Internet-based psychoeducation for bipolar disorder: a qualitative analysis of feasibility, acceptability and impact Patient experience of computerised therapy for depression in primary care Preferences regarding treatment for alcohol problems. Motivation to persist with internet-based cognitive behavioural treatment using blended care: a qualitative study Primary-care patients' expectations and experiences of online cognitive behavioural therapy for depression: a qualitative study. A Randomised Controlled Trial of Therapist-Assisted, Internet-Delivered Cognitive Behavior Therapy for Women with Maternal Depression The working alliance in a randomized controlled trial comparing online with face-to-face cognitive-behavioral therapy for depression Tailored vs. Standardized Internet-Based Cognitive Behavior Therapy for Depression and Comorbid Symptoms: A Randomized Controlled Trial Acceptability of a Web-Based and Tailored Intervention for the Self-Management of Pain After Cardiac Surgery: The Perception of Women and Men An exploration of chronic pain patients' perceptions of home telerehabilitation services. Acceptability of Online Self-Help to People With Depression: Users’ Views of MoodGYM Versus Informational Websites Treatment of panic disorder via the Internet: a randomized trial of CBT vs. applied relaxation. “A computer isn’t gonna judge you”: A qualitative study of users’ views of an internet-based cognitive behavioural guided self-care treatment package for bulimia nervosa and related disorders Women’s Experiences of Internet-Based or Postal Treatment for Stress Urinary Incontinence Computer Intervention Impact on Psychosocial Adaptation of Rural Women With Chronic Conditions Web-Based Treatment for Rural Women With Alcohol Problems: Preliminary Findings
Background In a recent exploratory r and omised trial we found that a novel , internet-based psychoeducation programme for bipolar disorder ( Beating Bipolar ) was relatively easy to deliver and had a modest effect on psychological quality of life . We sought to explore the experiences of participants with respect to feasibility , acceptability and impact of Beating Bipolar . Methods Participants were invited to take part in a semi-structured interview . Thematic analysis techniques were employed ; to explore and describe participants ’ experiences , the data were analysed for emerging themes which were identified and coded . Results The programme was feasible to deliver and acceptable to participants where they felt comfortable using a computer . It was found to impact upon insight into illness , health behaviour , personal routines and positive attitudes towards medication . Many participants regarded the programme as likely to be most beneficial for those recently diagnosed . Conclusions An online psychoeducation package for bipolar disorder , such as Beating Bipolar , is feasible and acceptable to patients , has a positive impact on self-management behaviours and may be particularly suited to early intervention . Alternative ( non-internet ) formats should also be made available to patients Objective To explore patient experience of computerised cognitive behaviour therapy ( cCBT ) for depression in a pragmatic r and omised controlled trial ( R and omised Evaluation of the Effectiveness and Acceptability of Computerised Therapy , REEACT ) . Design Qualitative semistructured interviews with 36 participants . Participants Depressed patients with a Patient Health Question naire 9 of 10 or above recruited into the REEACT r and omised controlled trial . Setting Primary care setting s in Engl and . Results Participant experience was on a continuum , with some patients unable or unwilling to accept psychological therapy without interpersonal contact while others appreciated the enhanced anonymity and flexibility of cCBT . The majority of patients were ambivalent , recognising the potential benefits offered by cCBT but struggling with challenges posed by the severity of their illness , lack of support and limited personalisation of programme content . Low completion rates were commonly reported , although more positive patients reported greater engagement . Both positive and ambivalent patients perceived a need for monitoring or follow-up to support completion , while negative patients reported deliberate non-adherence due to dissatisfaction with the programme . Patients also reported that severity of depression impacted on engagement , and viewed cCBT as unsuitable for patients undergoing more severe depressive episodes . Conclusions The study demonstrates both the unique dem and s and benefits of computerised therapy . cCBT was preferred by some patients and rejected by others , but the majority of patients were ambivalent about the therapy . cCBT could be offered within a menu of options in stepped care if matched appropriately to individual patients or could be offered with enhanced support to appeal to a greater number of patients . Trial registration number IS RCT N91947481 AIMS The aim of the study was to investigate preferences in the general population regarding type of treatment for alcohol problems and the preferred setting for delivery of treatment and reasons for not seeking treatment for alcohol problems . METHOD Data were from a r and om , cross-sectional , interview survey of 9005 of the Swedish general population . Proportions of respondents preferring a certain treatment and source of treatment , and reasons suggested for why people do not seek treatment , were analysed in relation to number of st and ard drinks , employment status , education and income . RESULTS Most frequently endorsed forms of treatment were alcoholics anonymous or similar support groups and psychotherapy . More than 50 % preferred psychiatric or addiction specialist treatment . Around 10 % preferred primary health care and around 20 % the occupational health services . About 5 % preferred the social services . Respondents rated ' feeling ashamed ' as the most important reason why people would not seek help for alcohol problems . CONCLUSION Large majorities of the respondents preferred treatment in the health care services and few in the social services . Internet-based treatment and pharmacological treatment attracted few respondents , the majority preferring more traditional forms of treatment . Alcohol treatment remains a stigmatized field , evidence d by shame being the most commonly reported reason for not seeking treatment Background The prevalence of depression is high and results in huge costs for society . Internet-based cognitive behavioural treatment ( ICBT ) has been suggested for use in primary care and has been shown to be more effective when combined with human support . However , non-completion rates remain a challenge . Current recommendations state that steps to improve persistence with ICBT should be determined and the impact of therapist support on persistence explored . A few earlier studies have explored motivations to persist with ICBT without face-to-face therapist support . The present study explored the motivation to persist as experienced by a group of patients who sought help in primary care and used “ blended care ” , i.e. ICBT supported by short face-to-face consultations .  Methods To eluci date motivation in an everyday context and the meaning of patients ’ experiences we chose a phenomenological hermeneutical approach . We interviewed participants in the intervention group of a r and omized controlled trial that evaluated the efficacy of an ICBT programme called MoodGYM , an eHealth intervention used to treat depression . Fourteen participants , both completers and non-completers , went through individual , semi-structured interviews after they ended their treatment . Results Hope of recovery and a desire to gain control of one ’s life were identified as intrinsic motivators . The feeling of being able to freely choose how , when and where to complete the ICBT modules was identified as an important supporting condition and satisfied the participants ’ need for autonomy . Furthermore , the importance of a sense of belonging towards partners , friends or family was essential for motivation as was the ability to identify with ICBT content . Another supporting condition was the experience of connectedness when met with acknowledgement , flexibility and feedback from a qualified therapist in the face-to-face consultations . Conclusions A key finding was that participants were motivated to persist with ICBT when their overall need for relatedness was satisfied . This was achieved through a sense of belonging towards partners , friends and family . Connectedness with the therapist and the participant ’s ability to identify with the ICBT modules also gave a sense of relatedness . Improving these motivational aspects may increase patients ’ persistence with ICBT OBJECTIVE To explore expectations and experiences of online cognitive behavioural therapy ( CBT ) among primary -care patients with depression , focusing on how this mode of delivery impacts upon the therapeutic experience . DESIGN Qualitative study , using repeat semi-structured interviews with patients before and after therapy . The study was conducted in parallel with a r and omized controlled trial examining the effectiveness and cost-effectiveness of online CBT for patients with depression . PARTICIPANTS Twenty-four patients with depression recruited from five general practice s in southwest Engl and , who were offered up to 10 sessions of CBT , delivered via the internet by a psychologist . RESULTS Most participants accessed the therapy from their home computer and found this to be a major advantage , in terms of convenience and fitting therapy into their daily routine , with any technical problems quickly resolved . Two key themes regarding expectations and experiences of online CBT were : developing a virtual relationship with a therapist , and the process of communicating thoughts and emotions via an online medium . Online CBT seems to be acceptable to , and experienced as helpful by , certain subgroups of patients with depression , particularly those who are familiar with computers , feel comfortable with writing their feelings down , enjoy the opportunities to review and reflect that written ( or typed ) communication offers are attracted to the ' anonymity ' of an online therapeutic relationship and are open to the proactive requirements of CBT itself . However , on-line CBT may feed into the vulnerability of depressed people to negative thoughts , given the absence of visual cues and the immediate response of face-to-face interaction . CONCLUSIONS Online CBT has the potential to enhance care for patients with depression who are open to engaging in ' talking ' ( or typing ) therapies as part of their treatment . If online CBT is to be provided via the NHS , it is important to establish patient preferences regarding this mode of delivery and ensure that referral practice s are appropriately targeted . The results of our main trial will provide evidence regarding the effectiveness and cost-effectiveness of receiving therapy via this modality Postpartum depression impacts up to 15 % of Canadian women following childbirth . Remarkably , many women suffering from this disorder do not receive appropriate treatment . The aim of this study was to conduct a parallel-group r and omized controlled trial to determine the efficacy of Therapist-Assisted Internet-delivered Cognitive Behavior Therapy ( TA-ICBT ) for the treatment of postpartum depression . This study was registered with the International St and ard R and omized Controlled Trials ( IS RCT N : 85456371 ) and received funding from Canadian Institutes of Health Research ( # 101526 ) and the Saskatchewan Health Research Foundation . Fifty women who gave birth to an infant in the past year , who scored above 10 on the Edinburgh Postnatal Depression Scale ( EPDS ) , and who resided in Saskatchewan , Canada were eligible to participate . Participants were r and omly assigned to receive either TA-ICBT ( n = 25 ) or waitlist control ( n = 25 ) . The efficacy of the treatment was investigated at baseline and at seven- to 10-week follow-up . TA-ICBT participants were also contacted four-weeks following treatment completion . Symptoms of postpartum depression decreased more for participants in the TA-ICBT group ( average reduction of 6.24 points on the EPDS ; n = 21 included in analyses ) compared to those participants in the waitlist control group ( average reduction of 2.42 points on the EPDS ; n = 20 included in analyses ) , and these results were clinical ly significant and maintained at four-week follow-up . TA-ICBT participants demonstrated a reduction in postnatal anxiety , general stress , and parental distress , and an increase in psychological and environmental quality of life when compared to the waitlist control participants . Study implication s , limitations , and future research directions are discussed . Trial Registration Controlled-Trials.com IS RCT Background Although numerous efficacy studies in recent years have found internet-based interventions for depression to be effective , there has been scant consideration of therapeutic process factors in the online setting . In face-to face therapy , the quality of the working alliance explains variance in treatment outcome . However , little is yet known about the impact of the working alliance in internet-based interventions , particularly as compared with face-to-face therapy . Methods This study explored the working alliance between client and therapist in the middle and at the end of a cognitive-behavioral intervention for depression . The participants were r and omized to an internet-based treatment group ( n = 25 ) or face-to-face group ( n = 28 ) . Both groups received the same cognitive behavioral therapy over an 8-week timeframe . Participants completed the Beck Depression Inventory ( BDI ) post-treatment and the Working Alliance Inventory at mid- and post- treatment . Therapists completed the  therapist version of the Working Alliance Inventory  at post-treatment . Results With the exception of therapists ' ratings of the tasks subscale , which were significantly higher in the online group , the two groups ' ratings of the working alliance did not differ significantly . Further , significant correlations were found between clients ' ratings of the working alliance and therapy outcome at post-treatment in the online group and at both mid- and post-treatment in the face-to-face group . Correlation analysis revealed that the working alliance ratings did not significantly predict the BDI residual gain score in either group . Conclusions Contrary to what might have been expected , the working alliance in the online group was comparable to that in the face-to-face group . However , the results showed no significant relations between the BDI residual gain score and the working alliance ratings in either group . Trial registration Background and Aims Major depression can be treated by means of cognitive behavior therapy , delivered via the Internet as guided self-help . Individually tailored guided self-help treatments have shown promising results in the treatment of anxiety disorders . This r and omized controlled trial tested the efficacy of an Internet-based individually tailored guided self-help treatment which specifically targeted depression with comorbid symptoms . The treatment was compared both to st and ardized ( non-tailored ) Internet-based treatment and to an active control group in the form of a monitored online discussion group . Both guided self-help treatments were based on cognitive behavior therapy and lasted for 10 weeks . The discussion group consisted of weekly discussion themes related to depression and the treatment of depression . Methods A total of 121 participants with diagnosed major depressive disorder and with a range of comorbid symptoms were r and omized to three groups . The tailored treatment consisted of a prescribed set of modules targeting depression as well as comorbid problems . The st and ardized treatment was a previously tested guided self-help program for depression . Results From pre-treatment to post-treatment , both treatment groups improved on measures of depression , anxiety and quality of life . The results were maintained at a 6-month follow-up . Subgroup analyses showed that the tailored treatment was more effective than the st and ardized treatment among participants with higher levels of depression at baseline and more comorbidity , both in terms of reduction of depressive symptoms and on recovery rates . In the subgroup with lower baseline scores of depression , few differences were seen between treatments and the discussion group . Conclusions This study shows that tailored Internet-based treatment for depression is effective and that addressing comorbidity by tailoring may be one way of making guided self-help treatments more effective than st and ardized approaches in the treatment of more severe depression . Trial Registration Clinical trials.gov Background Approximately two thirds of adults undergoing cardiac surgery suffer from moderate to severe postoperative pain . Assisting patients with pain management is therefore critical to prevent its negative consequences . Information technologies have become part of our lifestyle and can facilitate the implementation of interventions to manage pain in a busy care setting . A computer-tailored and Web-based intervention — referred to as SOUtien à L’AutoGEstion-Traitement-Assistance Virtuelle Infirmière-Enseignement (SOULAGE-TAVIE)—for the self-management of pain was developed . Findings from a previous pilot r and omized controlled trial ( RCT ) provided some evidence of the feasibility and preliminary effectiveness of this intervention in decreasing pain interference with a few postoperative activities and by modulating pain beliefs and analgesic intake . However , its acceptability from the patient ’s perspective remains unclear . Moreover , the proportion of women is much lower in the cardiac surgical population , making it difficult to detect differences in experiences between men and women . Objective The objectives were ( 1 ) to describe SOULAGE-TAVIE ’s acceptability from the perspective of adults experiencing pain after cardiac surgery and ( 2 ) to compare the perceptions of men and women . Methods A mixed- method approach was used to capture the various attributes of patients ’ perceptions of the intervention ’s acceptability and to compare the perceptions of men and women . Quota sample s of men ( n=10 ; mean age 62.5 years , SD 7.3 ) and women ( n=10 ; mean age 64.3 years , SD 10.7 ) who had cardiac surgery in the past month were invited to view the intervention , complete a brief question naire rating its acceptability , and then to discuss each component in a 60-minute , semistructured interview . Mann-Whitney U tests were used to compare groups . The transcripts were content analyzed to generate themes based on patients ’ experiences with the intervention and reports of acceptability . The content of each category and subcategory were compared between men and women . Frequency counts were also done to vali date the emergence of a difference between the 2 subgroups . Results Participants perceived the intervention to be very acceptable in terms of content and format , and tended to describe awareness-raising and convenient support experiences . Women scored higher than men in terms of the intervention ’s appropriateness ( U=13.5 , P=.008 ) . They were willing to adhere to the intervention based on the importance and relevance of the advice provided , whereas men were more focused on the delivery mode and its flexibility . Conclusions This study underlined the acceptability of computer tailoring and persuasive communication to modulate pain beliefs and attitudes in an acute care context . Both men and women appreciated the Web-based interface and general self-guided approach of the intervention . The delivery of SOULAGE-TAVIE across the continuum of care seems to be an interesting avenue to influence the transition from acute to chronic postoperative pain OBJECTIVES To explore patients ' perceptions regarding prospect i ve telerehabilitation services  and the factors that facilitate or impede patients ' intentions to use these services . DESIGN Using semi-structured interviews , patients reflected on the pros and cons of various scenarios of prospect i ve telerehabilitation services . Patients ' arguments were first arranged according to the Unified Theory of Acceptance and Use of Technology ( UTAUT ) . Next , using inductive analysis , the data for each UTAUT component were analysed and arranged into subthemes . SETTING AND PARTICIPANTS Twenty-five chronic pain patients were selected from a rehabilitation centre in the Netherl and s. RESULTS Overall , participants considered telerehabilitation helpful as a complementary or follow-up treatment , rather than an autonomous treatment . Arguments mainly related to the UTAUT constructs of ' performance expectancy ' and ' facilitating conditions ' . Patients valued the benefits such as reduced transportation barriers , flexible exercise hours and the possibility to better integrate skills into daily life . However , many patients feared a loss of treatment motivation and expressed concerns about both reduced fellow sufferer contact and reduced face-to-face therapist contact . Few arguments related to ' social norms ' and ' effort expectancy ' . CONCLUSIONS The effect of telerehabilitation on healthcare strongly depends on patients ' willingness to use . Our study showed that chronic pain patients valued the benefits of telerehabilitation but hesitate to use it as an autonomous treatment . Therefore , future initiatives should maintain traditional care to some degree and focus on patients ' attitudes as well . Either by giving information to increase patients ' confidence in telerehabilitation or by addressing reported drawbacks into the future design of these services . Further quantitative studies are needed to explore patients ' intentions to use telerehabilitation Background Little is known about the factors that influence acceptability of and adherence to  online psychological interventions . Evidence is needed to guide further development of promising programs . Objective Our goal was to investigate users ’ views of two online approaches to self-help for depression : computerized cognitive behavior therapy ( cCBT ) and informational websites , in a workplace context . Computerized CBT offers an inexpensive and accessible alternative to face-to-face therapy , and employers have an interest in reducing the working time lost to depression or stress . Yet little is known about how employees , who have actual experience of using online approaches , judge the intervention as a process . Methods The qualitative data reported here were collected within an online r and omized controlled trial whose participants had diagnosable depression . The experimental intervention was a 5-week cCBT program called MoodGYM , and the control condition was five informational websites about mental health . Data were collected via online question naires . There was no evidence of the superiority of either in terms of treatment outcomes . In parallel , using brief rating scales and open-ended questions design ed for this purpose , we examined the relative acceptability of each approach over time , including perceptions of cCBT compared to seeing a health care professional . Results At least 60 % of participants held online therapy to be at least as acceptable as seeing a professional about mental health issues , and they were more likely to retain this opinion over time if they used the interactive program , MoodGYM , rather than informational websites alone . Barriers to cCBT use fell into four categories : intrinsic , intrapersonal problems ; extrinsic technical problems ; generic issues mostly pertaining to perceptions of cCBT ; and specific issues about the intervention or control condition . These indicate strategies for improving engagement . Conclusions As first-aid for mild to moderate mental health problems , evidence -based computerized approaches have broad acceptability . This could be increased by attending to the barriers noted here and by proactively managing users ’ expectations at individual and organizational levels . The findings have implication s for occupational health providers and others addressing the needs of working-age adults with depression . They also raise method ological issues for online research . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 24529487 ; http://www.controlled-trials.com/IS RCT N24529487 ( Archived by Webcite at http://www.webcitation.org/6O8cCL4mh ) A r and omized trial was conducted of two different self-help programs for panic disorder ( PD ) on the Internet . After confirming the PD-diagnosis with an in-person structured clinical interview for DSM-IV ( SCID ) interview 22 participants were r and omized to either applied relaxation ( AR ) or a multimodal treatment package based on cognitive behavioral therapy ( CBT ) . Overall , the results suggest that Internet-administered self-help plus minimal therapist contact via e-mail has a significant medium to large effect ( Cohen 's d=0.71 for AR and d=0.42 for CBT ) . The results from this study generally provide evidence to support the continued use and development of Internet-distributed self-help programs Little is known about what determines uptake and acceptability of internetbased treatments in eating disorders , and users ’ experience with such treatments . We investigated these factors in participants of a r and omized controlled trial of an internet-based cognitive- behavioural treatment ( iCBT ) package ( Overcoming bulimia online ) . Nine participants were interviewed using purposive sampling . The content of interviews were analyzed using thematic analysis . Additionally , participants received question naires about their impressions of  iCBT . Participants talked about their experience of using iCBT  , its impact and compared it to other treatments . Question naire responses echoed themes identified in the interviews . iCBT was received positively as a way of fitting treatment into busy lives . Comments on the layout of some of the package content and the practitioner support offered were identified as areas that could be modified or improved Stress urinary incontinence is common and sometimes embarrassing . New , simple , and easily accessible treatments are needed . We telephone interviewed 21 women who participated in a r and omized controlled study comparing two treatment programs based on instructions for pelvic floor muscle training . One program was Internet-based and included email support by a urotherapist ; the other was sent by post . There was no face-to-face contact in either program . Our main aim was to explore the women ’s experiences of the Internet-based treatment .  Grounded theory analysis revealed three categories : hidden but present , at a distance but close , and by myself but not alone . These were incorporated in a core category : acknowledged but not exposed . The leakage was often a well-hidden secret , but the study treatments lowered the barrier for seeking care . In the Internet group , a supportive patient – provider relationship developed despite the lack of face-to-face contact . Internet-based treatment programs can increase access to care and empower women Background : Adapting to living with chronic conditions is a life-long psychosocial challenge . Objective : The purpose of this study was to report the effect of a computer intervention on the psychosocial adaptation of rural women with chronic conditions . Methods : A two-group study design was used with 309 middle-aged , rural women who had chronic conditions , r and omized into either a computer-based intervention or a control group .  Data were collected at baseline , at the end of the intervention , and 6 months later on the psychosocial indicators of social support , self-esteem , acceptance of illness , stress , depression , and loneliness . Results : The impact of the computer-based intervention was statistically significant for five of six of the psychosocial outcomes measured , with a modest impact on social support . The largest benefits were seen in depression , stress , and acceptance . Discussion : The women-to-women intervention result ed in positive psychosocial responses that have the potential to contribute to successful management of illness and adaptation . Other components of adaptation to be examined are the impact of the intervention on illness management and quality of life and the interrelationships among environmental stimuli , psychosocial response , and illness management Alcohol abuse among women in rural areas is a concern , particularly because treatment is not readily accessible and women are highly susceptible to the ill effects of alcohol misuse . The Internet may offer a treatment delivery alternative for women who can not easily take part in sex-focused programs that are located in urban centers . The purpose of this r and omized study was to evaluate a 90-day Web-based treatment program for women in rural areas of Missouri with problem drinking habits . The online treatment program consisted of reference and decision-making modules , synchronous and asynchronous communication features , and the option to interact privately with the research er . Preliminary findings relating to participant demographics , Web site use , and satisfaction are reported in this article . The enrolled participants ( n = 46 ) had a mean ( SD ) age of 50 ( 11 ) years and were relatively well educated and , to a large extent , financially secure . Based on their Web site usage , participants appeared to prefer reading communiqués over actively posting messages to the asynchronous bulletin board . In general , participants indicated satisfaction with the program , and 83 % noted that they would recommend it to a friend
There is a gap in knowledge of women 's perceptions of  e-health treatment .
This review aims to investigate women 's expectations and experiences regarding e-health .