Significant events in an Internet‐delivered (Space from Depression) intervention for depression

Abstract

Objective The advantages and effectiveness of Internet interventions have been established. Little is known about the critical processes of change in Internet‐delivered interventions and of the psychological experience of users. These are both clinically relevant and have a link to the overall outcome of therapy. The goal of this article was to gain an insight into the important therapeutic processes in an 8‐week supported online self‐administered CBT‐based treatment for depression. Method Respondents were participants (N = 88) in a randomised controlled trial with an initial score of 14–28 on the Beck Depression Inventory (BDI‐II), who completed at least one module of the online intervention, and at least one Helpful Aspects of Therapy (HAT) questionnaire. Analysis The HAT data were analysed using descriptive–interpretative qualitative analysis to (i) identify helpful and hindering events, (ii) describe key events and (iii) describe the corresponding impacts of these events on the clients. Results In total, six helpful events were reported (provision of information, core CBT activities, mindfulness, platform accessibility and usability, supporter, personal stories and examples) and eight associated impacts (applying new coping skills/behavioural change, awareness and insight, improved well‐being, support/validation, expression/relief, self‐efficacy/empowerment/sense of achievement, personal connection). In total, five hindering events were identified (platform features/design, external factors, internal factors, supporters' feedback and content of the programme) and five associated impacts (disappointment, frustration/irritation, confusion, mood deterioration and being self‐critical/blaming) were reported. Conclusions The current results support previous findings that CBT principles are important in online delivery. The role of the supporter emerges as a key ingredient in online delivery worthy of further investigation.

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

“…This study replicates a number of themes found in previous studies which involved different participants, different interventions, and different methodologies (Lillevoll et al , 2013; Richards and Timulak, 2013; Wilhelmsen et al , 2013; Johansson et al , 2015; Richards et al , 2016; Earley et al , 2017; Holst et al , 2017; Walsh and Richards, 2017; Burke et al , 2018; Richards et al , 2018a). These previous studies lend weight to the current study's findings.…”

“…This need for greater support has also been found for eCBT, even with telephone contact (Holst et al , 2017), so the finding that participants in this study felt they could form a therapeutic relationship online seems a significant improvement: Knowles et al (2015) theorised that greater support could enhance the experience for patients, and this appears to be the case. The current study fleshes out and supports the findings of previous studies into eCBT by providing more detail about how patients can positively experience the supporter's presence and feedback (Richards and Timulak, 2013; Wilhelmsen et al , 2013; Richards et al , 2016; Earley et al , 2017; Walsh and Richards, 2017; Burke et al , 2018; Richards et al , 2018a).…”

“…However, perhaps developers of the technology could use new features to ameliorate this. In addition to the above negative experiences of eCBT, previous qualitative studies of eCBT have also found that some patients can report deteriorating in response to it (Richards and Timulak, 2013; Enrique et al , 2018; Burke et al , 2018; Richards et al , 2018a). However, it should be acknowledged that negative responses to therapy can occur with face-to-face therapy.…”

“…Particularly in qualitative research, this social desirability bias of the researcher might affect interpretation of the data (Mehra, 2002). Some studies have acknowledged that patients can deteriorate whilst using eCBT, but this has not been discussed in much depth (Richards and Timulak, 2013; Enrique et al ., 2018; Richards et al ., 2018a).…”

“…Previous studies have also indicated that eCBT is most beneficial for patients who are conscientious, high achieving and goal driven, i.e. motivated, who have mild/moderate problems, and who are unwilling or unable to engage in face-to-face therapy (Richards and Timulak, 2013; Wilhelmsen et al ., 2013; Richards et al , 2016; Earley et al ., 2017; Holst et al , 2017; Walsh and Richards, 2017; Burke et al , 2018; Richards et al , 2018a). One study that focused on depression and generalized anxiety disorder in particular, found that patients can experience the treatment as demanding (in terms of content and concentration requirements); difficult without face-to-face support; and as lacking sufficient introductory information (Johansson et al , 2015).…”