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

Abstract

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.

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

“…Data for this study were retrieved from a previously conducted study on Internet-based relaxation training for people with mild to moderate stress and anxiety symptoms [ 9 ]. Participants were recruited from the general population primarily by online advertisement.…”

“…Inclusion criterion was self-reported stress symptoms, whereas the exclusion criteria were elevated symptom levels of anxiety or depression or other severe psychological or somatic problems that warranted immediate care, younger than 18 years of age, insufficient mastery of the Swedish language, or lacking daily access to computer, Internet, and cell phone. In the study, a total of 162 included participants were presented with an online intervention and were randomized to either normal or enhanced treatment presentation and either normal or enhanced therapist support in a full factorial design [ 9 ]. In the normal treatment condition, the treatment was presented as black-and-white text files, whereas in the enhanced presentation condition, the treatment was presented in full color and also in video format.…”

“…Intrinsic motivation and therapeutic bond were measured at midtreatment and stress symptoms were measured both at baseline as a predictor variable and at postmeasurement as an outcome variable. Because a previous analysis [ 9 ] had shown that enhanced support was associated with higher adherence to the online treatment program, treatment condition (normal vs enhanced therapeutic support) was also included as a predictor variable in the analyses. No other independent variable was significantly associated with any outcome variables.…”

“…With the growth of Internet-based interventions, there has been an increased interest in trying to find variables that affect treatment adherence and outcomes [ 5 - 7 ]. However, the association between treatment adherence and outcome is complex and in previous studies it has been shown that increased adherence does not automatically lead to better treatment outcomes [ 8 , 9 ]. It is also unknown to what degree treatment adherence can be affected by therapist behaviors because background variables such as education and personality traits affect patients’ ability to carry through and benefit from ICBT [ 10 ].…”

Factor structure and validity of the Depression, Anxiety and Stress Scale‐21 in Swedish translation

“…Those who chose to participate were asked to complete the instruments on paper and received a lottery ticket as compensation. For sample 3, participants in a study of a brief online treatment for stress and anxiety symptoms (Alfonsson et al 2015) were asked to complete the DASS-21 as well as the Patient Health Questionnaire-9 (PHQ-9), the GAD-7 and the Perceived Stress Scale-10 (PSS-10). These instruments were administrated as part of the pretreatment assessment on a secure webpage.…”