The acceptability of a therapist-assisted internet-delivered cognitive behaviour therapy program for the treatment of anxiety disorders in adolescents: a qualitative study

Abstract

Computerized treatments have been shown to be effective in young people with anxiety disorders. However, there has been limited investigation into the experiences of adolescents in undertaking this treatment. This qualitative study explored adolescents’ experiences of being treated for an anxiety disorder, using an online intervention with therapist support, as part of a randomised controlled trial. Individual semi-structured interviews were conducted with thirteen adolescents aged between 13 and 17 years, who had received the online intervention. Data were analysed using reflexive thematic analysis. Two cross-cutting themes were identified: (i) Usability of the program, and (ii) Putting techniques into practice. Although the convenience of online sessions was recognised as positive, many of the adolescents expressed a preference for face-to-face sessions. The length of sessions and the large amount of reading involved was highlighted by most participants. The transdiagnostic nature of the content meant some elements of the programme were seen as less relevant. While many participants appreciated the ‘fun’ aspect of the program, others felt that certain aspects of the program were not suitable for their age group. Exposure, psychoeducation and cognitive restructuring were generally received positively, whereas responses to the use of relaxation and rewards were much more mixed. Our findings highlight the potential utility for online treatments delivered with therapist support. However, they also highlight how issues with both the format and treatment components can impact the acceptability of a program. As such, further work is warranted to improve the acceptability of online treatments for adolescents with anxiety disorders.

Internet-based emotion-regulation training added to CBT in adolescents with depressive and anxiety disorders: A pilot randomized controlled trial to examine feasibility, acceptability, and preliminary effectiveness

“…However, although treatment adherence and patients' satisfaction were adequate, both could further be improved. In general, therapist guidance and program content are factors associated with adolescent satisfaction and adherence in digital health interventions ( Lehtimaki et al, 2021 ; Musiat et al, 2021 ; Smart et al, 2021 ). Previous studies have underlined the importance of online feedback being personalized, genuine, real, and relevant to users' own experience to improve adherence and motivation in internet-based treatments ( Richards et al, 2018 ; Beatty and Binnion, 2016 ).…”

Rethinking the role of technology-assisted cognitive behavioral therapy for youth in the post-COVID-19 era

“…The current issue presents a qualitative analysis of participants’ responses to semi-structured interviews following therapist-assisted internet-delivered cognitive behavioral therapy (ICBT) for anxiety disorders [ 4 ]. This study offers unique insight into their multifaceted experiences with the intervention.…”

“…Furthermore, interview analyses conducted by Smart et al [ 4 ] provide a novel and balanced report on the advantages and disadvantages of ICBT for adolescents with anxiety disorders. While the fundamental benefits of CBT (e.g., psychoeducation, cognitive restructuring, and gradual exposures) were maintained, participants also reported satisfaction with ICBT describing it as being convenient and available, while practical barriers associated with in-person therapy were eliminated.…”

“…The quality of therapeutic alliance is crucial as it has been associated with treatment outcome [ 11 ]. Despite the convenience of ICBT, participants’ expressed preference for face-to-face sessions emphasizes the importance of establishing a therapeutic alliance [ 4 ]. Studies have shown that ICBT therapists’ roles were less defined, that they lacked consensus on how to handle patient inactivity and feedback, and felt less confident in establishing a resilient therapeutic alliance [ 10 ].…”

“…These findings could shed light onto the limitations of ICBT. Additionally, relying on written communication could not only be experienced as burdensome to some patients [ 4 ], it may also interfere with evaluating nonverbal cues, which are crucial for accurately assessing and managing risk [ 9 ].…”