Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-15T09:19:38.421Z Has data issue: false hasContentIssue false
  • English
  • Français

Therapist Behaviours in Internet-Delivered Cognitive Behaviour Therapy: Analyses of E-Mail Correspondence in the Treatment of Generalized Anxiety Disorder

Published online by Cambridge University Press:  01 May 2012

Björn Paxling ,
Susanne Lundgren ,
Anita Norman ,
Jonas Almlöv ,
Per Carlbring ,
Pim Cuijpers  and
Gerhard Andersson
Björn Paxling
Affiliation:
Linköping University, Sweden and Vrije Universiteit, Amsterdam, Netherlands
Susanne Lundgren
Affiliation:
Linköping University, Sweden
Anita Norman
Affiliation:
Linköping University, Sweden
Jonas Almlöv
Affiliation:
Linköping University, Sweden
Per Carlbring
Affiliation:
Umeå University, Sweden
Pim Cuijpers
Affiliation:
Vrije Universiteit, Amsterdam, Netherlands
Gerhard Andersson*
Affiliation:
Linköping University, and Karolinska Institutet, Stockholm, Sweden
*
Reprint requests to Gerhard Andersson, Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Internet-delivered cognitive behaviour therapy (iCBT) has been found to be an effective way to disseminate psychological treatment, and support given by a therapist seems to be important in order to achieve good outcomes. Little is known about what the therapists actually do when they provide support in iCBT and whether their behaviour influences treatment outcome. Aims: This study addressed the content of therapist e-mails in guided iCBT for generalized anxiety disorder. Method: We examined 490 e-mails from three therapists providing support to 44 patients who participated in a controlled trial on iCBT for generalized anxiety disorder. Results: Through content analysis of the written correspondence, eight distinguishable therapist behaviours were derived: deadline flexibility, task reinforcement, alliance bolstering, task prompting, psychoeducation, self-disclosure, self-efficacy shaping, and empathetic utterances. We found that task reinforcement, task prompting, self-efficacy shaping and empathetic utterances correlated with module completion. Deadline flexibility was negatively associated with outcome and task reinforcement positively correlated with changes on the Penn State Worry Questionnaire. Conclusions: Different types of therapist behaviours can be identified in iCBT, and though many of these behaviours are correlated to each other, different behaviours have an impact on change in symptoms and module completion.

Keywords

Internet-delivered therapyCBTtherapist behaviourGADattrition
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 41 , Issue 3 , May 2013 , pp. 280 - 289
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2012

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

Almlöv, J., Carlbring, P., Berger, T., Cuijpers, P. and Andersson, G. (2009). Therapist factors in Internet-delivered CBT for major depressive disorder. Cognitive Behaviour Therapy, 38, 247–254.Google Scholar
Almlöv, J., Carlbring, P., Källqvist, K., Paxling, B., Cuijpers, P. and Andersson, G. (2011). Therapist effects in guided Internet-delivered CBT for anxiety disorders. Behavioural and Cognitive Psychotherapy, 39, 311–322.CrossRefGoogle ScholarPubMed
Andersson, G. (2009). Using the internet to provide cognitive behaviour therapy. Behaviour Research and Therapy, 47, 175–180.CrossRefGoogle ScholarPubMed
Andersson, G. and Cuijpers, P. (2009). Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cognitive Behaviour Therapy, 38, 196–205.Google Scholar
Andersson, G., Lundström, P., and Ström, L. (2003). Internet-based treatment of headache. Does telephone contact add anything? Headache, 43, 353–361.Google Scholar
Andrews, G., Cuijpers, P., Craske, M. G., McEvoy, P. and Titov, N. (2010). Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PloS one, 5, e13196.Google Scholar
Baldwin, S. A., Murray, D. M., Shadish, W. R., Pals, S. L., Holland, J., Abramowitz, J. S., et al. (2011). Intraclass correlation associated with therapists: estimates and applications in planning psychotherapy research. Cognitive Behaviour Therapy, 40, 15–33.Google Scholar
Barak, A., Hen, L., Boniel-Nissim, M. and Shapira, N. (2008). A comprehensive review and a meta-analysis of the effectiveness of Internet-based psychotherapeutic interventions. Journal of Technology in Human Services, 26, 109–160.Google Scholar
Barak, A., Klein, B. and Proudfoot, J. G. (2009). Defining Internet-supported therapeutic interventions. Annals of Behavioral Medicine, 38, 4–17.Google Scholar
Barlow, D. H. (2010). Negative effects from psychological treatments. A perspective. American Psychologist, 65, 13–20.CrossRefGoogle ScholarPubMed
Berger, T., Caspar, F., Richardson, R., Kneubühler, B., Sutter, D. and Andersson, G. (2011). Internet-based treatment of social phobia: a randomized controlled trial comparing unguided with two types of guided self-help. Behaviour Research and Therapy, 48, 158–169.Google Scholar
Beutler, L. E., Mailk, M., Harwood, T. M., Talebi, H., Noble, S. and Wong, E. (2004). Therapist variables. In Lambert, M. J. (Ed.), Bergin and Garfield's Handbook of Psychotherapy and Behaviour Change (pp. 227–306). New York: John Wiley and Sons.Google Scholar
Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research and Practice, 16, 252–260.CrossRefGoogle Scholar
Carlbring, P., Bohman, S., Brunt, S., Buhrman, M., Westling, B. E., Ekselius, L., et al. (2006). Remote treatment of panic disorder: a randomized trial of Internet-based cognitive behavioral therapy supplemented with telephone calls. American Journal of Psychiatry, 163, 2119–2125.CrossRefGoogle ScholarPubMed
Christensen, H., Griffiths, K., Groves, C. and Korten, A. (2006). Free range users and one hit wonders: community users of an Internet-based cognitive behaviour therapy program. Australian and New Zealand Journal of Psychiatry, 40, 59–62.Google Scholar
D'Arcy, J., Reynolds, J. R., Stiles, W. B. and Grohol, J. M. (2006). An investigation of session impact and alliance in internet based psychotherapy: preliminary results. Counselling and Psychotherapy Research, 6, 164–168.Google Scholar
Farvolden, P., Denisoff, E., Selby, P., Bagby, R. M. and Rudy, L. (2005). Usage and longitudinal effectiveness of a Web-based self-help cognitive behavioral therapy program for panic disorder. Journal of Medical Internet Research, 7, e7.Google Scholar
Furmark, T., Carlbring, P., Hedman, E., Sonnenstein, A., Clevberger, P., Bohman, B., et al. (2009). Guided and unguided self-help for social anxiety disorder: randomised controlled trial. British Journal of Psychiatry, 195, 440–447.CrossRefGoogle ScholarPubMed
Kazantzis, N., Deane, F. P. and Ronan, K. R. (2000). Homework assignments in cognitive and behavioral therapy: a meta-analysis. Clinical Psychology: Science and Practice, 7, 189–202.Google Scholar
Kessler, D., Lewis, G., Kaur, S., Wiles, N., King, M., Weich, S., et al. (2009). Therapist-delivered internet psychotherapy for depression in primary care: a randomised controlled trial. Lancet, 374, 628–634.Google Scholar
Knaevelsrud, C. and Maercker, A. (2006). Does the quality of the working alliance predict treatment outcome in online psychotherapy for traumatized patients? Journal of Medical Internet Research, 8, e31.Google Scholar
Knaevelsrud, C. and Maercker, A. (2007). Internet-based treatment for PTSD reduces distress and facilitates the development of a strong therapeutic alliance: a randomized controlled clinical trial. BMC Psychiatry, 7, 13.CrossRefGoogle Scholar
Lambert, M. J. and Barley, D. E. (2002). Research summary on the therapeutic relationship and psychotherapy outcome. In Norcross, J. C. (Ed.), Psychotherapy Relationships that Work (pp. 17–32). Oxford: Oxford University Press.Google Scholar
Marks, I. M., Cavanagh, K., and Gega, L. (2007). Hands-on Help. Maudsley Monograph no. 49. Hove: Psychology Press.Google Scholar
Martin, D. J., Garske, J. P. and Davis, M. (2000). Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. Journal of Consulting and Clinical Psychology, 68, 438–450.CrossRefGoogle ScholarPubMed
Meyer, T. J., Miller, M. L., Metzger, R. L. and Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487–495.CrossRefGoogle ScholarPubMed
Palmqvist, B., Carlbring, P. and Andersson, G. (2007). Internet-delivered treatments with or without therapist input: does the therapist factor have implications for efficacy and cost? Expert Review of Pharmacoeconomics and Outcomes Research, 7, 291–297.CrossRefGoogle ScholarPubMed
Paxling, B., Almlöv, J., Dahlin, M., Carlbring, P., Breitholtz, E., Eriksson, T., et al. (2011). Internet-delivered cognitive behaviour therapy for generalized anxiety disorder: a randomized controlled trial. Cognitive Behaviour Therapy, 40, 159–173.CrossRefGoogle ScholarPubMed
Robinson, E., Titov, N., Andrews, G., McIntyre, K., Schwencke, G. and Solley, K. (2010). Internet treatment for generalized anxiety disorder: a randomized controlled trial comparing clinician vs. technician assistance. PloS one, 5, e10942.Google Scholar
Sanderson, W. C. and Rygh, J. L. (2004). Treating Generalized Anxiety Disorder: evidence-based strategies, tools, and techniques. London: The Guilford Press.Google Scholar
Sittig, D. F. (2003). Results of a content analysis of electronic messages (e-mail) sent between patients and their physicians. BMC Medical Informatics and Decision Making, 3, 11.CrossRefGoogle ScholarPubMed
Spek, V., Cuijpers, P., Nyklicek, I., Riper, H., Keyzer, J. and Pop, V. (2007). Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychological Medicine, 37, 319–328.CrossRefGoogle ScholarPubMed
Titov, N., Andrews, G., Davies, M., McIntyre, K., Robinson, E. and Solley, K. (2010). Internet treatment for depression: a randomized controlled trial comparing clinician vs. technician assistance. PloS one, 5, e10939.CrossRefGoogle ScholarPubMed
Titov, N., Andrews, G., Schwencke, G., Solley, K., Johnston, L. and Robinson, E. (2009). An RCT comparing the effects 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.Google Scholar
Trepka, C., Rees, A., Shapiro, D. A., Hardy, G. E. and Barkham, M. (2004). Therapist competence and outcome of cognitive therapy for depression. Cognitive Therapy and Research, 28, 143–157.CrossRefGoogle Scholar
Waller, G. (2009). Evidence-based treatment and therapist drift. Behaviour Research and Therapy, 47, 119–127.Google Scholar
Wampold, B. E. (2001). The Great Psychotherapy Debate: models, methods, and findings. Mahaw, NJ: Lawrence Erlbaum.Google Scholar
Wampold, B. E. and Brown, G. S. (2005). Estimating the variability outcome attributable to therapists: a naturalistic study of outcomes in managed care. Journal of Consulting and Clinical Psychology, 73, 914–923.CrossRefGoogle ScholarPubMed
Webb, C. A., DeRubeis, R. J. and Barber, J. P. (2010). Therapist adherence/competence and treatment outcome: a meta-analytic review. Journal of Consulting and Clinical Psychology, 78, 200–211.Google Scholar
Submit a response

Comments

No Comments have been published for this article.