Cognitive behaviour therapy (CBT) for depression by computer vs. therapist: Patient experiences and therapeutic processes

Abstract This case series compares patient experiences and therapeutic processes between two modalities of cognitive behaviour therapy (CBT) for depression: computerized CBT (cCBT) and therapist-delivered CBT (tCBT). In a mixed-methods repeated-measures case series, six participants were offered cCBT and tCBT in sequence, with the order of delivery randomized across participants. Questionnaires about patient experiences were administered after each session and a semi-structured interview was completed with each participant at the end of each therapy modality. Therapy expectations, patient experiences and session impact ratings in this study generally favoured tCBT. Participants typically experienced cCBT sessions as less meaningful, less positive and less helpful compared to tCBT sessions in terms of developing understanding, facilitating problem-solving and building a therapeutic relationship.

[1]  W. Stiles,et al.  Dimensions of psychotherapy session impact across sessions and across clients. , 1984, The British journal of clinical psychology.

[2]  William B. Stiles,et al.  Client Introversion and Counseling Session Impact , 1986 .

[3]  W. Stiles,et al.  Do Sessions of Different Treatments Have Different Impacts , 1988 .

[4]  S. Llewelyn Psychological therapy as viewed by clients and therapists. , 1988, The British journal of clinical psychology.

[5]  Valerie J. Caracelli,et al.  Toward a Conceptual Framework for Mixed-Method Evaluation Designs , 1989 .

[6]  S. Garfield Issues and methods in psychotherapy process research. , 1990, Journal of consulting and clinical psychology.

[7]  Georgiana Shick Tryon,et al.  Session Depth and Smoothness in Relation to the Concept of Engagement in Counseling , 1990 .

[8]  N. Jacobson,et al.  Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. , 1991, Journal of consulting and clinical psychology.

[9]  Dennis M. Kivlighan,et al.  Live supervision in individual psychotherapy : effects on therapist's intention use and client's evaluation of session effect and working alliance , 1991 .

[10]  R. Elliott,et al.  Measuring the impact of sessions in process€xperiential therapy of depression: The Session Impacts Scale. , 1994 .

[11]  Michael Barkham,et al.  Evaluation and Description of Psychotherapy Sessions by Clients Using the Session Evaluation Questionnaire and the Session Impacts Scale. , 1994 .

[12]  D A Shapiro,et al.  Acceleration of changes in session impact during contrasting time-limited psychotherapies. , 1996, Journal of consulting and clinical psychology.

[13]  N. Jacobson,et al.  Reasons for depression and the process and outcome of cognitive-behavioral psychotherapies. , 1996, Journal of consulting and clinical psychology.

[14]  W. Stiles,et al.  Alliance structure assessed by the Agnew Relationship Measure (ARM). , 1998, The British journal of clinical psychology.

[15]  Barbara A. Kerr,et al.  Computer-mediated counseling: an empirical study of a new mental health treatment , 1998 .

[16]  R. Elliott,et al.  Evolving guidelines for publication of qualitative research studies in psychology and related fields. , 1999, The British journal of clinical psychology.

[17]  J. Garske,et al.  Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. , 2000, Journal of consulting and clinical psychology.

[18]  Frances P. Bernat,et al.  Liability and the Internet: Risks and Recommendations for Social Work Practice , 2000 .

[19]  A. Dunne,et al.  Adolescent males' experience of the counselling process. , 2000, Journal of adolescence.

[20]  Michael J. Lambert,et al.  Research summary on the therapeutic relationship and psychotherapy outcome. , 2001 .

[21]  R. Elliott Hermeneutic Single-Case Efficacy Design , 2002, Psychotherapy research : journal of the Society for Psychotherapy Research.

[22]  W. Stiles,et al.  Patterns of Client Emotion in Helpful Sessions of Cognitive-Behavioral and Psychodynamic-Interpersonal Therapy. , 2002 .

[23]  Jonathan E. Cook,et al.  Working Alliance in Online Therapy as Compared to Face-to-Face Therapy: Preliminary Results , 2002, Cyberpsychology Behav. Soc. Netw..

[24]  J. Barber,et al.  Therapeutic Alliance as a Measurable Psychotherapy Skill , 2003, Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry.

[25]  Amy Przeworski,et al.  Self-help and minimal-contact therapies for anxiety disorders: Is human contact necessary for therapeutic efficacy? , 2003, Journal of clinical psychology.

[26]  J. Treasure,et al.  Factors determining uptake of a CD-ROM-based CBT self-help treatment for bulimia: Patient characteristics and subjective appraisals of self-help treatment , 2003 .

[27]  Kate Cavanagh,et al.  Computer treatment for common mental health problems. , 2004, Journal of clinical psychology.

[28]  B. Everitt,et al.  Clinical efficacy of computerised cognitive-behavioural therapy for anxiety and depression in primary care: Randomised controlled trial , 2004, British Journal of Psychiatry.

[29]  Martin Knapp,et al.  Cost-effectiveness of computerised cognitive-behavioural therapy for anxiety and depression in primary care: Randomised controlled trial , 2004, British Journal of Psychiatry.

[30]  Patrice Renaud,et al.  Delivering cognitive-behavior therapy for panic disorder with agoraphobia in videoconference. , 2004, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[31]  A. Rees,et al.  The big idea: clients' perspectives of change processes in cognitive therapy. , 2004, Psychology and psychotherapy.

[32]  R. Ziegler,et al.  Introduction and Overview , 2004, Complementary Medicine Research.

[33]  Nice Depression: management of depression in primary and secondary care , 2005 .

[34]  I. Marks,et al.  Screening People With Anxiety/Depression for Suitability for Guided Self‐help , 2005, Cognitive behaviour therapy.

[35]  G. Larkin,et al.  Occult suicidality in an emergency department population , 2005, British Journal of Psychiatry.

[36]  D’Arcy J. Reynolds,et al.  An investigation of session impact and alliance in internet based psychotherapy: Preliminary results , 2006 .

[37]  Michelle G. Newman,et al.  Efficacy and Utility of Computer-Assisted Cognitive Behavioural Therapy for Anxiety Disorders , 2006 .

[38]  James Archer,et al.  An Exploratory Study of Client Perceptions of Internet Counseling and the Therapeutic Alliance , 2006 .

[39]  V. Braun,et al.  Using thematic analysis in psychology , 2006 .

[40]  Towards an Understanding of the Process and Mechanisms of Change in Cognitive Behavioral Therapy: Linking Innovative Methodology with Fundamental Questions. , 2007, Clinical psychology review.

[41]  P. Bower,et al.  A Qualitative Study of Patients' Perceptions of a ‘Minimal’ Psychological Therapy , 2007, The International journal of social psychiatry.

[42]  G. Andersson,et al.  Internet-delivered treatments with or without therapist input: does the therapist factor have implications for efficacy and cost? , 2007, Expert review of pharmacoeconomics & outcomes research.

[43]  Nick Mitchell,et al.  Pragmatic evaluation of the viability of CCBT self-help for depression in higher education , 2007 .

[44]  E. Mayo-Wilson Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. , 2007, Psychological medicine.

[45]  J. Pachankis,et al.  On the next generation of process research. , 2007, Clinical psychology review.

[46]  E. Kaltenthaler,et al.  The acceptability to patients of computerized cognitive behaviour therapy for depression: a systematic review , 2008, Psychological Medicine.

[47]  S. Gilbody,et al.  Barriers to the uptake of computerized cognitive behavioural therapy: a systematic review of the quantitative and qualitative evidence , 2008, Psychological Medicine.

[48]  Kate Cavanagh,et al.  Computer-aided psychological treatments: evolving issues. , 2009, Annual review of clinical psychology.

[49]  J. DiSantostefano,et al.  International Classification of Diseases 10th Revision (ICD-10) , 2009 .

[50]  G. Andersson Using the Internet to provide cognitive behaviour therapy. , 2009, Behaviour research and therapy.

[51]  Gerhard Andersson,et al.  Computer‐Aided Psychotherapy for Anxiety Disorders: A Meta‐Analytic Review , 2009, Cognitive behaviour therapy.

[52]  M. Reger,et al.  A meta-analysis of the effects of internet- and computer-based cognitive-behavioral treatments for anxiety. , 2009, Journal of clinical psychology.

[53]  K. Cavanagh,et al.  Computerised Cognitive Behavioural Therapy in an Adult Mental Health Service: A Pilot Study of Outcomes and Alliance , 2010, Cognitive behaviour therapy.

[54]  John H. Greist,et al.  Hands-On Help: Computer-Aided Psychotherapy , 2011 .

[55]  Clinical Excellence,et al.  Common mental health disorders : identification and pathways to care , 2011 .

[56]  R. Steer,et al.  Manual for the Beck Anxiety Inventory. , 2013 .