Youths’ and Parents’ Experiences and Perceived Effects of Internet-Based Cognitive Behavioral Therapy for Anxiety Disorders in Primary Care: Mixed Methods Study

Abstract

Background Anxiety is common among youths in primary care. Face-to-face treatment has been the first choice for clinicians, but during the COVID-19 pandemic, digital psychological interventions have substantially increased. Few studies have examined young people’s interest in internet treatment or the attitudes they and their parents have toward it. Objective This study aims to investigate adolescents’ and parents’ attitudes toward and experiences of internet-based cognitive behavioral anxiety treatment in primary care and its presumptive effects. Methods The study used mixed methods, analyzing qualitative data thematically and quantitative data with nonparametric analysis. Participants were 14 adolescents and 14 parents recruited in adolescent primary health care clinics. The adolescents and their parents filled out mental health questionnaires before and after treatment, and were interviewed during ongoing treatment. Results The quantitative data indicated that the internet-delivered cognitive behavioral therapy program used in this study was successful in reducing symptoms (χ22=8.333; P=.02) and that adolescents’ motivation is essential to the treatment outcome (r=0.58; P=.03). The qualitative results show that youths highly value their independence and freedom to organize treatment work on their own terms. The parents expressed uncertainty about their role and how to support their child in treatment. It was important for parents to respect the youths’ need for autonomy while also engaging with them in the treatment work. Conclusions Internet treatment in primary care is accepted by both youths and their parents, who need clarification about the difference between their role and the therapist’s role. Patient motivation should be considered before treatment, and therapists need to continue to develop the virtual alliance. Finally, primary care should be clearer in informing adolescents and their parents about the possibility of internet treatment.

“I didn’t have to look her in the eyes”—participants’ experiences of the therapeutic relationship in internet-based psychodynamic therapy for adolescent depression

“…A few young people reported not being interested in developing a relationship with their therapist and thus not making any efforts toward that. The same finding was reported by Lilja et al (2021), where some participants described not being interested in having contact with their therapist at all, despite having the opportunity. For those not interested in developing a relationship, it could be that the internet-based format allowed them to avoid it quite literally, as they could take part in the treatment but keep contact with their therapist very limited (i.e., not showing up to chat sessions, not responding to messages, and writing very little in response to exercises but still taking part in the treatment material).…”

“…In an interview study with 10 adolescents treated with ICBT for obsessive-compulsive disorder (OCD), Lenhard et al (2016) described one theme capturing the importance of the therapist's support. Lilja et al (2021) interviewed 16 adolescents having attended ICBT for anxiety disorders about their general experiences of treatment. They briefly described experiences of the therapeutic relationship, and its main benefit was described as being helpful in supporting the program or individualizing goals rather than a relationship being important in its own right.…”

Experiences of primary care among young adults with mental illness – A systematic literature review

“…Having 24‐h access to online resources is easier than face‐to‐face access to healthcare professionals [50]. However, internet and online services could also be experienced as a disadvantage, for example when interpersonal relationships were needed by the young adults [40, 46].…”

“…They appreciated meeting people with similar problems, felt less lonely and felt socially and emotionally supported [48] and included [45]. Further, the interventions helped them in developing greater independence, awareness and understanding of how to manage their feelings [46,47].…”

A Systematic Scoping Review of Digital Health Technologies During COVID-19: A New Normal in Primary Health Care Delivery

“…Additionally, big data and other DHTs, such as check-in kiosks, emails, online patient portals, self-management home monitoring devices, and chatbots, were also noted. eHealth: telehealth, telemedecine, e-prescription, e-referral, e-Mental health, telepsychiatry, clinic-based telehealth, telehealth visits (18)(19)(20)(21)(22)(23)(24)(25)27,49,52,55) Devices: wearables, wearable health devices, portable electrocardiograms, telemedical stethoscopes, telemedical ECGs, remote monitoring devices, laboratory-on-a-chip' devices (26,27,37,(48)(49)(50)(51)(52)(53)60) Digital tracing (28,29) Testing, self-testing (self-screening) (30,31) Websites, Platforms, Trials Platform (25,(32)(33)(34)(35)(36) Monitoring Internet of Things (IoT) (39,55) Artificial intelligence (AI) (26,37,(48)(49)(50)(51)(52)(53)60) Big data (39,55) G...…”