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Is online treatment adherence affected by presentation and therapist support?: A randomized controlled trial
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare.
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
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2016 (English)In: Computers in human behavior, ISSN 0747-5632, E-ISSN 1873-7692, Vol. 60, 550-558 p.Article in journal (Refereed) Published
Abstract [en]

In both face to face and Internet based Cognitive Behavior Therapy, patients' adherence can be improved by different means such as by using motivational techniques or automatic reminders. The main aim of this study was to investigate whether enriched treatment material presentation and/or increased frequency and quality of support would increase participants' adherence to an online relaxation program. One hundred and sixty-two participants with mild to moderate symptoms of stress or worry were included in this study. Participants were randomized to either Normal or Enhanced intervention presentation and Normal or Enhanced support in a full factorial design. Main outcome variables were progress through the online intervention and adherence to prescribed exercises. Participants in the Enhanced support group progressed further through the program than participants in the Normal support group (Z = 2.11, p = .035, r = .17) but there were no significant differences found between the Normal and Enhanced presentation groups. Participants registered a mean of 60% of the prescribed exercises with no significant differences between groups. This study shows that adherence to online interventions can be increased by increased frequency and quality of therapeutic contact. Future studies may investigate how to increase adherence to prescribed homework assignments and whether parts of the therapeutic support may be substituted with automatic systems with retained effects.

Place, publisher, year, edition, pages
2016. Vol. 60, 550-558 p.
Keyword [en]
Internet; Psychotherapy; Stress; Adherence
National Category
Psychology Engineering and Technology
Identifiers
URN: urn:nbn:se:uu:diva-279739DOI: 10.1016/j.chb.2016.01.035ISI: 000375811900056OAI: oai:DiVA.org:uu-279739DiVA: diva2:908813
Available from: 2016-03-03 Created: 2016-03-03 Last updated: 2017-11-30Bibliographically 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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Alfonsson, SvenOlsson, ErikHursti, Timo

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