Internet-delivered aftercare following multimodal rehabilitation program for chronic pain: a qualitative feasibility study

Nina Bendelin,1 Björn Gerdle,1 Gerhard Andersson2,3 1Pain and Rehabilitation Centre and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; 2Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; 3Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden Purpose: Methods for delivering aftercare to help chronic pain patients to continue practice self-management skills after rehabilitation are needed. Internet-delivered cognitive behavioral therapy (ICBT) has the potential to partly fill this gap given its accessibility and emphasis on self-care. Methods for engaging and motivating patients to persist throughout the full length of treatment are needed. The aim of this study was to describe how chronic pain patients work in an ICBT program, through their descriptions of what is important when they initiate behavior change in aftercare and their descriptions of what is important for ongoing practice of self-management skills in aftercare. Patients and methods: Following a multimodal rehabilitation program, 29 chronic pain patients participated in a 20-week-long Internet-delivered aftercare program (ACP) based on acceptance-based cognitive behavioral therapy. Latent content analysis was made on 138 chapters of diary-like texts written by participants in aftercare. Results: Attitudes regarding pain and body changed during ACP, as did attitudes toward self and the future for some participants. How participants practiced self-management skills was influenced by how they expressed motivation behind treatment goals. Whether they practiced acceptance strategies influenced their continuous self-management practice. Defusion techniques seemed to be helpful in the process of goal setting. Mindfulness strategies seemed to be helpful when setbacks occurred. Conclusion: Self-motivating goals are described as important both to initiate and in the ongoing practice of self-management skills. Experiencing a helpful effect of acceptance strategies seems to encourage participants to handle obstacles in new ways and to persist throughout treatment. Research on whether tailored therapist guidance might be helpful in stating self-motivating goals and contribute to ongoing practice of self-management skills is needed. Keywords: Internet-delivered cognitive-behavioral therapy, chronic pain, acceptance and commitment therapy, qualitative analysis, self-managemen

Development and initial evaluation of a smartphone application based on acceptance and commitment therapy

Background: An intervention, consisting of an ACT-based smartphone-application and a web-based psychoeducation, has been developed. The smartphone-application, together with the psychoeducation, aims to function as a self-help intervention for living consistently with one's values. The study is an exploratory investigation of this new smartphone-based tool. Case description: Primarily, the study aims at investigating a new field, providing a basis for generating hypotheses for further research. The first aim of this initial, exploratory study was to examine if this intervention had an effect on the variables of: valued actions, psychological flexibility, and life satisfaction as well as the states of depression, anxiety and stress, for a non-clinical sample of 11 Swedish Iphone users. This was made with a quasi-experimental pretest-posttest design without control group. The second aim was to investigate how the participants experienced the intervention, as measured by a qualitative questionnaire. Discussion and evaluation: The group analyses showed that the participants increased their valued action and psychological flexibility significantly during the intervention. Furthermore, value-based actions and psychological flexibility showed small effect sizes when comparing pretest and posttest score. However, the design of the study makes it impossible to draw any certain conclusions. The qualitative questionnaire showed a general positive experience of the intervention. Conclusions: The results from the present study indicated that the intervention should be studied further. The findings also generated a number of hypotheses that could be investigated in further research

Experiences of guided Internet-based cognitive-behavioural treatment for depression : A qualitative study

Background: Internet-based self-help treatment with minimal therapist contact has been shown to have an effect in treating various conditions. The objective of this study was to explore participants’ views of Internet administrated guided self-help treatment for depression. Methods: In-depth interviews were conducted with 12 strategically selected participants and qualitative methods with components of both thematic analysis and grounded theory were used in the analyses. Results: Three distinct change processes relating to how participants worked with the treatment material emerged which were categorized as (a) Readers, (b) Strivers, and (c) Doers. These processes dealt with attitudes towards treatment, views on motivational aspects of the treatment, and perceptions of consequences of the treatment. Conclusions: We conclude that the findings correspond with existing theoretical models of face-to-face psychotherapy within qualitative process research. Persons who take responsibility for the treatment and also attribute success to themselves appear to benefit more. Motivation is a crucial aspect of guided self-help in the treatment of depression

Behavioral activation-based guided self-help treatment administered through a smartphone application : study protocol for a randomized controlled trial

Background: The need for cost-effective interventions for people suffering from major depressive disorders is essential. Behavioral activation is an intervention that can largely benefit from the use of new mobile technologies (for example smartphones). Therefore, developing smartphone-based behavioral activation interventions might be a way to develop cost-effective treatments for people suffering from major depressive disorders. The aim of this study will be to test the effects of a smartphone-delivered behavioral activation treatment. Methods:The study will be a randomized controlled trial with a sample size of 120 participants, with 60 patients in each group. The treatment group includes an 8-week smartphone-based behavioral activation intervention, with minimal therapist contact. The smartphone-based intervention consists of a web-based psychoeducation, and a smartphone application. There is also a back-end system where the therapist can see reports from the patients or activities being reported. In the attention control group, we will include brief online education and then recommend use of a smartphone application that is not directly aimed at depression (for example, ‘ Effective meditation’). The duration of the control condition will also be 8 weeks. For ethical reasons we will give the participants in the control group access to the behavioral activation treatment following the 8-week treatment period. Discussions: We believe that this trial has at least three important implications. First, we believe that smartphones can be integrated even further into society and therefore may serve an important role in health care. Second, while behavioral activation is a psychological treatment approach for which there is empirical support, the use of a smartphone application could serve as the therapist ’ s prolonged arm into the daily life of the patient. Third, as we have been doing trials on guided Internet treatment for more than 10 years it is now time to move to the next generation of information technology - smartphones - which are not only relevant for Swedish conditions but also for developing countries in the world which are increasingly empowered by mobile phones with Internet connection. Trial registration: ClinicalTrials.gov NCT0146302

Computer and psychotherapy – do they fit? Review of the state of development of internet-based and blended interventions in psychotherapy

Die Verbreitung moderner Medien wirkt sich zunehmend auf psychologische Behandlungsangebote aus. Während die empirische Basis internetbasierter Interventionen zur Behandlung häufiger psychischer Beeinträchtigungen wächst und ihre Anwendung in der Regelversorgung gegenwärtig international erprobt wird, bestehen zusätzliche Bestrebungen, das gewonnene Knowhow mit konventioneller Psychotherapie zu kombinieren. Die daraus entstehende Behandlungsform der „gemischten Psychotherapie“ („blended therapy“) hat das deklarierte Ziel, das Beste aus beiden Welten zu vereinen. Nach einer einleitenden Begriffsbestimmung gibt die vorliegende Übersichtsarbeit Einblick in die Inhalte und die Bestandteile internetbasierter sowie gemischter Interventionen. Der aktuelle Forschungsstand wird skizziert und vor dem Hintergrund der praktischen Anwendbarkeit durch eine Zusammenschau quantitativer und qualitativer Studien dargelegt. Besonderes Augenmerk gilt der Rolle der therapeutischen Unterstützung und der Beschaffenheit der therapeutischen Allianz bei internetbasierten Interventionen sowie den Stärken und Schwächen beider Behandlungsstrategien. Ziel ist es, sowohl die Entwicklung als auch das Potenzial beider Forschungsrichtungen plausibel und realistisch darzustellen und in eine strategische Versorgungsperspektive zu setzen.Modern media have an increasing impact on psychological health services. While the empirical foundation of internet-based interventions for frequently occurring mental disorders grows and their effectiveness is investigated in routine care trials, efforts also exist to transfer the knowledge gained to classical psychotherapy. The resulting treatment format “blended therapy” aims to combine the best of both worlds. After an introductory definition of both terms this overview describes the contents and components of internet-based and blended interventions. Summarizing the current state of research with an emphasis on feasibility, selected quantitative and qualitative articles are presented. The article depicts the development, application and potential of both interventional strategies and focuses on the role of therapist support as well as on the nature of the therapeutic alliance. Strengths and weaknesses of each intervention are addressed and integrated into a strategic perspective