Improving Acceptability and Uptake Behavior for Internet-Based Cognitive-Behavioral Therapy

Abstract

Internet-based cognitive behavioral therapy (iCBT) programs have the potential to improve access to mental healthcare, but they are not viewed as acceptable nor widely utilized by the general public. This study tested whether two acceptance-facilitating interventions improved acceptability and uptake-related behavior for therapist assisted and self-guided iCBT. Participants were randomly assigned to read a treatment rationale for iCBT (vs. a brief definition) and to receive a small financial incentive (or not) for seeking more information about evidence-based iCBT programs. Participants (N = 662) were a diverse group recruited from a University participant pool and the surrounding community. Participants completed standardized measures of attitudes toward and outcome expectancy for iCBT and a single question about willingness to use it and were given the opportunity to get information about accessing evidence-based iCBT programs. A series of MANCOVAs showed small, positive effects of the treatment rationale on attitudes and outcome expectancy for both self-guided and therapist-assisted iCBT, but not for willingness to use it. A hierarchical logistic regression model found no effect of the treatment rationale or financial incentive on whether participants sought additional information about how to access iCBT, although psychopathology symptoms and identifying as White or multiracial were positively associated with information-seeking. Inconsistent with past research, participants rated therapist-assisted and self-guided iCBT as equally acceptable. Participants recruited from the community reported greater willingness to use iCBT than University students. These results underscore the urgent need for further research toward improving the acceptability and uptake of iCBT so that it may better fulfill its potential to fill the gap in unmet mental health need.

Engagement with mobile health interventions for depression: A systematic review

“…Finding ways to experimentally manipulate engagement with mHealth for individuals with depression will be a valuable next step for clinical trials. Researchers and clinicians could draw from theories of learning and persuasion to experimentally test strategies that improve engagement with programs ( Molloy et al, 2021 ), then examine whether these types of engagement significantly mediate clinical outcomes. For example, interventions could be designed to encourage adherence to recommendations using prompts, “gameification,” and other persuasive design features ( Kelders et al, 2012 ).…”

Increasing Acceptability and Outcome Expectancy for Internet-Based Cognitive Behavioral Therapy During the COVID-19 Pandemic

“…Individuals were recruited for a study examining the acceptability of iCBT from June 2018 to September 2019 (N = 662). 20 Participants in this parent study were students at a large university in the southeastern United States and adults from the surrounding urban community. Students participated online, whereas community participants were recruited in public places and completed the study on a tablet computer with a research assistant.…”

“…Participants also completed a measure of current psychopathology. For further details about the parent study, see Molloy et al 20 Follow-up survey. Participants from the parent study were re-contacted by e-mail in May 2020 and invited to participate in a follow-up survey.…”

“…Video-and text-based treatment rationales designed to improve attitudes toward digital mental health programs have shown promising results. [18][19][20] These rationales explain how a treatment works and describe the evidence that it is effective. They have been shown to increase acceptability, defined here as general attitudes and beliefs about programs, and outcome expectancy, the belief that a program will be effective.…”

“…21 The authors re-contacted participants from a large experimental study that examined the effects of a treatment rationale for iCBT before the COVID-19 pandemic. 20 Respondents to the follow-up repeated study procedures from the parent study, including the original experimental manipulation of receiving a treatment rationale or not. The authors hypothesized that there would be significant interactions between rationale condition and time point, such that the rationale caused a larger increase in acceptability and outcome expectancy for iCBT when administered during the COVID-19 pandemic, as compared with before the pandemic.…”