Motivation and Treatment Credibility Predicts Dropout, Treatment Adherence, and Clinical Outcomes in an Internet-Based Cognitive Behavioral Relaxation Program: A Randomized Controlled Trial.

Erik Olsson,Sven Alfonsson,Timo Hursti

doi:10.2196/jmir.5352

Abstract

BackgroundIn previous research, variables such as age, education, treatment credibility, and therapeutic alliance have shown to affect patients’ treatment adherence and outcome in Internet-based psychotherapy. A more detailed understanding of how such variables are associated with different measures of adherence and clinical outcomes may help in designing more effective online therapy.ObjectiveThe aims of this study were to investigate demographical, psychological, and treatment-specific variables that could predict dropout, treatment adherence, and treatment outcomes in a study of online relaxation for mild to moderate stress symptoms.MethodsParticipant dropout and attrition as well as data from self-report instruments completed before, during, and after the online relaxation program were analyzed. Multiple linear and logistical regression analyses were conducted to predict early dropout, overall attrition, online treatment progress, number of registered relaxation exercises, posttreatment symptom levels, and reliable improvement.ResultsDropout was significantly predicted by treatment credibility, whereas overall attrition was associated with reporting a focus on immediate consequences and experiencing a low level of intrinsic motivation for the treatment. Treatment progress was predicted by education level and treatment credibility, whereas number of registered relaxation exercises was associated with experiencing intrinsic motivation for the treatment. Posttreatment stress symptoms were positively predicted by feeling external pressure to participate in the treatment and negatively predicted by treatment credibility. Reporting reliable symptom improvement after treatment was predicted by treatment credibility and therapeutic bond.ConclusionsThis study confirmed that treatment credibility and a good working alliance are factors associated with successful Internet-based psychotherapy. Further, the study showed that measuring adherence in different ways provides somewhat different results, which underscore the importance of carefully defining treatment adherence in psychotherapy research. Lastly, the results suggest that finding the treatment interesting and engaging may help patients carry through with the intervention and complete prescribed assignments, a result that may help guide the design of future interventions.Trial RegistrationClinicaltrials.gov NCT02535598; http://clinicaltrials.gov/ct2/show/NCT02535598 (Archived by WebCite at http://www.webcitation.org/6fl38ms7y).

Highlights

It is well established that therapist-guided Internet-based cognitive behavior therapy (ICBT) and other behavioral interventions can be effective in improving psychological symptoms and well-being [1]
The study showed that measuring adherence in different ways provides somewhat different results, which underscore the importance of carefully defining treatment adherence in psychotherapy research
Of the self-reported psychological variables, the Treatment Self-Regulation Questionnaire (TSRQ)-internal motivation (IM) showed markedly higher standard deviation compared to other variables and it was the only variable that failed to significantly predict any outcome variable, so it was removed from further analyses

Summary

Introduction

It is well established that therapist-guided Internet-based cognitive behavior therapy (ICBT) and other behavioral interventions can be effective in improving psychological symptoms and well-being [1]. Not all patients are helped and one reason for this could be that treatment adherence may be somewhat lower in Internet-based psychotherapy compared to traditional face-to-face therapy [2]. This difference may be important because adherence is associated with treatment outcome in both face-to-face and Internet-based therapy [3]. Little is known about factors that affect treatment adherence to Internet-based interventions, but it is clear that therapist online support improves adherence substantially [4]. Variables such as age, education, treatment credibility, and therapeutic alliance have shown to affect patients’ treatment adherence and outcome in Internet-based psychotherapy. A more detailed understanding of how such variables are associated with different measures of adherence and clinical outcomes may help in designing more effective online therapy

Methods

Results

Discussion

Conclusion