Core belief content examined in a large sample of patients using online cognitive behaviour therapy

© 2015 The Authors. Abstract Background Computerised cognitive behavioural therapy provides a unique opportunity to collect and analyse data regarding the idiosyncratic content of people's core beliefs about the self, others and the world. Methods 'Beating the Blues' users recorded a core belief derived through the downward arrow technique. Core beliefs from 1813 mental health patients were coded into 10 categories. Results The most common were global self-evaluation, attachment, and competence. Women were more likely, and men were less likely (than chance), to provide an attachment-related core belief; and men were more likely, and women less likely, to provide a self-competence-related core belief. This may be linked to gender differences in sources of self-esteem. Those who were suffering from anxiety were more likely to provide power- and control-themed core beliefs and less likely to provide attachment core beliefs than chance. Finally, those who had thoughts of suicide in the preceding week reported less competence themed core beliefs and more global self-evaluation (e.g., 'I am useless') core beliefs than chance. Limitations Concurrent symptom level was not available. The sample was not nationally representative, and featured programme completers only. Conclusions Men and women may focus on different core beliefs in the context of CBT. Those suffering anxiety may need a therapeutic focus on power and control. A complete rejection of the self (not just within one domain, such as competence) may be linked to thoughts of suicide. Future research should examine how individual differences and symptom severity influence core beliefs

Klientbeteenden i internetterapi mot depression : Innehållsanalys av klienters skrift i beteendeaktiveringsbehandling

Klientbeteendens relation till behandlingsutfallet av psykoterapi på internet är ett underbeforskat område av klinisk vikt. Studien undersöker vilka skriftliga klientbeteenden i beteendeaktiveringsbehandling mot depression på internet som korrelerar med symtomförändring och slutförda moduler. Totalt 29 randomiserade deltagare med mild till måttlig depression ingick från forskningsprojektet Actua. Innehållsanalys med 8 deduktiva och två induktiva beteendekategorier genomfördes på samtliga mejl och modulsvar skickade från deltagare till internetterapeut. Signifikanta korrelationer återfanns i förhållande till symtomförändring för Observerar positiva konsekvenser (r=.49) och Allians (r=42). Med genomförda moduler korrelerade sju beteendekategorier. Resultaten tyder på att text som uttrycker allians och om att observera positiva konsekvenser kan användas som indikationer på hur behandlingen fortlöper.  Denna information kan användas av internetterapeuter för att individualisera behandlingen och göra den så effektiv som möjligt. Sammanfattningsvis visar denna studie att klientbeteenden kan identifieras i text i internetbaserad kognitiv beteende terapi och att dessa står i direkt relation till behandlingsutfallet.  Little research has been done on the relationship between client behavior and internet therapy outcome even though it is an area of clinical value. This study examines the relationship between client behaviors, treatment outcome and module completion, in a behavioral activation (BA) treatment for depression. A total of 29 randomized participants with mild to moderate depression were included from the research project Actua. Content analysis with 8 deductive and 2 inductive categories were performed on all emails and module responses sent from the participants to their internet therapist. Significant correlations was found between outcome and Observing positive consequences (r= .49) and Alliance (r= .42). Module completion correlated with 7 behavioral categories. The result implies that text about alliance and observing positive consequences can be used as indicators of how the treatment progresses. This information can be used by internet therapists to individualize treatment and make it more effective. In summary this study shows that client behaviors can be identified by text analysis and that these have a direct relationship with outcome. 

Klientbeteenden i internetterapi mot depression : Innehållsanalys av klienters skrift i beteendeaktiveringsbehandling

Klientbeteendens relation till behandlingsutfallet av psykoterapi på internet är ett underbeforskat område av klinisk vikt. Studien undersöker vilka skriftliga klientbeteenden i beteendeaktiveringsbehandling mot depression på internet som korrelerar med symtomförändring och slutförda moduler. Totalt 29 randomiserade deltagare med mild till måttlig depression ingick från forskningsprojektet Actua. Innehållsanalys med 8 deduktiva och två induktiva beteendekategorier genomfördes på samtliga mejl och modulsvar skickade från deltagare till internetterapeut. Signifikanta korrelationer återfanns i förhållande till symtomförändring för Observerar positiva konsekvenser (r=.49) och Allians (r=42). Med genomförda moduler korrelerade sju beteendekategorier. Resultaten tyder på att text som uttrycker allians och om att observera positiva konsekvenser kan användas som indikationer på hur behandlingen fortlöper.  Denna information kan användas av internetterapeuter för att individualisera behandlingen och göra den så effektiv som möjligt. Sammanfattningsvis visar denna studie att klientbeteenden kan identifieras i text i internetbaserad kognitiv beteende terapi och att dessa står i direkt relation till behandlingsutfallet.  Little research has been done on the relationship between client behavior and internet therapy outcome even though it is an area of clinical value. This study examines the relationship between client behaviors, treatment outcome and module completion, in a behavioral activation (BA) treatment for depression. A total of 29 randomized participants with mild to moderate depression were included from the research project Actua. Content analysis with 8 deductive and 2 inductive categories were performed on all emails and module responses sent from the participants to their internet therapist. Significant correlations was found between outcome and Observing positive consequences (r= .49) and Alliance (r= .42). Module completion correlated with 7 behavioral categories. The result implies that text about alliance and observing positive consequences can be used as indicators of how the treatment progresses. This information can be used by internet therapists to individualize treatment and make it more effective. In summary this study shows that client behaviors can be identified by text analysis and that these have a direct relationship with outcome. 

Klientbeteenden i internetterapi mot depression : Innehållsanalys av klienters skrift i beteendeaktiveringsbehandling

Klientbeteendens relation till behandlingsutfallet av psykoterapi på internet är ett underbeforskat område av klinisk vikt. Studien undersöker vilka skriftliga klientbeteenden i beteendeaktiveringsbehandling mot depression på internet som korrelerar med symtomförändring och slutförda moduler. Totalt 29 randomiserade deltagare med mild till måttlig depression ingick från forskningsprojektet Actua. Innehållsanalys med 8 deduktiva och två induktiva beteendekategorier genomfördes på samtliga mejl och modulsvar skickade från deltagare till internetterapeut. Signifikanta korrelationer återfanns i förhållande till symtomförändring för Observerar positiva konsekvenser (r=.49) och Allians (r=42). Med genomförda moduler korrelerade sju beteendekategorier. Resultaten tyder på att text som uttrycker allians och om att observera positiva konsekvenser kan användas som indikationer på hur behandlingen fortlöper.  Denna information kan användas av internetterapeuter för att individualisera behandlingen och göra den så effektiv som möjligt. Sammanfattningsvis visar denna studie att klientbeteenden kan identifieras i text i internetbaserad kognitiv beteende terapi och att dessa står i direkt relation till behandlingsutfallet.  Little research has been done on the relationship between client behavior and internet therapy outcome even though it is an area of clinical value. This study examines the relationship between client behaviors, treatment outcome and module completion, in a behavioral activation (BA) treatment for depression. A total of 29 randomized participants with mild to moderate depression were included from the research project Actua. Content analysis with 8 deductive and 2 inductive categories were performed on all emails and module responses sent from the participants to their internet therapist. Significant correlations was found between outcome and Observing positive consequences (r= .49) and Alliance (r= .42). Module completion correlated with 7 behavioral categories. The result implies that text about alliance and observing positive consequences can be used as indicators of how the treatment progresses. This information can be used by internet therapists to individualize treatment and make it more effective. In summary this study shows that client behaviors can be identified by text analysis and that these have a direct relationship with outcome. 

A content analysis of client e-mails in guided internet-based cognitive behavior therapy for depression

The relationship between what a client writes when communicating with an online therapist and treatment outcome in internet-based cognitive behavior therapy (ICBT) is largely unknown. The aim of this study was to address if written correspondence from the client to the therapist correlates with outcome and treatment completion. A total of 29 participants with mild to moderate depression were included from an ongoing randomized controlled trial targeting depression. Content analysis involving ten categories was performed on all emails and module responses sent by the participants to their internet therapist. A total of 3756 meaning units were identified and coded. Significant positive correlations were found between change in depression and statements in the two categories “observing positive consequences” (r = .49) and “alliance” (r = .42). Treatment module completion correlated with seven categories. The result suggests that text dealing with alliance and observing positive consequences can be used as indicators of how the treatment is progressing. This study suggests that written correspondence from an online client can be divided into ten categories and the frequency of those can be used by internet therapists to individualize treatment and perhaps make ICBT more effective

A content analysis of client e-mails in guided internet-based cognitive behavior therapy for depression

The relationship between what a client writes when communicating with an online therapist and treatment outcome in internet-based cognitive behavior therapy (ICBT) is largely unknown. The aim of this study was to address if written correspondence from the client to the therapist correlates with outcome and treatment completion. A total of 29 participants with mild to moderate depression were included from an ongoing randomized controlled trial targeting depression. Content analysis involving ten categories was performed on all emails and module responses sent by the participants to their internet therapist. A total of 3756 meaning units were identified and coded. Significant positive correlations were found between change in depression and statements in the two categories “observing positive consequences” (r = .49) and “alliance” (r = .42). Treatment module completion correlated with seven categories. The result suggests that text dealing with alliance and observing positive consequences can be used as indicators of how the treatment is progressing. This study suggests that written correspondence from an online client can be divided into ten categories and the frequency of those can be used by internet therapists to individualize treatment and perhaps make ICBT more effective

Treating tinnitus distress via the Internet: A mixed methods approach of what makes patients seek help and stay motivated during Internet-based cognitive behavior therapy

Background: Internet-based cognitive behavioral therapy (ICBT) has proven to be an effective treatment in improving patients' ability to cope with tinnitus. However, some patients prefer face-to-face therapy to ICBT, and a few studies have shown considerable dropout rates if the treatment is not guided. This renders it important to identify factors that contribute to the commencement and continuation of ICBT programs. Aims: Because treatment motivation and expectations are important factors in psychological treatment, the aim of our study was to investigate what leads tinnitus patients to seek out ICBT, what helps them to keep up with the treatment, and what (if any) impact these factors have on dropout rates and treatment outcomes. Method: 112 tinnitus patients taking part in ICBT for tinnitus responded to symptom-related questionnaires at three points in time (pre-treatment, post-treatment, and one-year-follow-up) and to a questionnaire consisting of open-ended questions about their treatment motivation and expectations before beginning treatment. Data were analyzed using qualitative content analysis, and the results were used to divide the participants into groups. The treatment outcomes of these groups were compared using t-tests, χ2-tests, and both one-factorial and mixed ANOVAs. Results: Four main categories emerged as factors conducive to starting treatment: 1) Targets participants wanted to address, 2) circumstances that led to participation, 3) attitudes towards the treatment, and 4) training features. Participants identified six facilitators for continuing the treatment: success, training, individual attitude, hope, evidence, and support. Naming specific tinnitus-associated problems as targets was associated with greater improvement from pre-treatment to 1-year-follow-up. Describing an active involvement in the treatment was related to increased improvement from post-treatment to follow-up. Conclusion: There are several motivational factors that tinnitus patients consider relevant for beginning and continuing ICBT. Particularly, focusing on specific targets that do not involve the tinnitus itself, and encouraging participants to take an active role in treatment may increase treatment effectiveness. However, further hypothesis-guided research is necessary to confirm our explorative results