Client-identified helpful and hindering events in therapist-delivered vs. self-administered online cognitive-behavioural treatments for depression in college students

Abstract

The study investigated what participants found helpful and/or hindering in therapist-delivered vs. self-administered online cognitive-behavioural therapy (CBT) for depression. A descriptive–interpretive analysis was used to investigate client-identified helpful and hindering events and impacts in online treatment. Eighty participants with symptoms of depression were randomly allocated to either eight sessions of therapist-delivered asynchronous e-mail CBT counselling (eCBT; n = 37), or computerised CBT self-administered treatment (cCBT; n = 43) for depression. From sessions 2–8, participants were asked to complete the Helpful Aspects of Therapy form (HAT). Participants completed 149 HAT forms representing a response rate of 45% (eCBT: 49%; cCBT: 42%). Reported helpful events included provision of information, monitoring, scheduling, restructuring, problem solving and distraction techniques and led to impacts such as learning new coping skills and behavioural changes, developing awareness and insight and achieving self-efficacy. Additionally, therapist responsiveness seems to have a worthy impact of feeling supported and validated as identified by the eCBT group, who solely reported helpful events such as acknowledgement/listening, advice and guidance and provision of compassion. Unhelpful events also surfaced for both groups, though more for the cCBT group, and included the burden of work, time and pace, issues with the content and its form of delivery, and technical problems, which led to impacts such as being frustrated, confused, irritated, disappointed, anxious and self-critical. CBT principles remain established in online work and, in addition, therapist responsiveness seems to have a worthy helpful impact, beyond any established CBT techniques or strategies.

Keywords:

• online treatments for depression
• helpful and hindering impacts
• significant events in therapy
• depression
• descriptive and interpretive framework

Acknowledgements

The authors would like to thank Paul Hayes for the blind rating of the material that was used for credibility assessment.