TY - JOUR

T1 - Therapist behaviours in Internet-delivered cognitive behaviour therapy

T2 - analyses of e-mail correspondence in the treatment of generalized anxiety disorder

AU - Paxling, Björn

AU - Lundgren, Susanne

AU - Norman, Anita

AU - Almlöv, Jonas

AU - Carlbring, Per

AU - Cuijpers, Pim

AU - Andersson, Gerhard

PY - 2013/5

Y1 - 2013/5

N2 - BACKGROUND:Internet-delivered cognitive behaviour therapy (iCBT) has been found to be an effective way to disseminate psychological treatment, and support given by a therapist seems to be important in order to achieve good outcomes. Little is known about what the therapists actually do when they provide support in iCBT and whether their behaviour influences treatment outcome.AIMS:This study addressed the content of therapist e-mails in guided iCBT for generalized anxiety disorder.METHOD:We examined 490 e-mails from three therapists providing support to 44 patients who participated in a controlled trial on iCBT for generalized anxiety disorder.RESULTS:Through content analysis of the written correspondence, eight distinguishable therapist behaviours were derived: deadline flexibility, task reinforcement, alliance bolstering, task prompting, psychoeducation, self-disclosure, self-efficacy shaping, and empathetic utterances. We found that task reinforcement, task prompting, self-efficacy shaping and empathetic utterances correlated with module completion. Deadline flexibility was negatively associated with outcome and task reinforcement positively correlated with changes on the Penn State Worry Questionnaire.CONCLUSIONS:Different types of therapist behaviours can be identified in iCBT, and though many of these behaviours are correlated to each other, different behaviours have an impact on change in symptoms and module completion.

AB - BACKGROUND:Internet-delivered cognitive behaviour therapy (iCBT) has been found to be an effective way to disseminate psychological treatment, and support given by a therapist seems to be important in order to achieve good outcomes. Little is known about what the therapists actually do when they provide support in iCBT and whether their behaviour influences treatment outcome.AIMS:This study addressed the content of therapist e-mails in guided iCBT for generalized anxiety disorder.METHOD:We examined 490 e-mails from three therapists providing support to 44 patients who participated in a controlled trial on iCBT for generalized anxiety disorder.RESULTS:Through content analysis of the written correspondence, eight distinguishable therapist behaviours were derived: deadline flexibility, task reinforcement, alliance bolstering, task prompting, psychoeducation, self-disclosure, self-efficacy shaping, and empathetic utterances. We found that task reinforcement, task prompting, self-efficacy shaping and empathetic utterances correlated with module completion. Deadline flexibility was negatively associated with outcome and task reinforcement positively correlated with changes on the Penn State Worry Questionnaire.CONCLUSIONS:Different types of therapist behaviours can be identified in iCBT, and though many of these behaviours are correlated to each other, different behaviours have an impact on change in symptoms and module completion.

KW - Psychology

KW - attrition

KW - CBT

KW - GAD

KW - Internet-delivered therapy

KW - therapist behaviour

UR - http://www.scopus.com/inward/record.url?scp=84872426719&partnerID=8YFLogxK

U2 - 10.1017/S1352465812000240

DO - 10.1017/S1352465812000240

M3 - Journal articles

C2 - 22717145

VL - 41

SP - 280

EP - 289

JO - Behavioural and Cognitive Psychotherapy

JF - Behavioural and Cognitive Psychotherapy

SN - 1469-1833

IS - 3

ER -