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Therapist behaviours in internet-based cognitive behaviour therapy (ICBT) for depressive symptoms

Fredrik Holländare · Sanna Aila Gustafsson · Maria Berglind · Frida Grape · Per Carlbring · Gerhard Andersson +2 more

65 citations0/0 files storedInternet Interventions

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Digital Mental Health Interventions Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Psychotherapy Techniques and Applications

Abstract

Internet-based cognitive behaviour therapy (ICBT) is efficacious for treating depression, with therapist guidance identified as important for favourable outcomes. We have limited knowledge, however, about the fundamental components of therapist guidance in ICBT. The purpose of this study was to systematically examine therapist messages sent to patients during the course of ICBT for depressive symptoms in order to identify common “therapist behaviours” and the extent to which these behaviours correlate with completion of modules and improvements in symptoms at post-treatment, one- and two-year follow-up. A total of 664 e-mails from 5 therapists to 42 patients were analysed using qualitative content analysis. The most frequent behaviour was encouraging that accounted for 31.5% of the total number of coded behaviours. This was followed by affirming (25.1%), guiding (22.2%) and urging (9.8%). Less frequently the therapists clarified the internet treatment framework , informed about module content , emphasised the importance of patient responsibility , confronted the patient and made self-disclosures . Six of the nine identified therapist behaviours correlated with module completion. Three behaviours correlated with symptom improvement. Affirming correlated significantly ( r = .42, p = .005) with improvement in depressive symptoms at post-treatment and after two years ( r = .39, p = .014). Encouraging was associated with outcome directly after treatment ( r = .52, p = .001). Self-disclosure was correlated with improvement in depressive symptoms at post-treatment ( r = .44, p = .003). The study contributes to a better understanding of therapist behaviours in ICBT for depressive symptoms. Future directions for research are discussed.

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References

2005Three Approaches to Qualitative Content Analysis 1987Handbook of Psychotherapy and Behavior Change 2003Bergin and Garfield's Handbook of Psychotherapy and Behavior Change 2001Research summary on the therapeutic relationship and psychotherapy outcome.2012Computer-based psychological treatments for depression: A systematic review and meta-analysis 2009Internet-Based and Other Computerized Psychological Treatments for Adult Depression: A Meta-Analysis 2014Advantages and limitations of Internet-based interventions for common mental disorders 2003Psychotherapy Relationships That Work: Therapist Contributions and Responsiveness to Patients

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2020Understanding Client Support Strategies to Improve Clinical Outcomes in an Online Mental Health Intervention 2017Patients’ experiences of a computerised self-help program for treating depression – a qualitative study of Internet mediated cognitive behavioural therapy in primary care 2018Development and evaluation of a scale assessing therapist fidelity to guidelines for delivering therapist-assisted Internet-delivered cognitive behaviour therapy 2017Internet-Assisted Cognitive Behavioral Therapy

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