Effective Structure and Contents of Guidance in the Treatment of Common Mental Disorders with Internet-Based Cognitive Behavioral Therapy: A Review of the Literature
Year: 2019
Type: dissertation
Study design: Systematic Review
Abstract: Background: Depression and anxiety disorders are the most common mental disorders among adults and are associated with a high burden of disease. While there are effective treatments for these disorders, many do not get help. Today, new technologies enable Internet-based treatment programs to be delivered directly to patients at low cost, available at any time. Research has demonstrated a promising effect on guided Internet-based cognitive behavioural therapy (iCBT), and its routine care implementation is increasing. Guidance is considered one of the three main components of iCBT. The role of guidance in this treatment, however, is not yet determined. This paper aims to review the existing literature on the structure and content of effective iCBT guidance in the treatment of depression and anxiety. Method: The thesis will be presented as a review of the literature of RCTs on guidance in iCBT. The paper is twofold, (1) comparing different degree or modes of guidance in iCBT and (2) retrospective analysis of therapist behaviours. Based on the systematic search in PyscINFO and hand search, 28 studies were included. Results: Six subgroups of trials exploring guidance in iCBT were identified: guided versus unguided iCBT (n=16); level of therapist expertise (n=5); human versus automated guidance (n=1); communication modality and synchronicity of guidance (n=2); scheduling of human guidance (n=3), and intensity of guidance (n=1). Two trials were included in the analysis of therapist behaviour. The results suggest that iCBT can provide good treatment effect independent of human guidance, and automated guidance provides similar results to human guidance. Based on the included trials, the level of therapist expertise, intensity, and guidance modality appear to be of minor importance. However, scheduling of the guidance may provide better treatment effect than unscheduled guidance. That therapists reinforce and strengthen clients' positive behaviour also appears to be an essential part of the guidance. Discussion/conclusions: There were few trials in each category and there is still limited knowledge of the distinct components of the guidance in iCBT. The findings from this review highlight that in predicting the effect in iCBT, some guidance factors may be more important than others. It is a promising way to overcome common barriers in mental health care. However, it requires new roles for the psychologists who provide this treatment and underlines the need for updated research and guidance information.
Author: Kristina Kristianslund
Language: English
Subfield: Applied Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W2973227046