JMIR Publications

ABSTRACT

Background:

Cognitive behavioural therapy (CBT) for children is increasingly provided using technology-assisted formats for a range of psychological difficulties. There is a rich evidence-base underpinning such interventions, with significant levels of effectiveness regularly reported across the literature. The literature has also highlighted challenges with implementation factors, as illustrated by high attrition rates and variable user engagement. However, despite the proliferation of quantitative research on the effectiveness of technology-assisted CBT, there remains a lack of high-quality qualitative research reviews.

Objective:

The primary of aim of this review was to systematically identify and synthesise the overall experiences of children that have used technology-assisted CBT.

Methods:

This systematic review applied Thomas and Harden’s 2008 qualitative thematic synthesis approach. Inclusion criteria were: 1) school-aged children over preschool age (6) but under the age of 18; 2) use of any form of tech-assisted CBT for any time period; 3) a stated focus of qualitative data to document the experiences of participants; and 4) studies published in English. Exclusion criteria were: 1) interventions only provided face-to-face with no technological component; 2) only focussed on the performance of the technology, rather than participant experience; and 3) numerical data that sought to represent qualitative data.

Results:

14 diverse studies published between 2013 and 2018 were included in this review. Overall, these studies represented interventions for low mood and anxiety (n = 10), trauma or self-harm (n = 2), and physical difficulties (n = 2). There were five analytical themes emerging from children’s experiences with tech-assisted CBT: 1) helpfulness; 2) therapeutic process; 3) transferability; 4) gameplay experience; and 5) limitations. Additionally, these analytical themes contained the following subthemes: positive experiences, tech-assisted CBT versus face-to-face, understanding of CBT model, process of change, skills development, application to everyday, parental involvement, character relatedness, playability, negative experiences, and broad content.

Conclusions:

Reflecting the dominant trend in the quantitative literature, this qualitative synthesis demonstrated that tech-assisted CBT is experienced as a mostly positive and helpful intervention for children. While technology can produce different barriers and facilitators to effective CBT, children evidenced their ability to nonetheless engage in a therapeutic process, and transfer this learning into their everyday lives. Future research and design can improve positive outcomes for children by focussing on these novel factors.