JMIR Publications

ABSTRACT

In recent years, research into internet-based cognitive behavioural therapy (iCBT) has suggested that therapist-guided digital interventions have greater engagement, adherence and effectiveness than self-directed digital therapies. Whilst research has focused on the effectiveness of, and adherence to, these interventions, less attention has been paid to their implementation in practice and what aspects of the therapist role support success. An understanding of the key factors related to the therapist role and intervention delivery is required if these iCBTs are to be applied in routine clinical care and outcomes optimised. In light of the COVID-19 pandemic, there is greater emphasis on allowing patients access to remote therapies. We report the experiences and reflections of therapists delivering an online, therapist supported intervention in a randomised controlled trial for children and young people with tic disorders (the ORBIT Trial). Themes discussed include the importance of training, supervision, creating support documents/manuals, and record keeping. Alongside this are communication strategies used by therapists to encourage patient adherence and treatment effectiveness. These include rapport building, treatment personalisation and suggestions for overcoming non-engagement. These reflections offer important considerations for the delivery of iCBTs as well as implications associated with the implementation of these interventions in existing services and future research studies. We share thoughts on where iCBTs may sit in a stepped care model, how services may deal with co-morbid conditions and the potential role of iCBTs in collecting clinical data.