Month: March 2017

Client correspondence in Internet-delivered cognitive behaviour therapy: An examination into client communication with therapists and symptom improvement

Honours Thesis Results, Catherine Couture 2017

Background: Internet-delivered cognitive behavioral therapy (ICBT) is an efficacious treatment for anxiety and depression. Most ICBT programs include therapist assistance in the form of secure online messaging; however, a high degree of variability has been found in the content of client and therapist correspondence. Recent research conducted by Svartvatten et al. (2015) found that client statements suggesting alliance bolstering and text expressing a positive change in mood after the implementation of a suggested skill or exercise appear to correlate with greater symptom improvement.

Purpose: The current study sought to examine: (1) if previously identified themes in client communication with their Internet therapist (Svartvatten et al., 2015) would replicate in a transdiagnostic ICBT program for depression and anxiety; and (2) if these themes correlated with symptom improvement and treatment completion. 

Method: The present study used data from 80 randomly selected patients from a previously published trial of ICBT for depression and or anxiety. Client emails (on average 5.69 per client) were examined for the presence of 10 themes reported by Svartvatten et al. (2015).

Results: Statistically significant differences were found in the frequency of all themes between the two studies. Further, in the current study, greater frequency of statements classified as maladaptive repetitive thinking and problems with treatment content correlated with smaller improvements in symptoms of anxiety from pre- to post-treatment.

Implications: This research provides a better understanding of the parameters of client communication and information for future therapists regarding the content of clients’ correspondence in ICBT.

Analyzing therapist emails in Internet-delivered cognitive behavioural therapy

Honours Thesis Results, Kristen Klassen 2017

Background: Internet-delivered cognitive behaviour therapy (ICBT) arose as a response to barriers associated with face-to-face therapy and has shown to be efficacious especially when offered with therapist assistance.

Objective: Despite the importance of therapist-assistance to ICBT, there has been minimal research on this topic. No scales have been developed to specifically assess presence of therapist behaviours during ICBT. As such, the purpose of this study was to: 1) develop an ICBT rating scale that captures the main elements of the therapist/client interactions in secure email messages, and 2) evaluate a random selection of ICBT therapists using this scale to assess average ratings on therapist/client interactions during the course of ICBT.

Method: The initial scale was developed based on past content analysis of therapist behaviours during ICBT. Five therapists trialed this initial measure and provided feedback on their experiences during a focus group. The measure was then revised and inter-rater reliability was established between three student raters. The scale was used to examine emails that were sent to 50 patients who completed an 8-week transdiagnostic ICBT course for depression and anxiety (Wellbeing Course).

Results: Review of ratings suggested that most therapists were providing high quality emails. Multiple significant correlations were found which indicated that clients who sent more emails to their therapist were receiving better quality emails, that therapists who were solely focused on delivering ICBT, and therapists with a psychology background obtained higher ratings on the scale.

Practical Implications: Numerous directions for future research exist, such as exploring the applicability of the scale to other ICBT units.