaforma terapeutica online Giocaresponsabile. Condizioni socio-economiche e comportamenti di gioco

“…Elementi che suggeriscono la necessità di ricerche che esplorino un ampio spettro di variabili associate all'interruzione di una terapia. Oltre agli eventi stressanti di vita e la presenza o meno di relazioni sociale supportive, dovrebbero essere esaminate, tra le altre, impulsività e variabili legate al trattamento, quali aspettative e motivazioni dei pazienti, durata della terapia, credibilità del trattamento, buona qualità dell'alleanza terapeutica, disponibilità di accessi internet e di un ambiente tranquillo e riservato per utilizzare il computer (González-Ortega et al, 2014;Alfonsson et al, 2016). Nel caso della piattaforma GR, 40 soggetti hanno completato nel periodo considerato un questionario di 14 item per esprimere la propria soddisfazione rispetto all'ef- ficacia e alla qualità della terapia seguita (score minimo = 1; massimo = 5), con un punteggio medio di 4.…”