J. Med. Internet Res. - Patients' experiences of helpfulness in guided internet-based treatment for depression: qualitative study of integrated therapeutic dimensions.


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CKGROUND: Quantitative research on Internet-based cognitive behavioral therapy (ICBT) has collected substantial evidence for the effectiveness of this treatment approach on health outcomes. Less is known about how patients find ICBT to be generally meaningful and helpful for treating depression.OBJECTIVE: To explore patients' experiences of being in ICBT treatment with a focus on the treatment dimensions that they considered helpful.METHODS: Choosing a phenomenological-hermeneutical approach, 14 patients were interviewed with semistructured qualitative interviews to elicit their understanding of using ICBT. The patients took part in a clinical trial using ICBT with MoodGYM, which also featured brief consultations with a clinical psychologist. The interviews were transcribed and analyzed according to the chosen methodology and organized into significant themes.RESULTS: The phenomenological-hermeneutical analysis identified 5 themes relating overall to the meaning of this mode of treatment in terms of helpfulness. Two related to treatment in general: (1) taking action to address one's problems and (2) the value of talking to a professional. The next two themes specifically addressed guided self-help using the MoodGYM program: (3) acquiring relevant knowledge, and (4) restructuring the new knowledge acquired through ICBT. A fifth theme concerned (5) actual changes in patients' perceptions and interactions, related to either the self-help material or the face-to-face consultations with the therapist.CONCLUSIONS: Three important dimensions were made explicit: the active engagement of the patient, the guidance of the therapist, and the content of the treatment program. The findings pointed to (1) the role of MoodGYM as a source of new knowledge providing patients with a structured approach to work with their depression, (2) the patient's role as the primary agent of change through adapting relevant knowledge from MoodGYM to their situation, and (3) the dialogue with the therapist as a trusting relationship in which to share thoughts and feelings, receive feedback and advice, and to assist the patient in making use of the MoodGYM content.

Resumo Limpo

ckground quantit research internetbas cognit behavior therapi icbt collect substanti evid effect treatment approach health outcom less known patient find icbt general meaning help treat depressionobject explor patient experi icbt treatment focus treatment dimens consid helpfulmethod choos phenomenologicalhermeneut approach patient interview semistructur qualit interview elicit understand use icbt patient took part clinic trial use icbt moodgym also featur brief consult clinic psychologist interview transcrib analyz accord chosen methodolog organ signific themesresult phenomenologicalhermeneut analysi identifi theme relat overal mean mode treatment term help two relat treatment general take action address one problem valu talk profession next two theme specif address guid selfhelp use moodgym program acquir relev knowledg restructur new knowledg acquir icbt fifth theme concern actual chang patient percept interact relat either selfhelp materi facetofac consult therapistconclus three import dimens made explicit activ engag patient guidanc therapist content treatment program find point role moodgym sourc new knowledg provid patient structur approach work depress patient role primari agent chang adapt relev knowledg moodgym situat dialogu therapist trust relationship share thought feel receiv feedback advic assist patient make use moodgym content

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