uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Differences in motivation and adherence to a prescribed assignment after face-to-face and online psychoeducation: A randomized experiment
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare. Centre for Psychiatry Research, Department of Clinical Neuroscience Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Sweden.ORCID iD: 0000-0003-4570-5891
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
2017 (English)In: BMC Psychology, E-ISSN 2050-7283, Vol. 5, no 1, article id 3Article in journal (Refereed) Published
Abstract [en]

Background: Adherence to treatment homework is associated with positive outcomes in behavioral psychotherapy but compliance to assignments is still often moderate. Whether adherence can be predicted by different types of motivation for the task and whether motivation plays different roles in face-to-face compared to online psychotherapy is unknown. If models of motivation, such as Self-determination theory, can be used to predict patients’ behavior, it may facilitate further research into homework promotion. The aims of this study were, therefore, to investigate whether motivation variables could predict adherence to a prescribed assignment in face-to-face and online interventions using a psychotherapy analog model. Methods: A total of 100 participants were included in this study and randomized to either a face-to-face or online intervention. Participants in both groups received a psychoeducation session and were given an assignment for the subsequent week. The main outcome measurements were self-reported motivation and adherence to the assignment. Results: Participant in the face-to-face condition reported significantly higher levels of motivation and showed higher levels of adherence compared to participants in the online condition. Adherence to the assignment was positively associated with intrinsic motivation and intervention credibility in the whole sample and especially in the online group. Conclusions: This study shows that intrinsic motivation and intervention credibility are strong predictors of adherence to assignments, especially in online interventions. The results indicate that intrinsic motivation may be partly substituted with face-to-face contact with a therapist. It may also be possible to identify patients with low motivation in online interventions who are at risk of dropping out. Methods for making online interventions more intrinsically motivating without increasing external pressure are needed.

Place, publisher, year, edition, pages
2017. Vol. 5, no 1, article id 3
Keywords [en]
Adherence, Motivation, Psychoeducation, Internet, Homework assignments
National Category
Applied Psychology
Identifiers
URN: urn:nbn:se:uu:diva-280799DOI: 10.1186/s40359-017-0172-5PubMedID: 28126022OAI: oai:DiVA.org:uu-280799DiVA, id: diva2:912117
Available from: 2016-03-15 Created: 2016-03-15 Last updated: 2018-05-08Bibliographically 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. p. 79
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1196
Keywords
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: 2018-05-08

Open Access in DiVA

fulltext(628 kB)17 downloads
File information
File name FULLTEXT01.pdfFile size 628 kBChecksum SHA-512
02f63620b883f56a33bd6bc7fee13b8f245d1005a13ff0b2bef93b0bb5143355192c8e9f82b1911f4c804139b05078f9451f48ac655da3f2b5d2e8fee456af1a
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMed

Authority records BETA

Alfonsson, SvenHursti, Timo

Search in DiVA

By author/editor
Alfonsson, SvenHursti, Timo
By organisation
Clinical Psychology in HealthcareDepartment of Psychology
In the same journal
BMC Psychology
Applied Psychology

Search outside of DiVA

GoogleGoogle Scholar
Total: 17 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 478 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf