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The effects of therapist support and treatment presentation on the clinical outcomes of an Internet based applied relaxation program
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare. (Psykosocial onkologi och stödjande vård, Psychosocial oncology and supportive care)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare. (Psykosocial onkologi och stödjande vård, Psychosocial oncology and supportive care)ORCID iD: 0000-0002-1591-7407
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
2015 (English)In: Internet Interventions, ISSN 2214-7829, Vol. 2, no 3, 289-296 p.Article in journal (Refereed) Published
Abstract [en]

Symptoms of stress are common in the general population and associated with health risks and economic costs. Applied relaxation training has shown to be effective for reducing stress and worry both as a self-help treatment and as an internet-based intervention with therapist support. However, what factors may affect the outcome of internet based relaxation training is unclear. The aims of the present study were to investigate the effect of a brief internet based relaxation program for people with symptoms of stress or worry and to assess whether enhancing the quality of intervention presentation or therapist support had an impact on outcomes.

Participants were randomized in a full factorial design to either Normal or Enhanced treatment Presentation and either Normal or Enhanced therapist Support in a four-week online program with applied relaxation. The main outcome measures were self-report instruments of stress and worry.

A total of 162 participants were included in the study and 94 and 84 participants completed the post and follow-up measurements respectively. Participants in all conditions improved significantly on the main outcome measures, and the different levels of Presentation or therapist Support did not significantly affect treatment outcome. Registered number of completed exercises was a predictor of better treatment outcome, but this effect was independent of treatment condition. Enhancing internet based interventions by improving presentations and the quality of support may thus not be the best way to further improve the effect of internet based interventions. More specific knowledge of the mechanisms that affect outcomes in online psychotherapy is needed.

Place, publisher, year, edition, pages
2015. Vol. 2, no 3, 289-296 p.
National Category
Psychology
Identifiers
URN: urn:nbn:se:uu:diva-260069DOI: 10.1016/j.invent.2015.07.005OAI: oai:DiVA.org:uu-260069DiVA: diva2:846198
Available from: 2015-08-14 Created: 2015-08-14 Last updated: 2017-12-04Bibliographically approved
In thesis
1. Treatment Adherence in Internet-Based CBT: The Effects of Presentation, Support and Motivation
Open this publication in new window or tab >>Treatment Adherence in Internet-Based CBT: The Effects of Presentation, Support and Motivation
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Homework assignments that patient work with between sessions is a key component in both face-to-face and Internet-based Cognitive Behavior Therapy (CBT). However, adherence to assignments is often low and it is largely unclear what factors predict or affect treatment adherence, and in the end, treatment outcomes. The overall aim of this thesis was to investigate if treatment presentation and therapist support can affect adherence and treatment outcome in internet-based CBT, whether adherence can be predicted by motivation variables and to compare differences in face-to-face and online conditions in this regard.

A randomized controlled trial with a brief online relaxation program for people with stress and anxiety symptoms was conducted (n = 162). Participants in the enhanced support conditions completed a larger proportion of the online treatment but adherence was not affected by enhanced treatment presentation (Study I). Participants reported reduced symptoms of stress and anxiety after the relaxation program but there were no significant additional effects of enhanced presentation or support (Study II). Participants who adhered to the prescribed assignments reported lower symptom levels at study end, regardless of treatment conditions. Adherence to the online treatment was predicted by subject factors such as treatment credibility prior to the treatment and intrinsic motivation during the treatment (Study III). To further elucidate how motivation may affect adherence, an experiment with a one-session psychotherapy model was subsequently conducted (n = 100). Participants who were randomized to the face-to-face condition reported higher motivation for the assignment and completed significantly more of the homework compared to participants in the online condition (Study IV). Self-reported intrinsic motivation could predict adherence in both conditions while new motivational variables were identified specifically for the online condition.

The results from these studies confirm that adherence to assignments in Internet-based CBT is difficult to affect with treatment features but can be predicted early in treatment by subject factors such as treatment credibility and motivation. How such motivational variables can be affected to improve treatments is still unclear.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. 79 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1196
Keyword
Cognitive Behavior Therapy, Internet, Treatment adherence, Compliance, Motivation
National Category
Applied Psychology
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-280804 (URN)978-91-554-9514-5 (ISBN)
Public defence
2016-05-13, The auditorium, Museum Gustavianum, Akademigatan 3, Uppsala, 14:00 (Swedish)
Opponent
Supervisors
Available from: 2016-04-21 Created: 2016-03-15 Last updated: 2016-04-29

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Publisher's full texthttp://linkinghub.elsevier.com/retrieve/pii/S2214782915000342

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Alfonsson, SvenOlsson, ErikHursti, Timo

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