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Client Contact in Self-Help Therapy for Anxiety and Depression: Necessary But Can Take a Variety of Forms Beside Therapist Contact

Published online by Cambridge University Press:  06 July 2012

France Talbot
France Talbot*
Affiliation:
Université de Moncton, Canada
*
Address for correspondence: France Talbot, École de psychologie, Université de Moncton, Moncton, NB, Canada, E1A 3E9. Email: [email protected]
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Abstract

Self-administered therapies (SATs) have been promoted as a way to increase access to evidence-based mental health services. Recent meta-analyses and literature reviews suggest that SATs with clinical guidance are more effective than SATs with no contact for the treatment of anxiety and depression. However, little attention has been paid to the role of nonguidance contact, contact that does not involve the provision of assistance in the application of specific therapy techniques such as emails to encourage treatment adherence. The present article examines the impact of nonguidance contact on the outcomes of SATs for anxiety and depression. Electronic databases were searched to identify studies conducted over the past two decades by independent research teams that have tested cognitive-behavioural SATs over multiple trials. Findings suggest that the involvement or guidance of a therapist is not essential for SATs to produce significant benefits as long as nonguidance contact is provided. It is suggested that even very minimal levels of nonguidance contact increase SAT's outcomes by motivating treatment engagement and improving adherence. The benefit of SATs that can be accessed directly by large numbers of individuals and that do not require therapist involvement to ensure efficacy can potentially significantly increase the cost effectiveness and quality of mental health service delivery.

Keywords

self-help therapyanxietydepressionminimal contacttreatment outcome
Type
Standard Papers
Information
Behaviour Change , Volume 29 , Issue 2 , June 2012 , pp. 63 - 76
Copyright
Copyright © The Authors 2012

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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.CrossRefGoogle ScholarPubMed
Andersson, G., Carlbring, P., Holmstrom, A., Sparthan, E., Furmark, T., Nilsson-Ihfelt, E., . . . Ekselius, L. (2006). Internet-based self-help with therapist feedback and in-vivo group exposure for social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74, 677–686.CrossRefGoogle ScholarPubMed
Aydos, L., Titov, N., & Andrews, G. (2009). Shyness 5: The clinical effectiveness of internet-based clinician-assisted treatment of social phobia. Australasian Psychiatry, 17, 488–492.CrossRefGoogle ScholarPubMed
Carlbring, P., Bohman, S., Brunt, S., Buhrman, M., Westling, B.E., Ekselius, L., & Andersson, G. (2006a). Remote treatment of panic disorder: A randomized trial of internet-based cognitive behavior therapy supplemented with telephone calls. American Journal of Psychiatry, 163, 2119–2125.CrossRefGoogle ScholarPubMed
Carlbring, P., Ekselius, L., & Andersson, G. (2003). Treatment of panic disorder via the internet: A randomized trial of CBT vs. applied relaxation. Journal of Behavior Therapy and Experimental Psychiatry, 34, 129–140.CrossRefGoogle ScholarPubMed
Carlbring, P., Furmark, T., Steczko, J., Ekselius, L., & Andersson, G. (2006b). An open study of internet-based bibliotherapy with minimal therapist contact via email for social phobia. Clinical Psychologist, 10, 30–38.CrossRefGoogle Scholar
Carlbring, P., Gunnarsdottir, M., Hedensjo, L., Andersson, G., Ekselius, L., & Furmark, T. (2007). Treatment of social phobia: Randomized trial of internet-delivered cognitive-behavioral therapy with telephone support. British Journal of Psychiatry, 190, 123–128.CrossRefGoogle ScholarPubMed
Carlbring, P., Nilsson-Ihrfelt, E., Waara, J., Kollenstam, C, Buhrman, M., Kaldo, V., . . . Andersson, G. (2005). Treatment of panic disorder: Live therapy vs. self-help via internet. Behavior Research and Therapy, 43, 1321–1333.CrossRefGoogle ScholarPubMed
Carlbring, P., Westling, B.E., Ljungstrand, P., Ekselius, L., & Andersson, G. (2001) Treatment of panic disorder via the internet: A randomized trial of a self-help program. Behavior Therapy, 32, 751–764.CrossRefGoogle Scholar
Christensen, H., Griffiths, K.M., & Jorm, A.F. (2004a). Delivering interventions for depression by using the internet: Randomized controlled trial. British Medical Journal, 328, 265–269. doi:10.1136/bmj.37945.566632.EECrossRefGoogle Scholar
Christensen, H., Griffiths, K.M., & Korten, A. (2002). Web-based cognitive behavior therapy: Analysis of site usage and changes in depression and anxiety scores. Journal of Medical Internet Research, 4 (1), 3.CrossRefGoogle ScholarPubMed
Christensen, H., Griffiths, K.M., Korten, A.E., Brittliffe, K., & Groves, C. (2004b). A comparison of changes in anxiety and depression symptoms of spontaneous users and trial participants of a cognitive behavior therapy website. Journal of Medical Internet Research, 6 (4), e46.CrossRefGoogle ScholarPubMed
Christensen, H., Griffiths, K.M., Mackinnon, A.J., & Brittlife, K. (2006). Online randomized controlled trial of brief and full cognitive behavior therapy for depression. Psychological Medicine, 36, 1737–1746.CrossRefGoogle ScholarPubMed
Clarke, G., Eubanks, D., Reid, E., Kelleher, C., O'Connor, E., DeBar, L.L., . . . Gullion, C. (2005). Overcoming depression on the internet (ODIN) (2): A randomized trial of a self-help depression skills program with reminders. Journal of Medical Internet Research, 7, 16.CrossRefGoogle Scholar
Clarke, G., Reid, E., Eubanks, D., O'Connor, E., DeBar, L.L., Kelleher, C., . . . Nunley, S. (2002). Overcoming depression on the Internet (ODIN): A randomized controlled trial of an Internet depression skills intervention program. Journal of Medical Internet Research, 4 (3), e14.CrossRefGoogle Scholar
Clarke, G., Kelleher, C., Hornbrooke, M., DeBar, L., Dickerson, J., & Gullion, C. (2009). Randomized effectiveness trial of an internet pure self-help cognitive behavioral intervention for depressive symptoms in young adults. Cognitive Behaviour Therapy, 38, 222–234.CrossRefGoogle ScholarPubMed
Clum, G.A. (1990). Coping with panic. Pacific Grove, CA: Brooks/Cole Publishing.Google Scholar
Collins, K.A., Westra, H.A., Dozois, D.J.A., & Burns, D.D. (2004). Gaps in accessing treatment for anxiety and depression: Challenges for the delivery of care. Clinical Psychology Review, 24, 583–616.CrossRefGoogle ScholarPubMed
Cuijpers, P., Donker, T., Johansson, R., Mohr, D.C., van Straten, A., Andersson, G. (2011). Self-guided psychological treatment for depressive symptoms: A meta-analysis. PLoS ONE 6 (6), e21274. doi:10.1371/journal.pone.0021274.CrossRefGoogle ScholarPubMed
Cuijpers, P., & Schuurmans, J. (2007). Self-help interventions for anxiety disorders: An overview. Current Psychiatry Reports, 9, 284–290.CrossRefGoogle ScholarPubMed
Febbraro, G.A.R., Clum, G.A., Roodman, A.A., & Wright, J.H. (1999). The limits of bibliotherapy: A study of the differential effectiveness of self-administered interventions in individuals with panic attacks. Behavior Therapy, 30, 209–222.CrossRefGoogle Scholar
Febbraro, G.A. (2005). An investigation into the effectiveness of bibliotherapy and minimal contact interventions in the treatment of panic attacks. Journal of Clinical Psychology, 61, 763–779.CrossRefGoogle ScholarPubMed
Fertuck, E.A., Bucci, W., Blatt, S.J., & Ford, R.Q. (2004). Verbal representation and therapeutic change in anaclitic and introjective inpatients. Psychotherapy: Theory, Research, Practice, Training, 41, 13–25.CrossRefGoogle Scholar
Furmark, T., Carlbring, P., Hedman, E., Sonnenstein, A., Clevberger, P., Bohman, B., . . . Andersson, G. (2009). Guided and unguided self-help for social anxiety disorder: Randomized controlled trial. British Journal of Psychiatry, 195, 440–447.CrossRefGoogle Scholar
Gould, R.A., & Clum, G.A. (1995). Self-help plus minimal therapist contact in the treatment of panic disorder: A replication and extension. Behavior Therapy, 26, 533–546.CrossRefGoogle Scholar
Gould, R.A., Clum, G.A., & Shapiro, D. (1993). The use of bibliotherapy in the treatment of panic: A preliminary investigation. Behavior Therapy, 24, 241–252.CrossRefGoogle Scholar
Gellatly, J., Bower, P., Hennessy, S., Richards, D., Gilbody, S., & Lovell, K. (2007). What makes self-help interventions effective in the management of depressive symptoms? Meta-analysis and meta-regression. Psychological Medicine, 37, 1217–1228.CrossRefGoogle ScholarPubMed
Hedman, E., Furmark, T., Carlbring, P., Ljotsson, B., Ruck, C., Lindefors, N., . . . Andersson, G. (2011). A 5-year follow-up of internet-based cognitive behavior therapy for social anxiety disorder. Journal of Medical Internet Research, 3 (2), e39. doi:10.2196/jmir.1776CrossRefGoogle Scholar
Hirai, M., & Clum, G.A. (2006). A meta-analytic study of self-help interventions for anxiety problems. Behavior Therapy, 37, 99–111.CrossRefGoogle ScholarPubMed
Hollon, S.D., & Beck, A. (1994). Cognitive and cognitive-behavioral therapies. In Bergin, A.E., & Garfield, S.L., (Eds.), Handbook of psychotherapy and behavior change (4th ed; pp. 428–466). New York: John Wiley.Google Scholar
Klein, B., Austin, D., Pier, C., Kiropoulos, L., Mitchell, J., Gilson, K., & Ciechomski, L. (2009). Internet-based treatment for panic disorder: Does frequency of therapist contact make a difference? Cognitive Behaviour Therapy, 38, 100–113.CrossRefGoogle Scholar
Lidren, D.M., Watkins, P.L., Gould, R.A., Clum, G.A., Asterino, M., & Tulloch, H.L. (1994). A comparison of bibliotherapy and group therapy in the treatment of panic disorder. Journal of Consulting and Clinical Psychology, 62, 865–869.CrossRefGoogle ScholarPubMed
Mackinnon, A., Griffiths, K.M., & Christensen, H. (2008). Comparative randomized trial of online cognitive-behavioural therapy and an information website for depression: 12-month outcomes. British Journal of Psychiatry, 192, 130–134.CrossRefGoogle Scholar
Mahalik, J.R., & Kivlighan, D.M. (1988). Self-help treatment for depression: Who succeeds? Journal of Counseling Psychology, 35, 237–242.CrossRefGoogle Scholar
Newman, M.G., Szkodny, L.E., Llera, S.J., & Przeworski, A. (2011). A review of technology-assisted self-help and minimal contact therapies for anxiety and depression: Is human contact necessary for therapeutic efficacy? Clinical Psychology Review, 31, 89–103.CrossRefGoogle Scholar
Nordin, S., Carlbring, P., Cuijpers, P., & Andersson, G. (2010). Expanding the limits of bibliotherapy for panic disorder: Randomized trial of self-help without support but with a clear deadline. Behavior Therapy, 41, 267–276.CrossRefGoogle ScholarPubMed
Spek, V., Cuijpers, P., Nyklicek, I., Riper, H., Keyzer, J., & Pop, V. (2007). Internet-based cognitive behavior therapy for symptoms of depression and anxiety: A meta-analysis. Psychological Medicine, 37, 319–328.CrossRefGoogle ScholarPubMed
Tillfors, M., Carlbring, P., Furmark, T., Lewenhaupt, S., Spak, M., Eriksson, A., . . . Andersson, G. (2008). Treating university students with social phobia and public speaking fears: Internet delivered self-help with or without live group exposure sessions. Depression and Anxiety, 25, 708–717.CrossRefGoogle ScholarPubMed
Titov, N., Andrews, G., Choi, I., Schwencke, G., & Johnson, L. (2009a). Randomized controlled trial of web-based treatment of social phobia without clinician guidance. Australian and New Zealand Journal of Psychiatry, 43, 913–919.CrossRefGoogle Scholar
Titov, N., Andrews, G., Choi, I, Schwencke, G., & Mahoney, A. (2008a). Shyness 3: Randomized controlled trial of guided versus unguided internet-based CBT for social phobia. Australian and New Zealand Journal of Psychiatry, 42, 1030–40.CrossRefGoogle ScholarPubMed
Titov, N., Andrews, G., Johnson, L., Schwenke, G., & Choi, I. (2009b). Shyness programme: Longer term benefits, cost-effectiveness, and acceptability. Australian and New Zealand Journal of Psychiatry, 43, 36–44.CrossRefGoogle ScholarPubMed
Titov, N., Andrews, G., & Schwencke, G. (2008b). Shyness 2: Treating social phobia online: Replication and extension. Australian and New-Zealand Journal of Psychiatry, 42, 595–605.CrossRefGoogle ScholarPubMed
Titov, N., Andrews, G., Schwencke, G., Drobny, J., & Einstein, D. (2008c). Shyness 1: Distance treatment of social phobia over the internet. Australian and New Zealand Journal of Psychiatry, 42, 585–94.CrossRefGoogle Scholar
Titov, N., Andrews, G., Schwencke, G., Robinson, E., Peters, L., & Spence, J. (2010b). Randomized controlled trial of internet cognitive behavioural treatment for social phobia with and without motivational enhancement strategies. Australian and New Zealand Journal of Psychiatry, 44, 938–945.CrossRefGoogle ScholarPubMed
Titov, N., Andrews, G., Schwencke, G., Solley, K., Johnston, L., & Robinson, E. (2009c). An RCT comparing effect of two types of support on severity of symptoms for people completing internet-based cognitive behaviour therapy for social phobia. Australian and New Zealand Journal of Psychiatry, 43, 920–926.CrossRefGoogle Scholar