Hostname: page-component-848d4c4894-4hhp2 Total loading time: 0 Render date: 2024-06-01T15:00:18.641Z Has data issue: false hasContentIssue false
  • English
  • Français

Internet-delivered Cognitive Behaviour Therapy for Depressive Symptoms: An Exploratory Examination of Therapist Behaviours and their Relationship to Outcome and Therapeutic Alliance

Published online by Cambridge University Press:  15 June 2016

Luke H. Schneider ,
Heather D. Hadjistavropoulos  and
Y. Nichole Faller
Luke H. Schneider
Affiliation:
University of Regina, Canada
Heather D. Hadjistavropoulos*
Affiliation:
University of Regina, Canada
Y. Nichole Faller
Affiliation:
University of Regina, Canada
*
Correspondence to Heather Hadjistavropoulos, University of Regina, Department of Psychology, 3737 Wascana Parkway, Regina, Saskatchewan S4S0A2, Canada. E-mail: heather.hadjistavropoulos@uregina.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: A previous study of therapist-assisted Internet-delivered cognitive behaviour therapy (ICBT) for generalized anxiety (Paxling et al., 2013) identified eight distinct therapist behaviours in ICBT (task reinforcement, self-efficacy shaping, task prompting, alliance bolstering, psychoeducation, empathetic utterances, deadline flexibility, and self-disclosure). It is unknown how generalizable these behaviours are across ICBT programs. Aims: We systematically examined the frequency of these eight therapist behaviours and additional newly identified behaviours in e-mails sent to patients during the course of ICBT for depressive symptoms. We also conducted exploratory analyses to examine relationships between therapist behaviours, symptom improvement, and therapeutic alliance. Method: Data was obtained from a previously published open trial (Hadjistavropoulos et al., 2014). A total of 1013 e-mails sent from therapists (n = 24) to patients (n = 41) during ICBT for depressive symptoms were analyzed. Therapist behaviours were correlated with symptom change scores and ratings of therapeutic alliance at mid- and post-treatment. Results: Therapist behaviours described by Paxling et al. were reliably identified in the e-mails using qualitative content analysis; the frequencies of these behaviours differed, however, from the Paxling et al. study and three additional therapist behaviours were identified (administrative statements, questionnaire feedback, asking clarifying questions). Several therapist behaviours (e.g. administrative statements, task prompting) were associated with lower symptom improvement at post-treatment. Questionnaire feedback and task reinforcement were associated with higher patient ratings of therapeutic alliance. Conclusions: The study provides partial support for the generalizability of therapist-assistance across ICBT programs. Experimental research is needed to examine the impact of varying therapist-assistance on patient outcomes.

Keywords

Internet-delivered cognitive behaviour therapydepressiononline communicationtherapist behaviourstherapeutic process
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 44 , Issue 6 , November 2016 , pp. 625 - 639
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2016 

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

Andersson, G. and Titov, N. (2014). Advantages and limitations of Internet-based interventions for common mental disorders. World Psychiatry, 13, 4–11. doi: 10.1002/wps.20083 Google Scholar
Baumeister, H., Reichler, L., Munzinger, M. and Lin, J. (2014). The impact of guidance on Internet-based mental health interventions: a systematic review. Internet Interventions, 1, 205–215. doi: 10.1016/j.invent.2014.08.003 CrossRefGoogle Scholar
Cameron, I. M., Crawford, J. R., Lawton, K. and Reid, I. C. (2008). Psychometric comparison of PHQ-9 and HADS for measuring depression severity in primary care. British Journal of General Practice, 58, 32–36. doi: 10.3399/bjgp08X263794 Google Scholar
Elo, S. and Kyngas, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62, 107–115. doi: 10.1111/j.1365-2648.2007.04569.x Google Scholar
Hadjistavropoulos, H. D., Pugh, N. E., Nugent, M. M., Hesser, H., Andersson, G., Ivanov, M., et al. (2014). Therapist-assisted Internet-delivered cognitive behavior therapy for depression and anxiety: translating evidence into clinical practice. Journal of Anxiety Disorders, 28, 884–893. doi: 10.1016/j.janxdis.2014.09.018 Google Scholar
Hadjistavropoulos, H. D., Thompson, M. J., Klein, B. and Austin, D. W. (2012). Dissemination of therapist-assisted Internet cognitive behaviour therapy: development and open pilot study of a workshop. Cognitive Behaviour Therapy, 41, 230–240. doi: 10.1080/16506073.2011.645550 Google Scholar
Hedman, E., Ljotsson, B. and Lindefors, N. (2012). Cognitive behavior therapy via the Internet: a systematic review of applications, clinical efficacy and cost-effectiveness. Expert Review of Pharmacoeconomics and Outcomes Research, 12, 745–764. doi: 10.1586/erp.12.67 Google Scholar
Hsieh, H. F. and Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15, 1277–1288. doi: 10.1177/1049732305276687 Google Scholar
Johansson, R. and Andersson, G. (2012). Internet-based psychological treatments for depression. Expert Review of Neurotherapeutics, 12, 861–869; quiz 870. doi: 10.1586/ern.12.63 Google Scholar
Kiropoulos, L. A., Klein, B., Austin, D. W., Gilson, K., Pier, C., Mitchell, J. and Ciechomski, L. (2008). Is Internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT? Journal of Anxiety Disorders, 22, 1273–1284. doi: 10.1016/j.janxdis.2008.01.008 Google Scholar
Klein, B., Austin, D., Pier, C., Kiropoulos, L., Shandley, K., Mitchell, J., et al. (2009). Internet-based treatment for panic disorder: does frequency of therapist contact make a difference? Cognitive Behaviour Therapy, 38, 100–113. doi: 10.1080/16506070802561132 Google Scholar
Klein, B., Meyer, D., Austin, D. and Kyrios, M. (2011). Anxiety online: a virtual psychology clinic - participant outcomes following completion of fully automated self-help treatment programs for the anxiety disorders. Journal of Medical Internet Research, 13, e89. doi: 10.2196/jmir.1918 Google Scholar
Kroenke, K., Spitzer, R. L. and Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613. doi: 10.1046/j.1525-1497.2001.016009606.x CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L., Williams, J. B. and Lowe, B. (2010). The Patient Health Questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. General Hospital Psychiatry, 32, 345–359. doi: 10.1016/j.genhosppsych.2010.03.006 CrossRefGoogle ScholarPubMed
Lovibond, S. H. and Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.). Sydney, Australia: Psychology Foundation of Australia.Google Scholar
Luborsky, L., Barber, J. P., Siqueland, L., Johnson, S., Najavits, L. M., Frank, A. and Daley, D. (1996). The Revised Helping Alliance Questionnaire (HAq-II). Journal of Psychotherapy Practice and Research, 5, 260–271.Google Scholar
McHugh, M. L. (2012). Interrater reliability: the kappa statistic. Biochemica Medica, 22, 276–282. doi: 10.11613/BM.2012.031 Google Scholar
Ng, F., Trauer, T., Dodd, S., Callaly, T., Campbell, S. and Berk, M. (2007). The validity of the 21-item version of the Depression Anxiety Stress Scales as a routine clinical outcome measure. Acta Neuropsychiatrica, 19, 304–310. doi: 10.1111/j.1601-5215.2007.00217.x CrossRefGoogle ScholarPubMed
Paxling, B., Lundgren, S., Norman, A., Almlov, J., Carlbring, P., Cuijpers, P. and Andersson, G. (2013). Therapist behaviours in internet-delivered cognitive behaviour therapy: analyses of e-mail correspondence in the treatment of generalized anxiety disorder. Behavioural and Cognitive Psychotherapy, 41, 280–289. doi: 10.1017/s1352465812000240 Google Scholar
Spitzer, R. L., Kroenke, K., Williams, J. B. and Lowe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 1092–1097. doi: 10.1001/archinte.166.10.1092 Google Scholar
Steketee, G. and Chambless, D. L. (1992). Methodological issues in prediction of treatment outcome. Clinical Psychology Review, 12, 387–400. doi: 10.1016/0272-7358(92)90123-p Google Scholar
Submit a response

Comments

No Comments have been published for this article.