1
|
Exploring client messages in a therapist-guided internet intervention for alcohol use disorders - A content analysis. Internet Interv 2021; 26:100483. [PMID: 34824984 PMCID: PMC8605073 DOI: 10.1016/j.invent.2021.100483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There is a growing interest in offering therapist-guided internet interventions for alcohol use disorders (AUD) in regular addiction services. Elucidating the therapeutic processes during these interventions may help improve clinical delivery. The aim of this paper was to investigate written messages from client to therapist in a therapist-guided internet intervention for AUD. METHODS Data was extracted from the therapist-guided arm (n = 57) of a randomized trial of internet interventions for AUD. Qualitative content analysis was used to identify distinct categories of client behaviors in written messages to therapists. Coding was deductive (applying categories from past literature) as well as inductive (identifying new categories from the data). Subsequently, exploratory correlational and regression analyses were conducted to investigate whether identified client behaviors predicted module completion and drinking outcomes. Also, client questions posed in messages to therapists were categorized separately. RESULTS Eleven distinct behavior categories were identified, of which the two most common were alliance (26.6% of total categorizations) and identifying patterns and problem behaviors (22.8%). Confrontational alliance rupture was the least common category (0.4%). One new behavior category was identified inductively - alcohol-related setback (4.1%). In the exploratory analyses, no categories consistently predicted module completion or drinking outcomes. Client questions were most commonly posed to improve understanding or use of program content or skills. DISCUSSION The behavior categories, although not predictive of module completion or outcomes, may be of use for therapists, treatment developers and health care providers as a tool for understanding therapeutic processes in internet interventions for AUD.
Collapse
|
2
|
Beahm JD, McCall HC, Carleton RN, Titov N, Dear B, Hadjistavropoulos HD. Insights into internet-delivered cognitive behavioural therapy for public safety personnel: Exploration of client experiences during and after treatment. Internet Interv 2021; 26:100481. [PMID: 34815951 PMCID: PMC8593259 DOI: 10.1016/j.invent.2021.100481] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 11/01/2021] [Accepted: 11/09/2021] [Indexed: 12/26/2022] Open
Abstract
Canadian public safety personnel (PSP) experience high rates of mental health problems and barriers to receiving care. Internet-delivered cognitive behavioural therapy (ICBT) may help reduce barriers to care; however, there is no literature involving qualitative analyses of client feedback to describe PSP experiences with ICBT. Identifying these experiences is important because it can inform future use of ICBT with this group that has unique needs. The current study was designed to explore how clients (N = 82) experienced ICBT that had been tailored to meet their needs; specifically, the study assessed their perceptions of program impacts, what clients found helpful, and client suggestions for improvements. The ICBT course included five core lessons, client stories, and nine initial additional resources, as well as flexible frequencies (optional, once weekly, or twice weekly) and durations (8 to 16 weeks) of therapist support. A qualitative reliability thematic analysis was used to analyze client communications and feedback. Responses to a Treatment Satisfaction Questionnaire administered at eight weeks post-enrollment were available for 57 clients. Client emails with therapists were also examined among all clients, including an additional 25 clients who did not complete the Treatment Satisfaction Questionnaire. Themes identified in the qualitative analyses were related to: reported impacts and hindering events, helpful and challenging course skills and content, helpful aspects of the course, and areas for improvement. Clients who completed the Treatment Satisfaction Questionnaire and those who did not reported beneficial impacts from the program, with the most commonly endorsed themes being skill development and normalizing mental health issues. Hindering events were experienced by both groups and included timeline challenges, technology challenges, and negative effects. Comments from both groups suggested that clients had more success than challenges when practicing the skills. Thought challenging was the skill most frequently identified as helpful. Clients described many aspects of the program as helpful with the most frequently endorsed themes being the course format and content, the flexible nature of the course, access to additional materials and case stories, and therapist assistance. Clients also provided suggestions for improving the course (e.g., case stories, additional resources, timelines audio and videos). Overall, client communications suggest that ICBT is accepted and perceived as beneficial among PSP. These results informed rapid improvements to the ICBT program tailored for PSP and may inform others seeking to provide digital mental health services to PSP.
Collapse
Affiliation(s)
- Janine D. Beahm
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada,PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Hugh C. McCall
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada,PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - R. Nicholas Carleton
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada,PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Nick Titov
- Department of Psychology, Macquarie University, Sydney, Australia,eCentreClinic, Macquarie University, Sydney, Australia
| | - Blake Dear
- Department of Psychology, Macquarie University, Sydney, Australia,eCentreClinic, Macquarie University, Sydney, Australia
| | - Heather D. Hadjistavropoulos
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada,PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada,Corresponding author at: PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada.
| |
Collapse
|
3
|
Soucy JN, Hadjistavropoulos HD, Karin E, Dear BF, Titov N. Brief online motivational interviewing pre-treatment intervention for enhancing internet-delivered cognitive behaviour therapy: A randomized controlled trial. Internet Interv 2021; 25:100394. [PMID: 33996510 PMCID: PMC8099490 DOI: 10.1016/j.invent.2021.100394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022] Open
Abstract
While the efficacy of therapist-guided internet-delivered cognitive behaviour therapy (iCBT) for anxiety and depression is well-established, a significant proportion of clients show little to no improvement with this approach. Given that motivational interviewing (MI) is found to enhance face-to-face treatment of anxiety, the current trial examined potential benefits of a brief online MI intervention prior to therapist-guided iCBT. Clients applying to transdiagnostic therapist-guided iCBT in routine care were randomly assigned to receive iCBT with (n = 231) or without (n = 249) the online MI pre-treatment. Clients rated motivation at screening and pre-iCBT and anxiety and depression at pre- and post-treatment and at 13- and 25-week follow-up after enrollment. Clients in the MI plus iCBT group made more motivational statements in their emails and were enrolled in the course for a greater number of days compared to clients who received iCBT only, but did not demonstrate higher motivation after completing the MI intervention or have higher course completion. Clients in both groups, at screening and pre-iCBT, reported high levels of motivation. No statistically significant group differences were found in the rate of primary symptom change over time, with both groups reporting large reductions in anxiety and depression pre- to post-treatment (Hedges' g range = 0.96-1.11). During follow-up, clients in the iCBT only group reported additional small reductions in anxiety, whereas clients in the MI plus iCBT group did not. The MI plus iCBT group also showed small increases in depression during follow-up, whereas improvement was sustained for the iCBT only group. It is concluded that online MI does not appear to enhance client outcomes when motivation at pre-treatment is high.
Collapse
Affiliation(s)
- Joelle N. Soucy
- Department of Psychology, University of Regina, Regina, Canada
| | - Heather D. Hadjistavropoulos
- Department of Psychology, University of Regina, Regina, Canada,Corresponding author at: 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada.
| | - Eyal Karin
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Blake F. Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Nickolai Titov
- MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, Australia
| |
Collapse
|
4
|
Kioskli K, Scott W, Winkley K, Godfrey E, McCracken LM. Online Acceptance and Commitment Therapy for People with Painful Diabetic Neuropathy in the United Kingdom: A Single-Arm Feasibility Trial. PAIN MEDICINE (MALDEN, MASS.) 2020; 21:2777-2788. [PMID: 32358608 PMCID: PMC7685693 DOI: 10.1093/pm/pnaa110] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aimed to assess the feasibility of online Acceptance and Commitment Therapy for painful diabetic neuropathy in the United Kingdom and to determine if a larger randomized controlled trial testing treatment efficacy is justified. METHODS Participants with painful diabetic neuropathy were recruited online and from hospital services. This was a single-arm study in which all participants received online Acceptance and Commitment Therapy. Participants completed questionnaires at baseline and three months post-treatment. Primary feasibility outcomes were recruitment, retention, and treatment completion rates. Secondary outcomes were pre- to post-treatment effects on pain outcomes and psychological flexibility. RESULTS Of 225 potentially eligible participants, 30 took part in this study. Regarding primary feasibility outcomes, the treatment completion and follow-up questionnaire completion rates were 40% and 100%, respectively. Generally, at baseline those who completed the treatment, compared with those who did not, had better daily functioning and higher psychological flexibility. With respect to secondary outcomes, results from the completers group showed clinically meaningful effects at post-treatment for 100% of participants for pain intensity and pain distress, 66.7% for depressive symptoms, 58.3% for functional impairment, 41.7% for cognitive fusion, 66.7% for committed action, 58.3% for self-as-context, and 41.7% for pain acceptance. CONCLUSIONS This preliminary trial suggests feasibility of recruitment and follow-up questionnaire completion rates, supporting planning for a larger randomized controlled trial. However, treatment completion rates did not achieve the prespecified feasibility target. Changes to the treatment content and delivery may enhance the feasibility of online Acceptance and Commitment Therapy for people with painful diabetic neuropathy on a larger scale.
Collapse
Affiliation(s)
- Kitty Kioskli
- Health Psychology Section, Psychology Department, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Whitney Scott
- Health Psychology Section, Psychology Department, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Kirsty Winkley
- King’s College London, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, London, UK
| | - Emma Godfrey
- Health Psychology Section, Psychology Department, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | | |
Collapse
|
5
|
Wilkie R, Bjork M, Costa-Black KM, Parker M, Pransky G. Managing work participation for people with rheumatic and musculoskeletal diseases. Best Pract Res Clin Rheumatol 2020; 34:101517. [PMID: 32321677 DOI: 10.1016/j.berh.2020.101517] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Improving work participation for individuals with rheumatic and musculoskeletal diseases (RMDs), has gained increasing interest over the last 10 years. New approaches are based upon increasing adoption of a biopsychosocial approach to improving work participation, incorporating evidence that health professionals within multidisciplinary teams have a key and critical role. In particular, interaction between health professionals and employers, and rehabilitation services that are linked to the workplace are key elements for improving work participation for people with RMDs. This review outlines recent research that underpins approaches for health professionals to develop their role in improving work participation for people with RMDs based on recent research; it outlines how to measure work-related outcomes in clinical practice, models of work participation, and approaches for health professionals to improve work participation outcomes. The potential for developing the role of health professionals in future years is also outlined.
Collapse
Affiliation(s)
- Ross Wilkie
- Versus Arthritis Primary Care Centre, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom; MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, UK.
| | - Mathilda Bjork
- Unit of Occupational Therapy, Department of Health, Medicine and Caring Sciences, Faculty of Health Sciences, Linköping University, Department of Rheumatology, Heart and Medicine Center, Region Östergötland, Sweden.
| | - Katia M Costa-Black
- The British Standards Institution, Environmental Health and Safety Services and Solutions, Hillsboro, OR, USA; Graduate Program in Ergonomics and Biomechanics, School of Medicine, New York University, New York, NY, USA.
| | - Marty Parker
- Versus Arthritis Primary Care Centre, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom.
| | - Glenn Pransky
- Dept. of Quantitative Health Sciences, Univ of Massachusetts Medical School, Worcester, MA, USA.
| |
Collapse
|
6
|
Beck CD, Soucy JN, Hadjistavropoulos HD. Mixed-method evaluation of an online motivational intervention as a pre-treatment to internet-delivered cognitive behaviour therapy: Immediate benefits and user feedback. Internet Interv 2020; 20:100311. [PMID: 32154118 PMCID: PMC7052510 DOI: 10.1016/j.invent.2020.100311] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/13/2020] [Accepted: 02/19/2020] [Indexed: 11/19/2022] Open
Abstract
•An online MI intervention was recently developed to complement ICBT.•Intervention consists of videos, exercises, feedback to better simulate face-to-face MI.•Study evaluated intervention impact on motivation and perceptions of MI.•Ratings of motivation and MI perceptions significantly increased from pre- to post-MI.•Future research should explore longer term impact of online MI on ICBT.
Collapse
Affiliation(s)
- Cynthia D. Beck
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - Joelle N. Soucy
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | | |
Collapse
|
7
|
Chen AT, Swaminathan A, Kearns WR, Alberts NM, Law EF, Palermo TM. Understanding User Experience: Exploring Participants' Messages With a Web-Based Behavioral Health Intervention for Adolescents With Chronic Pain. J Med Internet Res 2019; 21:e11756. [PMID: 30985288 PMCID: PMC6487347 DOI: 10.2196/11756] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 02/05/2019] [Accepted: 02/10/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Delivery of behavioral health interventions on the internet offers many benefits, including accessibility, cost-effectiveness, convenience, and anonymity. In recent years, an increased number of internet interventions have been developed, targeting a range of conditions and behaviors, including depression, pain, anxiety, sleep disturbance, and eating disorders. Human support (coaching) is a common component of internet interventions that is intended to boost engagement; however, little is known about how participants interact with coaches and how this may relate to their experience with the intervention. By examining the data that participants produce during an intervention, we can characterize their interaction patterns and refine treatments to address different needs. OBJECTIVE In this study, we employed text mining and visual analytics techniques to analyze messages exchanged between coaches and participants in an internet-delivered pain management intervention for adolescents with chronic pain and their parents. METHODS We explored the main themes in coaches' and participants' messages using an automated textual analysis method, topic modeling. We then clustered participants' messages to identify subgroups of participants with similar engagement patterns. RESULTS First, we performed topic modeling on coaches' messages. The themes in coaches' messages fell into 3 categories: Treatment Content, Administrative and Technical, and Rapport Building. Next, we employed topic modeling to identify topics from participants' message histories. Similar to the coaches' topics, these were subsumed under 3 high-level categories: Health Management and Treatment Content, Questions and Concerns, and Activities and Interests. Finally, the cluster analysis identified 4 clusters, each with a distinguishing characteristic: Assignment-Focused, Short Message Histories, Pain-Focused, and Activity-Focused. The name of each cluster exemplifies the main engagement patterns of that cluster. CONCLUSIONS In this secondary data analysis, we demonstrated how automated text analysis techniques could be used to identify messages of interest, such as questions and concerns from users. In addition, we demonstrated how cluster analysis could be used to identify subgroups of individuals who share communication and engagement patterns, and in turn facilitate personalization of interventions for different subgroups of patients. This work makes 2 key methodological contributions. First, this study is innovative in its use of topic modeling to provide a rich characterization of the textual content produced by coaches and participants in an internet-delivered behavioral health intervention. Second, to our knowledge, this is the first example of the use of a visual analysis method to cluster participants and identify similar patterns of behavior based on intervention message content.
Collapse
Affiliation(s)
- Annie T Chen
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, United States
| | - Aarti Swaminathan
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, United States
| | - William R Kearns
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, United States
| | - Nicole M Alberts
- Department of Psychology, St Jude Children's Research Hospital, Memphis, TN, United States
| | - Emily F Law
- Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA, United States
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA, United States
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| |
Collapse
|