Motivation Key to Internet-based Therapy




The Internet has become a place to do almost everything — work, play, organize, and communicate. In recent years, the Internet has also become a place where people can obtain cognitive behavioral therapy for a variety of mental health conditions. According to new research, motivation is essential to engaging in effective Internet-based treatment.

A recent study examined the experiences of 12 participants with diagnosed depression who completed either Internet-based cognitive behavioral therapy (ICBT) or were placed on a waiting list for ICBT. Patients receiving ICBT were divided into two groups, one that participated in self-guided study sessions with minimal therapist contact and another that received less-structured email-based treatment from a therapist. The participants who were placed on the waiting list for ICBT were used as the control group.

After therapy was completed, participants were interviewed regarding the effectiveness of the treatment, as well as their motivations and attitudes related to ICBT. Overall, the working processes in which patients engaged signified their attitudes and motivation. The participants were divided into three categories, based on the results: Readers, Strivers, and Doers. Readers were the least engaged in the treatment, often not completing the full course of therapy. The inability to commit to self-guided sessions and the flexibility offered by ICBT proved to be a barrier to effective treatment. Strivers were more likely than Readers to complete assignments, but had difficulty putting the assignments into real-life practice. Doers, however, were motivated to complete assignments and engage in therapy; doers were able to put the skills learned into practice and received the most benefit from ICBT.

Not surprisingly, the Doers in this study took responsibility for their own treatment and attributed the success of the ICBT to themselves more than the other groups. This is true in any form of treatment for virtually any health condition. For example, a physician can prescribe cholesterol-lowering medication for a patient, but if he is not motivated to take the medication or adopt a healthy lifestyle, too, he will not experience maximum benefits. The same is true for mental health treatment. A fully-engaged patient who is aware of the benefits of therapy and is self-sufficient enough to work hard and take the emotional insights to heart will have a better chance of successful treatment than other, more skeptical and less motivated individuals.

ICBT has proved effective for several mental health disorders across several patient populations. But, as underscored by the current research, it is not appropriate for everyone. ICBT can enhance care for patients that enjoy the flexibility and self-guided nature of treatment. ICBT can also be a practical and cost-effective health care solution for those who might otherwise receive no treatment. However, if the patients are not “doers”, the failure to achieve long-term success with ICBT could actually worsen symptoms of depression or anxiety, according to some experts.

Internet-based treatment is opening new avenues for treatment of common mental health disorders that could prove helpful to many patients. But, selecting the right patient is imperative. Self-motivation and an understanding of the benefits and consequences of ICBT, as compared to traditional face-to-face therapy, are critical to success in this type of treatment.

References

Andrews G, Cuijpers P, Craske MG, McEvoy P, & Titov N (2010). Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PloS one, 5 (10) PMID: 20967242

Beattie A, Shaw A, Kaur S, & Kessler D (2009). Primary-care patients’ expectations and experiences of online cognitive behavioural therapy for depression: a qualitative study. Health expectations : an international journal of public participation in health care and health policy, 12 (1), 45-59 PMID: 19250152

Bendelin N, Hesser H, Dahl J, Carlbring P, Nelson KZ, & Andersson G (2011). Experiences of guided Internet-based cognitive-behavioural treatment for depression: a qualitative study. BMC Psychiatry, 11 PMID: 21718523

Hedman E, Andersson E, Ljótsson B, Andersson G, Rück C, & Lindefors N (2011). Cost-effectiveness of Internet-based cognitive behavior therapy vs. cognitive behavioral group therapy for social anxiety disorder: Results from a randomized controlled trial. Behaviour research and therapy PMID: 21851929

Hedman E, Andersson G, Ljótsson B, Andersson E, Rück C, Mörtberg E, & Lindefors N (2011). Internet-based cognitive behavior therapy vs. cognitive behavioral group therapy for social anxiety disorder: a randomized controlled non-inferiority trial. PloS one, 6 (3) PMID: 21483704

Kessler D, Lewis G, Kaur S, Wiles N, King M, Weich S, Sharp DJ, Araya R, Hollinghurst S, & Peters TJ (2009). Therapist-delivered Internet psychotherapy for depression in primary care: a randomised controlled trial. Lancet, 374 (9690), 628-34 PMID: 19700005

Serfaty MA, Haworth D, Blanchard M, Buszewicz M, Murad S, & King M (2009). Clinical effectiveness of individual cognitive behavioral therapy for depressed older people in primary care: a randomized controlled trial. Archives of general psychiatry, 66 (12), 1332-40 PMID: 19996038

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  • Emma Hodges

    “ICBT has proved effective for several mental health disorders across several patient populations. But, as underscored by the current research, it is not appropriate for everyone.”

    I agree, and think it is important that we do not become too reliant on ICBT. It is important to remember the role that mental health nurses can play in helping sufferers of mental disorders.

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Jennifer Gibson, PharmD

Jennifer Gibson, PharmD, is a practicing clinical pharmacist and medical writer/editor with experience in researching and preparing scientific publications, developing public relations materials, creating educational resources and presentations, and editing technical manuscripts. She is the owner of Excalibur Scientific, LLC.
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