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Helpful and Hindering Events in Internet-Delivered Cognitive Behavioural Treatment for Generalized Anxiety

Published online by Cambridge University Press:  28 August 2018

John Burke Open the ORCID record for John Burke [Opens in a new window] ,
Derek Richards Open the ORCID record for Derek Richards [Opens in a new window]  and
Ladislav Timulak
John Burke
Affiliation:
E-Mental Health Research Group, School of Psychology, Trinity College, Dublin and Research and Innovation, SilverCloud Health, Dublin, Ireland
Derek Richards*
Affiliation:
E-Mental Health Research Group, School of Psychology, Trinity College, Dublin and Research and Innovation, SilverCloud Health, Dublin, Ireland
Ladislav Timulak
Affiliation:
E-Mental Health Research Group School of Psychology, Trinity College, Dublin
*
Correspondence to Derek Richards, E-Mental Health Research Group, School of Psychology, Trinity College, Dublin, Ireland. E-mail: derek.richards@tcd.ie
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Abstract

Background: Anxiety disorders are a highly prevalent cause of impairment globally with generalized anxiety disorder (GAD) sharing many features with other anxiety disorders. Aims: The present study investigated the helpful and hindering events and impacts for individuals with generalized anxiety who engaged with a supported 6-week online intervention based on cognitive behavioural therapy (iCBT). Method: Participants (n = 36) completed the Helpful and Hindering Aspects of Therapy (HAT) for each session. A descriptive-interpretative framework was used to analyse the data. Results: Helpful events were identified by participants as CBT techniques including psychoeducation, monitoring, cognitive restructuring and relaxation, and found supporter interaction, mindfulness and reading personal stories helpful. The associated impacts were identified as support and validation; behavioural change/applying coping strategies; clarification, awareness, and insight; reassurance/relief; and self-efficacy/empowerment. Hindering events were identified as treatment content/form; and amount of work/technical issues, which led to impacts such as frustration/irritation; increased anxiety; and isolation. Conclusion: The implications of the results, potential future directions of research and limitations of the study are discussed.

Keywords

significant events in therapyhelpful and hindering eventsinternet-delivered interventionsgeneralized anxietydescriptive-interpretative framework
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 47 , Issue 3 , May 2019 , pp. 386 - 399
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2018 

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References

Andersson, G. and Cuijpers, P. (2009). Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cognitive Behaviour Therapy, 38, 196–205. doi: 10.1080/16506070903318960Google Scholar
Batelaan, N. M., Smit, J. H., Cuijpers, P., van Marwijk, H. W., Terluin, B. and van Balkom, A. J. (2012). Prevention of anxiety disorders in primary care: a feasibility study. BMC Psychiatry, 12, 1. doi: 10.1186/1471-244X-12-206Google Scholar
Bendelin, N., Hesser, H., Dahl, J., Carlbring, P., Nelson, K. Z. and Andersson, G. (2011). Experiences of guided internet-based cognitive-behavioural treatment for depression: a qualitative study. BMC Psychiatry, 11, 1. doi: 10.1186/1471-244X-11-107Google Scholar
Cuijpers, P., Sijbrandij, M., Koole, S., Huibers, M., Berking, M. and Andersson, G. (2014). Psychological treatment of generalized anxiety disorder: a meta-analysis. Clinical Psychology Review, 34, 130–140. doi: 10.1016/j.cpr.2014.01.002Google Scholar
Dwyer, L. A., Hornsey, M. J., Smith, L. G., Oei, T. P. and Dingle, G. A. (2011). Participant autonomy in cognitive behavioral group therapy: an integration of self-determination and cognitive behavioral theories. Journal of Social and Clinical Psychology, 30, 24. doi: 10.1521/jscp.2011.30.1.24Google Scholar
Elliott, R. (1985). Helpful and nonhelpful events in brief counseling interviews: an empirical taxonomy. Journal of Counseling Psychology, 32, 307–322. doi: 10.1037/0022-0167.32.3.307Google Scholar
Elliott, R. (2008). Research on client experiences of therapy: introduction to the special section. Psychotherapy Research, 18, 239–242. doi: 10.1080/10503300802074513Google Scholar
Elliott, R., James, E., Reimschuessel, C., Cislo, D. and Sack, N. (1985). Significant events and the analysis of immediate therapeutic impacts. Psychotherapy: Theory, Research, Practice, Training, 22, 620. doi: 10.1037/h0085548Google Scholar
Elliott, R., Slatick, E. and Urman, M. (2001). Qualitative change process research on psychotherapy: alternative strategies. Psychological Test and Assessment Modeling, 43, 69. doi: 10.1002/9781119973249.ch6Google Scholar
Elliott, R. and Timulak, L. (2005). Descriptive and interpretative approaches to qualitative research. In Miles, J. and Gilbert, P. (eds), A Handbook of Research Methods in Clinical and Health Psychology (pp. 147–160). Oxford: Oxford University Press. Retrieved from: http://nideffer.net/classes/GCT_RPI_S14/readings/interpretive.pdfGoogle Scholar
Gega, L., Smith, J. and Reynolds, S. (2013). Cognitive behaviour therapy (CBT) for depression by computer vs. therapist: patient experiences and therapeutic processes. Psychotherapy Research, 23, 218–231. doi: 10.1080/10503307.2013.766941Google Scholar
Gulliver, A., Griffiths, K. M., Christensen, H. and Brewer, J. L. (2012). A systematic review of help-seeking interventions for depression, anxiety and general psychological distress. BMC Psychiatry, 12, 1. doi: 10.1186/1471-244X-12-81Google Scholar
Jones, S. L. (2014). An efficacy trial of therapist-assisted internet-delivered cognitive-behaviour therapy for older adults with generalized anxiety. Unpublished doctoral dissertation, University of Regina, Canada. Retrieved from: http://ourspace.uregina.ca/handle/10294/5818Google Scholar
Judd, L., Kessler, R., Paulus, M., Zeller, P., Wittchen, H. and Kunovac, J. (1998). Comorbidity as a fundamental feature of generalized anxiety disorders: results from the National Comorbidity Study (NCS). Acta Psychiatrica Scandinavica Supplement, 393, 6–11. doi: 10.1111/j.1600-0447.1998.tb05960.xGoogle Scholar
Linehan, M. M. (1997). Validation and Psychotherapy. In Bohart, A. C. and Greenberg, L. S. (eds), Empathy Reconsidered: New Directions in Psychotherapy (pp. 353–392). doi: 10.1037/10226-016Google Scholar
Llewelyn, S. P. (1988). Psychological therapy as viewed by clients and therapists. British Journal of Clinical Psychology, 27, 223–237.Google Scholar
Mowbray, C. T., Mandiberg, J. M., Stein, C. H., Kopels, S., Curlin, C., Megivern, D., Strauss, S., Collins, K. and Lett, R. (2006). Campus mental health services: recommendations for change. American Journal of Orthopsychiatry, 76, 226–237. doi: 10.1037/0002-9432.76.2.226Google Scholar
Richards, D., Dowling, M., O'Brien, E., Viganò, N. and Timulak, L. (2017). Significant events in an internet-delivered (Space from Depression) intervention for depression. Counselling and Psychotherapy Research. doi: 10.1002/capr.12142Google Scholar
Richards, D. and Richardson, T. (2012). Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clinical Psychology Review, 332, 329–342. doi: 10.1016/j.cpr.2012.02.004Google Scholar
Richards, D., Richardson, T., Timulak, L. and McElvaney, J. (2015). The efficacy of internet-delivered treatment for generalized anxiety disorder: a systematic review and meta-analysis. Internet Interventions, 2, 272–282. doi: 10.1016/j.invent.2015.07.003Google Scholar
Richards, D. and Timulak, L. (2012). Satisfaction with therapist-delivered vs. self-administered online cognitive behavioural treatments for depression symptoms in college students. British Journal of Guidance and Counselling, 41, 193–207. doi: 10.1080/03069885.2012.726347Google Scholar
Richards, D., Timulak, L., Doherty, G., Sharry, J., McLoughlin, O., Rashleigh, C., Colla, A. and Joyce, C. (2014). Low-intensity internet-delivered treatment for generalized anxiety symptoms in routine care: protocol for a randomized controlled trial. Trials, 15. doi: 10.1186/1745-6215-15-145Google Scholar
Richards, D., Timulak, L. and Hevey, D. (2013). A comparison of two online cognitive-behavioural interventions for symptoms of depression in a student population: the role of therapist responsiveness. Counselling and Psychotherapy Research, 13, 184–193. doi: 10.1080/14733145.2012.733715Google Scholar
Richards, D., Timulak, L., Rashleigh, C., McLoughlin, O., Colla, A., Joyce, C., Doherty, G., Sharry, J., Duffy, D. and Anderson-Gibbons, M. (2016). Effectiveness of an internet-delivered intervention for generalized anxiety disorder in routine care: a randomised controlled trial in a student population. Internet Interventions, 1–9. doi: 10.1016/j.invent.2016.10.003Google Scholar
Ritterband, L. M., Gonder-Frederick, L. A., Cox, D. J., Clifton, A. D., West, R. W. and Borowitz, S. M. (2003). Internet interventions: in review, in use, and into the future. Professional Psychology: Research and Practice, 34, 527. doi: 10.1037/0735-7028.34.5.527Google Scholar
Rochlen, A. B., Zack, J. S. and Speyer, C. (2004). Online therapy: review of relevant definitions, debates, and current empirical support. Journal of Clinical Psychology, 60, 269–283. doi: 10.1002/jclp.10263Google Scholar
Spitzer, R. L., Kroenke, K., Williams, J. B. and Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 1092–1097. doi: 10.1001/archinte.166.10.1092Google Scholar
Somers, J. M., Goldner, E. M., Waraich, P. and Hsu, L. (2006). Prevalence and incidence studies of anxiety disorders: a systematic review of the literature. Canadian Journal of Psychiatry, 51, 100–113. Retrieved from: http://ww1.cpa-apc.org:8080/Publications/Archives/CJP/2006/february/sommers-RP.aspGoogle Scholar
Thomas, N., McLeod, B., Jones, N. and Abbott, J. A. (2015). Developing internet interventions to target the individual impact of stigma in health conditions. Internet Interventions, 2, 351–358. doi: 10.1016/j.invent.2015.01.003Google Scholar
Timulak, L. (2007). Identifying core categories of client-identified impact of helpful events in psychotherapy: a qualitative meta-analysis. Psychotherapy Research, 17, 305–314. doi: 10.1080/10503300600608116Google Scholar
Timulak, L. (2010). Significant events in psychotherapy: an update of research findings. Psychology and Psychotherapy: Theory, Research and Practice, 83, 421–447. doi: 10.1348/147608310X499404Google Scholar
Titov, N., Dear, B. F., Johnston, L., Lorian, C., Zou, J., Wootton, B., Spence, J., McEvoy, P. M. and Rapee, R. M. (2013). Improving adherence and clinical outcomes in self-guided internet treatment for anxiety and depression: randomised controlled trial. PLoS One, 8, e62873. doi: 10.1371/journal.pone.0062873Google Scholar
Tyrer, P. and Baldwin, D. (2006). Generalised anxiety disorder. The Lancet, 368, 2156–2166. doi: 10.1016/S0140-6736(06)69865-6Google Scholar
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