Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jan 28, 2025
Date Accepted: Jun 26, 2025
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
ON THE IMPORTANCE OF THERAPEUTIC ASSISTANCE IN iCBTs: A QUALITATIVE STUDY OF THE PATIENTS’ PERCEPTIONS
ABSTRACT
Background:
Internet-based cognitive behavioral therapies (iCBTs) fall into two categories, therapist-assisted and self-guided iCBTs have amassed substantial evidence for cost-effectiveness and effectiveness in treating various mental health conditions. Lower drop-out rates are seen in therapist-assisted compared to self-guided treatments. However, relatively high treatment dropout rates, especially in the self-guided iCBTs, indicate that some level of therapist assistance is needed to curb dropout rates. In-depth understanding on why and for what purposes therapeutic assistance is needed is, underexplored phenomenon.
Objective:
By examining patients’ experiences in therapist-assisted iCBTs, this study seeks to understand the elements patients perceived as important for their adherence and elucidate the role of therapist-assistance in iCBTs.
Methods:
The data consists of 89 semi-structured in-depth interviews of iCBT users. Patients took part in nine different therapist-assisted iCBT programs (depression (32), anxiety disorder (17), OCD (10), bipolar disorder (5), social phobia (5), bulimia (3), alcohol abuse (1), panic disorder (10), insomnia (6)) all provided nationwide by Helsinki University Hospital (HUS) in Finland. The interviews were transcribed verbatim and analyzed with qualitative Gioia method.
Results:
The study finds three categories that explain why users find therapist’s assistance crucial for their adherence in iCBTs: 1) strengthening of individual autonomy, 2) the therapist's commitment to strengthening the therapeutic alliance, and 3) assistance in emotion regulation.
Conclusions:
Similar elements of alliance and adherence strengthening appear to be important in both face-to-face and iCBT programs. However, in iCBT programs, the experience of being seen, heard, validated, and supported seems to stem from small, text-based gestures.This study reveals that therapist’s assistance is considered pivotal, identifying eight elements that iCBT patients find essential– all of which are challenging to implement solely without the therapist’s assistance. Consequently, this study concludes that the role of therapists should not be excluded at the expense of digitalization; instead, combining human and digital elements can yield numerous benefits.
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