Following up internet-delivered cognitive behaviour therapy (CBT): A longitudinal qualitative investigation of clients' usage of CBT skills.

Nora Eilert,Derek Richards,Daniel Duffy,Clare Mccormack,Rebecca Wogan,Ladislav Timulak,Jorge Palacios,Caroline Earley,Polly Kennedy,Angel Enrique

doi:10.1002/cpp.2619

Abstract

While the acquisition and application of Cognitive Behaviour Therapy (CBT) skills is a core component and likely mechanism of effect maintenance in all CBT-based treatments, the extent of post-therapeutic CBT skills usage among internet-delivered CBT (iCBT) clients remains under-researched. Nested within a pragmatic randomized controlled trial, 241 participants received an 8-week supported iCBT intervention for anxiety and/or depression and answered open-ended questions about their use and experience of CBT skills at 3-, 6-, 9-, and 12-month follow-up. Recurrent, cross-sectional qualitative analysis following the descriptive and interpretive approach was used to create a taxonomy, through which all qualitative data was coded. In total, 479 qualitative responses across 181 participants were analysed. Participants reported using a wide range of CBT skills and associated helpful and hindering experiences and impacts. The reasons for discontinued CBT skills usage were diverse, ranging from rare adverse effects to healthy adaptation. The study shows how clients receiving iCBT in routine care learn CBT skills during treatment and utilize them in productive ways post-treatment. Findings coincide with similar research in face-to-face CBT and may inform future research to drive innovation and iCBT intervention development.

Highlights

Cognitive Behaviour Therapy (CBT) today may be considered an umbrella term for a large variety of evidence-based psychological interventions, principally uniting behavioural and cognitive approaches, and in recent years acceptance and mindfulnessbased approaches under its wings
Of the 241 participants randomized to the internet-delivered CBT (iCBT) treatment group, 181 (75%) answered at least one open-ended question at one of the follow-up time points
The findings extend upon previous research on clients' continuous use of CBT skills after face-to-face CBT (French et al, 2017; Glasman et al, 2004) to include minimally supported iCBT—further establishing iCBT's ability to produce change at a meaningful and sustainable level (Mogoase et al, 2017; Strunk et al, 2007)

Summary

Introduction

Cognitive Behaviour Therapy (CBT) today may be considered an umbrella term for a large variety of evidence-based psychological interventions, principally uniting behavioural and cognitive approaches, and in recent years acceptance and mindfulnessbased approaches under its wings. The common goal across CBTs is a behavioural adaptation, which is achieved through the implementation of specific evidence-based techniques and strategies (sometimes referred to as CBT skills) designed to drive universal change principles like context engagement and attention and cognitive changes (Hayes & Hofmann, 2018; Mennin et al, 2013). While the acquisition and application of Cognitive Behaviour Therapy (CBT) skills is a core component and likely mechanism of effect maintenance in all CBT-based treatments, the extent of post-therapeutic CBT skills usage among internet-delivered CBT (iCBT) clients remains under-researched. Findings coincide with similar research in face-to-face CBT and may inform future research to drive innovation and iCBT intervention development

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Discussion

Conclusion