The effects of component‐specific treatment compliance in individually tailored internet‐based treatment

Abstract

The objective of this study was to explore the effects of treatment compliance in a guided individually tailored internet‐based treatment (TAIL) in relation to depression and co‐morbid symptoms. Compliance with the homework in the different treatment components in TAIL, each aimed at a specific condition, was rated for 207 participants by independent assessors. Six subgroups ( n = 34–131) were constructed consisting of participants with co‐occurring symptoms of worry, panic, social anxiety, stress, insomnia, or pain. For each group, hierarchical regression was used to investigate whether the total sum of compliance points, Overall Compliance, predicted reductions in depression and in condition‐specific symptoms. Also, in each subgroup, it was tested whether working with specific treatment components, Specific Compliance, predicted reduction of the targeted symptoms. Overall Compliance predicted 15% of the reduction in depression symptoms. For participants with worry, panic, social anxiety, stress, or insomnia, Overall Compliance also predicted symptom reductions in that specific condition. Specific Compliance predicted reduction in the targeted symptoms for participants with social anxiety, stress, and insomnia. Specific Compliance with stress and insomnia components also predicted reductions in depression. Our results strengthen the importance of compliance in internet‐based treatments. Because compliance with stress and insomnia components was particularly important for broad symptom reductions, these conditions should not be ignored when treating patients with co‐morbid symptoms.

Predicting treatment failure in regular care Internet-Delivered Cognitive Behavior Therapy for depression and anxiety using only weekly symptom measures.

“…They also found that component specific compliance predicted reduction in targeted symptoms in social anxiety, stress, and insomnia, but not for stress and pain, while component specific compliance with stress and insomnia components actually predicted further reductions in depression. Thus, in some conditions, doing the specific interventions that are believed to be directly targeting the mechanism of change is driving the improvements whereas in other conditions, such as depression, just "doing treatment" may be as effective as doing behavioral activation specifically according to the findings by Kraepelien et al (2019). Regardless, whether or not a patient is doing the treatment as prescribed, or at least being actively engaged with the treatment should be an important predictor, at least theoretically.…”

“…Insomnia is a relatively specific problem where we have relatively substantial evidence that engaging in the proposed mechanism of change (i.e. sleep restriction and stimulus control) produces positive outcomes Harvey, Dong, Bélanger, & Morin, 2017;Kaldo, Ramnerö, & Jernelöv, 2015;Kraepelien et al, 2019). This could make it easier for therapists to make adapted treatment efficient.…”

“…One possible future avenue for this is natural language processing or other text/language based machine learning methods, where the contents of patient and therapist messages and well as written work sheets could be mined for compliance/adherence/onboarding indicators (Boman et al, 2019;Nadkarni, Ohno-Machado, & Chapman, 2011). The findings by Kraepelien et al (2019), where messages and work sheets were rated by experts, suggest that such indicators can be gleaned from those sources and that they do predict outcomes. Having machines do this instead could save a lot of time and resources.…”

“…3) By ignoring some of the seemingly unimportant clinician rated domains and instead perhaps having clinicians make more detailed ratings on the domains that were important. For example by doing as in Kraepelien et al (2019) and separating adherence and homework into how much the patient has done on one hand and how well the patient has done it on the other. 4) By removing some seemingly unimportant patient-rated variables (such as beliefs and attitudes about sleep at baseline) and perhaps replace with other variables such as the personality traits conscientiousness and openness to experiences, and some indicator of current psychosocial chaos as well as attitudes towards the treatment format.…”

The Role of Homework Engagement, Homework-Related Therapist Behaviors, and Their Association with Depressive Symptoms in Telephone-Based CBT for Depression

“…To the best of the authors' knowledge, a limited number of studies with regard to homework in guided self-help and technology-supported treatment exists. One study investigating overall and component-specific homework compliance in an internet-based treatment with minimal therapist guidance found that overall homework compliance predicted 15% of the reductions in depressive symptoms (Kraepelien et al 2019). Another study investigated TBH-R and homework completion in a telephone-delivered CBT (Aguilera et al 2018).…”