Therapist Behaviours in Internet-Delivered Cognitive Behaviour Therapy: Analyses of E-Mail Correspondence in the Treatment of Generalized Anxiety Disorder

Abstract

Background: Internet-delivered cognitive behaviour therapy (iCBT) has been found to be an effective way to disseminate psychological treatment, and support given by a therapist seems to be important in order to achieve good outcomes. Little is known about what the therapists actually do when they provide support in iCBT and whether their behaviour influences treatment outcome. Aims: This study addressed the content of therapist e-mails in guided iCBT for generalized anxiety disorder. Method: We examined 490 e-mails from three therapists providing support to 44 patients who participated in a controlled trial on iCBT for generalized anxiety disorder. Results: Through content analysis of the written correspondence, eight distinguishable therapist behaviours were derived: deadline flexibility, task reinforcement, alliance bolstering, task prompting, psychoeducation, self-disclosure, self-efficacy shaping, and empathetic utterances. We found that task Reprint requests to Gerhard Andersson, Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden. E-mail: gerhard.andersson@liu.se © British Association for Behavioural and Cognitive Psychotherapies 2012Therapist behaviours in Internet therapy 281 reinforcement, task prompting, self-efficacy shaping and empathetic utterances correlated with module completion. Deadline flexibility was negatively associated with outcome and task reinforcement positively correlated with changes on the Penn State Worry Questionnaire. Conclusions: Different types of therapist behaviours can be identified in iCBT, and though many of these behaviours are correlated to each other, different behaviours have an impact on change in symptoms and module completion.

Therapist-related feasibility of blended group therapy (bGT): Mixed methods study of a brief online- and mobile-supported group intervention for major depression (Preprint)

“…However, contrary to literature concerning online interventions [80][81][82] current bGT literature lacks research that focusses on the therapist´s perspective. Even though not all therapists initially were fond of bGT, their retrospective appraisals can be described as positive.…”

The Internet and CBT: A New Clinical Application of an Effective Therapy

“…Further, much of the iCBT support can be performed by trained staff rather than a clinician [37,71]. Many of the behaviors that therapists teach patients, such as task reinforcement, psychoeducation, and deadline flexibility [72], can be performed by trained staff rather than a clinician. Overall, iCBT has been shown to be more resource efficient even with clinician input, which would give more patients access overall.…”

Using the Internet to Provide Psychodynamic Psychotherapy

“…In most research on guided self-help treatments, the self-help material has been in the form of text provided via the Internet with guidance being given through 10 to 20 minutes of e-mail contact once a week per client. Despite the advancement of technology in the last decade, most Internet-delivered psy-chotherapies have used quite simple technology, what we might call "net-bibliotherapy" with basic therapist support (Paxling et al, 2013;Sánchez-Ortiz, Munro, Startup, Treasure, & Schmidt, 2011). In this text, the terms guided self-help and Internet-delivered psychotherapy/psychological treatments will be used synonymously.…”