Previously submitted to: JMIR Mental Health (no longer under consideration since Dec 17, 2025)
Date Submitted: Dec 15, 2025
Open Peer Review Period: Dec 17, 2025 - Dec 17, 2025
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Patient Experiences with Internet-Based Cognitive Behavioral Therapy for Multi-System Functional Somatic disorder: A Qualitative Study
ABSTRACT
Background:
Cognitive behavioral therapy (CBT) is an effective treatment for functional somatic disorder (FSD), but access to treatment remains limited in many countries. Studies indicate that internet-based CBT (iCBT) for FSD might improve accessibility and scalability without compromising effectiveness. However, most research on iCBT for FSD has relied on quantitative designs, providing limited insight into participants' subjective experiences with this digital approach.
Objective:
This study aimed to explore the experience of receiving iCBT for FSD, with a focus on how participants experienced the therapeutic process, the online format, the role of the therapist, and the outcome of the treatment.
Methods:
In total, 15 semi-structured qualitative interviews were conducted three months post- treatment in the context of a larger randomized controlled trial testing the efficacy of therapist-assisted iCBT for multi-system FSD. The interviews were transcribed and analyzed by two researchers using reflexive thematic analysis.
Results:
The reflexive thematic analysis identified three themes. The first theme labelled “Helpful - but not Enough” explored the participants' descriptions of the changes they observed following treatment. The second theme labelled “Reversing a History of Overexertion” described how participants had engaged with the treatment content, and what they had found helpful in their therapeutic process. The third theme labelled “Psychotherapy is Hard” addressed the factors that facilitated or hindered engagement with the digital treatment.
Conclusions:
Findings from this study highlight that participants with FSD found iCBT relevant, acceptable, and helpful. The internet format did not compromise treatment delivery and may be a way to improve treatment access and make treatment participation more feasible for individuals with FSD. Several factors served as both facilitators and impediments to treatment engagement, which may account for the heterogeneity of the reported treatment outcome. The study suggests that future iCBT development should adopt a more iterative user-centered design approach to continually identify and mitigate barriers to engagement while strengthening key facilitators Clinical Trial: ClinicalTrial.gov NCT05525598; https://clinicaltrials.gov/study/NCT05525598
Citation
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