Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-10T07:26:26.276Z Has data issue: false hasContentIssue false
  • English
  • Français

Patient experience of supported computerized CBT in an inner-city IAPT service: a qualitative study

Part of: Low Intensity CBT

Published online by Cambridge University Press:  14 January 2019

Ramesh P. Perera-Delcourt  and
Gemma Sharkey
Ramesh P. Perera-Delcourt*
Affiliation:
Centre for Anxiety Disorders and Trauma, 99 Denmark Hill, London SE5 8AZ
Gemma Sharkey
Affiliation:
Department of Psychology, University of Bath, Claverton Down, Bath BA2 7AY
*
*Author for correspondence: Dr Ramesh Perera-Delcourt (email: ramesh.perera-delcourt@slam.nhs.uk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Computerized cognitive behavioural therapy (cCBT) has been developed to address economic and clinical issues around limited access to evidence-based therapy. Supported cCBT (variously termed iCBT or eCBT) has been developed to address issues with the effectiveness of, and engagement with, cCBT. There has been no in-depth qualitative exploration of the patient experience of eCBT within the UK, which might aid improving its effectiveness. The aim of this study was to explore patient experience of eCBT in one inner-city National Health Service (NHS) Improving Access to Psychological Therapies (IAPT) service using a semi-structured interview and Thematic Analysis methodology. Ten patients took part. Six main themes were identified: (1) Being Offered eCBT; (2) How eCBT Compares with Self-help; (3) The Patient's State of Mind; (4) The Relationship with the Supporter; (5) Preferring to Talk; (6) eCBT's Value as a Treatment. Participants in this study indicated a preference for face-to-face talking therapy, but were clear that they could form a therapeutic relationship via asynchronous messaging. They reported clinical benefit from the eCBT programme and online relationship, and acknowledged that accessing this immediately was valuable. Issues around the process of selecting patients for eCBT, including with regard to acknowledging or mitigating any negative emotional effects of eCBT, and how to offer and support users with it, are discussed.

Keywords

eCBTiCBTinternet-based CBTguided cCBTSilverCloudpatient experience
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 12 , 2019 , e13
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Further reading

Carlbring, P, Andersson, G, Cuijpers, P, Riper, H, Hedman-Lagerlöf, E (2018). Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis, Cognitive Behaviour Therapy 47, 1–18. doi: 10.1080/16506073. 2017.1401115Google Scholar
Fairburn, CG, Patel, V (2017). The impact of digital technology on psychological treatments and their dissemination. Behaviour Research and Therapy 88, 19–25.Google Scholar
Olthuis, JV, Watt, MC, Bailey, K, Hayden, JA, Stewart, SH (2016). Therapist-supported internet cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database of Systematic Reviews 3: CD011565. doi: 10.1002/14651858.CD011565.pub2Google Scholar
Richards, D, Enrique, A, Palacios, J, Duffy, D (2018). Internet-delivered cognitive behaviour therapy, cognitive behavioral therapy and clinical applications. In Şenormancı O and Şenormancı G (eds), IntechOpen. Retrieved from: https://www.intechopen.com/books/cognitive-behavioral-therapy-and-clinical-applications/internet-delivered-cognitive-behaviour-therapy. doi: 10.5772/intechopen.71412Google Scholar

References

Andersson, G, 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
Andersson, G, Cuijpers, P, Carlbring, P, Riper, H, Hedman, E (2014). Guided internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: a systematic review and meta-analysis. World Psychiatry 13, 288–295.Google Scholar
Andersson, G, Hedman, E (2013). Effectiveness of guided internet-based cognitive behavior therapy in regular clinical settings. Verhaltenstherapie 23,140–148.Google Scholar
Bendelin, N, Hesser, H, Dahl, J, Carlbring, P, Nelson, KZ, Andersson, G (2011). Experiences of guided internet-based cognitive-behavioural treatment for depression: a qualitative study. BMC Psychiatry 11, 107.Google Scholar
Braun, V, Clarke, V (2006). Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77–101.Google Scholar
Burke, J, Richards, D, Timulak, L (2018). Helpful and hindering events in internet-delivered cognitive behavioural treatment for generalized anxiety. Behavioural and Cognitive Psychotherapy, 1–14. doi: 10.1017/S1352465818000504Google Scholar
Carlbring, P, Andersson, G, Cuijpers, P, Riper, H, Hedman-Lagerlöf, E (2018). Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis, Cognitive Behaviour Therapy 47, 1–18. doi: 10.1080/16506073.2017.1401115Google Scholar
Cludius, B, Schröder, J, Moritz, S. (2018). Expectancy effects in self-help depression treatment: first evidence that the rationale given for an online study impacts the outcome. Behavioural and Cognitive Psychotherapy 46, 195–208. doi: 10.1017/S1352465817000571Google Scholar
Crawford, MJ, Thana, L, Farquharson, L, Palmer, L, Hancock, E, Bassett, P, Clarke, J, Parry, GD (2016). Patient experience of negative effects of psychological treatment: results of a national survey. British Journal of Psychiatry 208, 260–265. doi: 10.1192/bjp.bp.114.162628Google Scholar
Cuijpers, P, Donker, , T, van Straten, A, Li, , J, Andersson, G (2010). Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychological Medicine 40, 1943–1957. https://doi.org/10.1017/S0033291710000772Google Scholar
de Graaf, LE, Gerhards, SAH, Arntz, A, Riper, H, Metsemakers, JFM, Evers, SMAA, Severens, JL, Widdershoven, G, Huibers, MJH (2009). Clinical effectiveness of online computerised cognitive-behavioural therapy without support for depression in primary care: randomised trial. British Journal of Psychiatry 195, 73–80.Google Scholar
Department of Health (2005). Creating a Patient-Led NHS: Delivering the NHS Improvement Plan. Retrieved from: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4106506Google Scholar
Donkin, L, Glozier, N (2012). Motivators and motivations to persist with online psychological interventions: a qualitative study of treatment completers. Journal of Medical Internet Research 14, e91.Google Scholar
Earley, C, Joyce, C, McElvaney, J, Richards, D, Timulak, L (2017). Preventing depression: qualitatively examining the benefits of depression-focused iCBT for participants who do not meet clinical thresholds, Internet Interventions 9, 82–87. https://doi.org/10.1016/j.invent.2017.07.003Google Scholar
Enrique, A, Burke, J, Richards, D, Timulak, L (2018). Quality of life outcomes in internet-delivered (space from depression) treatment for depression. Applied Research in Quality of Life, 1–13. doi: 10.1007/s11482-018-9654-8Google Scholar
Fairburn, CG, Patel, V (2017). The impact of digital technology on psychological treatments and their dissemination. Behaviour Research and Therapy 88, 19–25.Google Scholar
Fleming, T, Bavin, L, Lucassen, M, Stasiak, K, Hopkins, S, Merry, S (2018). Beyond the trial: systematic review of real-world uptake and engagement with digital self-help interventions for depression, low mood, or anxiety. Journal of Medical Internet Research 20, e199. doi: 10.2196/jmir.9275Google Scholar
Friesen, LN, Hadjistavropoulos, HD, Pugh, NE (2014). A qualitative examination of psychology graduate students’ experiences with guided internet-delivered cognitive behaviour therapy. Internet Interventions 1, 41–48.Google Scholar
Gerskowitch, C, Norman, I, Rimes, KA (2015). Patients with medically unexplained physical symptoms experience of receiving treatment in a primary-care psychological therapies service: a qualitative study. the Cognitive Behaviour Therapist 8, e12.Google Scholar
Gilbody, S, Littlewood, E, Hewitt, C, Brierley, G, Tharmanathan, P, Araya, R et al. (2015). Computerised cognitive behaviour therapy (cCBT) as treatment for depression in primary care (REEACT trial): large scale pragmatic randomised controlled trial. BMJ 351, h5627.Google Scholar
Gilburt, H (2015). Mental Health Under Pressure. King's Fund (Briefing): London.Google Scholar
Gratzer, D, Khalid-Khan, F (2016). Internet-delivered cognitive behavioural therapy in the treatment of psychiatric illness. Canadian Medical Association Journal 188, 263–272. http://doi.org/10.1503/cmaj.150007Google Scholar
Green, J, Thorogood, N (2014). Qualitative Methods for Health Research. London: Sage.Google Scholar
Griffiths, KM, Farrer, L, Christensen, H (2010). The efficacy of internet interventions for depression and anxiety disorders: a review of randomised controlled trials. MJA 192, S4–11.Google Scholar
Halmetoja, CO, Malmquist, A, Carlbring, P, Andersson, G (2014). Experiences of internet-delivered cognitive behavior therapy for social anxiety disorder four years later: a qualitative study. Internet Interventions 1, 158–163. doi: 10.1016/j.invent.2014.08.001Google Scholar
Hollis, C, Sampson, S, Simons, L, Davies, EB, Churchill, R, Betton, V, Butler, D, Chapman, K, Easton, K, Gronlund, TA, Kabir, T, Rawsthorne, M, Rye, E, Tomlin, A (2018). Identifying research priorities for digital technology in mental health care: results of the James Lind Alliance Priority Setting Partnership. The Lancet Psychiatry. https://doi.org/10.1016/S2215-0366(18)30296-7Google Scholar
Holst, A, Nejati, S, Björkelund, C, Eriksson, MC, Hange, D, Kivi, M, Wikberg, C, Petersson, EL (2017). Patients’ experiences of a computerised self-help program for treating depression – a qualitative study of Internet mediated cognitive behavioural therapy in primary care. Scandinavian Journal of Primary Health Care 35, 46–53.Google Scholar
Johansson, O, Michel, T, Andersson, G, Paxling, B (2015). Experiences of non-adherence to Internet-delivered cognitive behavior therapy: a qualitative study. Internet Interventions 2, 137–142. https://doi.org/10.1016/j.invent.2015.02.006Google Scholar
Kaltenthaler, E, Parry, G, Beverley, C, Ferriter, M (2008). Computerised cognitive-behavioural therapy for depression: systematic review. British Journal of Psychiatry 193, 181–184. doi: 10.1192/bjp.bp.106.025981Google Scholar
Knowles, SE, Lovell, K, Bower, P, Gilbody, S, Littlewood, E, Lester, H (2015). Patient experience of computerised therapy for depression in primary care BMJ Open 5, e008581. doi: 10.1136/bmjopen-2015-008581Google Scholar
Lilienfeld, SO (2007). Psychological treatments that cause harm. Perspectives on Psychological Science 2, 53–70.Google Scholar
Lillevoll, KR, Wilhelmsen, M, Kolstrup, N, Hoifodt, RS, Waterloo, K, Eisemann, M, Risor, MB (2013). Patients’ experiences of helpfulness in guided internet-based treatment for depression: qualitative study of integrated therapeutic dimensions. Journal of Medical Internet Research 15, e126.Google Scholar
Lovell, K, Bower, P, Gellatly, J et al. (2017). Clinical effectiveness, cost-effectiveness and acceptability of low-intensity interventions in the management of obsessive-compulsive disorder: the Obsessive-Compulsive Treatment Efficacy randomised controlled Trial (OCTET). Health Technology Assessment 21, 1–132.Google Scholar
Meisel, SF, Drury, H, Perera-Delcourt, RP (2018). Therapists’ attitudes to offering eCBT in an inner-city IAPT service: a survey study. the Cognitive Behaviour Therapist (in press).Google Scholar
Mehra, B (2002). Bias in qualitative research: voices from an online classroom. The Qualitative Report, 7, 1–19.Google Scholar
Mitchell, N, Gordon, PK (2007). Attitudes towards computerized CBT for depression amongst a student population. Behavioural and Cognitive Psychotherapy 35, 421–430.Google Scholar
Mogoașe, C, Cobeanu, O, David, O, Giosan, C, Szentagotai, A. (2017). Internet-based psychotherapy for adult depression: what about the mechanisms of change? Journal of Clinical Psychology 73, 5–64 doi: 10.1002/jclp.22326Google Scholar
Morgan, C, Mason, E, Newby, JM, Mahoney, AEJ, Hobbs, MJ, McAloon, J, Andrews, G (2017). The effectiveness of unguided internet cognitive behavioural therapy for mixed anxiety and depression. Internet Interventions 10, 47–53. https://doi.org/10.1016/j.invent.2017.10.003Google Scholar
Morrison, C, Walker, G, Ruggeri, K, Hacker Hughes, J (2014). An implementation pilot of the MindBalance web-based intervention for depression in three IAPT services. the Cognitive Behaviour Therapist 7, E15. doi: 10.1017/S1754470X14000221Google Scholar
National Institute for Clinical Excellence (NICE) (2011). Common mental health disorders. Clinical Guideline 123. London: NICE.Google Scholar
National Institute for Clinical Excellence (NICE) (2018). Depression in adults: recognition and management. Clinical Guideline 90. London: NICE.Google Scholar
Office for National Statistics (2009). Adult Psychiatric Morbidity in England – 2007, Results of a Household Survey. Retrieved from: http://content.digital.nhs.uk/pubs/psychiatricmorbidity07Google Scholar
Olthuis, JV, Watt, MC, Bailey, K, Hayden, JA, Stewart, SH (2016). Therapist-supported internet cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database of Systematic Reviews 3: CD011565. doi: 10.1002/14651858.CD011565.pub2Google Scholar
Rennick-Egglestone, S, Knowles, S, Toms, G, Bee, P, Lovell, K, Bower, P (2016). Health technologies ‘in the wild’: experiences of engagement with computerised CBT. In Proceedings of the 2016 CHI Conference on Human Factors in Computing Systems, 2124–2135. doi: https://doi.org/10.1145/2858036.2858128Google Scholar
Richards, D, Dowling, M, O'Brien, E, Viganò, N, Timulak, L (2018a). Significant events in an internet-delivered (space from depression) intervention for depression. Counselling and Psychotherapy Research 18, 35–48. doi: 10.1002/capr.12142Google Scholar
Richards, D, Enrique, A, Palacios, J, Duffy, D (2018b). Internet-delivered cognitive behaviour therapy, cognitive behavioural therapy and clinical applications. In Şenormancı O and Şenormancı G (eds), IntechOpen. Retrieved from: https://www.intechopen.com/books/cognitive-behavioral-therapy-and-clinical-applications/internet-delivered-cognitive-behaviour-therapy. doi: 10.5772/intechopen.71412Google Scholar
Richards, D, Murphy, T, Viganó, N, Timulak, L, Doherty, G, Sharry, J, Hayes, C (2016). Acceptability, satisfaction and perceived efficacy of ‘Space from Depression’, an internet-delivered treatment for depression. Internet Interventions 5, 12–22. https://doi.org/10.1016/j.invent.2016.06.007Google Scholar
Richards, D, Richardson, T (2012). Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clinical Psychology Review 32, 329–342.Google Scholar
Richards, D, Timulak, T (2012). Client-identified helpful and hindering events in therapist-delivered vs. self-administered online cognitive-behavioural treatments for depression in college students. Counselling Psychology Quarterly 25, 251–262.Google Scholar
Richards, D, Timulak, L (2013). 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.Google Scholar
Rost, T, Stein, J, Löbner, M, Kersting, A, Luck-Sikorski, C, Riedel-Heller, SG (2017). User acceptance of computerized cognitive behavioral therapy for depression: systematic review. Journal of Medical Internet Research 9, e309.Google Scholar
Rozental, A, Kottorp, A, Boettcher, J, Andersson, G, Carlbring, P (2016). Negative effects of psychological treatments: an exploratory factor analysis of the negative effects questionnaire for monitoring and reporting adverse and unwanted events. PLoS ONE 11, e0157503. http://doi.org/10.1371/journal.pone.0157503Google Scholar
Sharry, J, Davidson, R., McLoughlin, O, Doherty, G (2013). A service-based evaluation of a therapist-supported online cognitive behavioral therapy program for depression. Journal of Medical Internet Research 15, E121.Google Scholar
Simon, GE, Ludman, EJ (2009). It's time for disruptive innovation in psychotherapy. Lancet 374, 594–595.Google Scholar
So, M, Yamaguchi, S, Hashimoto, S, Sado, M, Furukawa, TA, McCrone, P (2013). Is computerised CBT really helpful for adult depression? A meta-analytic re-evaluation of CCBT for adult depression in terms of clinical implementation and methodological validity. BMC Psychiatry 13, 113. http://doi.org/10.1186/1471-244X-13-113Google Scholar
Waller, R, Gilbody, S (2009). Barriers to the uptake of computerized cognitive behavioural therapy: a systematic review of the quantitative and qualitative evidence. Psychological Medicine 39, 705–12.Google Scholar
Walsh, A, Richards, D (2017). Experiences and engagement with the design features and strategies of an internet-delivered treatment programme for generalised anxiety disorder: a service-based evaluation, British Journal of Guidance and Counselling 45, 16–31. doi: 10.1080/03069885.2016.1153039Google Scholar
Wells, MJ, Owen, JJ, McCray, LW, Bishop, LB, Eells, TD, Brown, GK, Richards, D, Thase, ME, Wright, JH (2018). Computer-assisted cognitive-behavior therapy for depression in primary care: systematic review and meta-analysis. Primary Care Companion CNS Disorders 20,17r02196.Google Scholar
Wilhelmsen, M, Lillevoll, K, Risør, MB, Høifødt, R, Johansen, ML, Waterloo, K, Eisemann, M, Kolstrup, N (2013). Motivation to persist with internet-based cognitive behavioural treatment using blended care: a qualitative study. BMC Psychiatry 13, 296. https://doi.org/10.1186/1471-244X-13-296Google Scholar
Submit a response

Comments

No Comments have been published for this article.