Experiences of non-adherence to Internet-delivered cognitive behavior therapy: a qualitative study
Open accessAbstract
Many trials on Internet-delivered psychological treatments have had problems with nonadherence, but not much is known about the subjective reasons for non-adhering. The aim of this study was to explore participants' experiences of non-adherence to Internet-delivered psychological treatment. Grounded theory was used to analyze data from seven in-depth interviews with persons who had non-adhered to a study on Internet-delivered cognitive behavioral therapy for generalized anxiety disorder . The process of non-adherence is described as an interaction between patient factors and treatment factors. A working model theory was generated to illustrate the experience of nonadherence. The model describes a process where treatment features such as workload, text-content complexity and treatment process don't match personal prerequisites regarding daily routines, perceived language skills and treatment expectations respectively, resulting in the decision to nonadhere. Negative effects were also stated as a reason for non-adherence. Several common strategies used for increasing adherence to Internet-delivered therapy in general are by these non-completers regarded as factors directly related to their reason for non-adherence.
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Among treatment factors, a lack of program flexibility was identified as a reason to not adhere when interfering with patient factors such as daily routine or individual capacities.
“Among treatment factors, a lack of program flexibility was identified as a reason to not adhere when interfering with patient factors such as daily routine or individual capacities.”
From Increasing access to pain management: Feasibility of a self-compassion psychoeducational website using a minimally monitored delivery model (2021) · cites this paper as Johansson et al., 2015
Several improvements are consistent with a model that examines the interaction between patient and treatment factors to explain experiences of non-adherence to Internet psychotherapy.
“Several of these improvements are consistent with a model that examines the interaction between patient and treatment factors to explain experiences of non-adherence to Internet psychotherapy (Johansson et al., 2015).”
From Increasing access to pain management: Feasibility of a self-compassion psychoeducational website using a minimally monitored delivery model (2021) · cites this paper as Johansson et al., 2015
Complex and unclear materials can diminish the effectiveness and usability of internet-based programs.
“Complex and unclear materials can diminish the effectiveness and usability of internet‐based programs (Johansson et al. 2015).”
From Internet‐Based Acceptance and Commitment Therapy With Interoceptive Exposure for Panic Disorder: A Randomized Controlled Trial and Working Alliance Analysis. (2026) · cites this paper as Johansson et al. 2015
Many DMH interventions are based on a one-size-fits-all approach, which is systematic but problematic because of perceived inflexibility.
“Many DMH interventions are based on a one-size-fits-all approach (eg, a linear progression with content released to all participants using time-based rules [44]), which has its advantages because it is systematic, but remains problematic because of its perceived inflexibility [45].”
From Use of the Principles of Design Thinking to Address Limitations of Digital Mental Health Interventions for Youth: Viewpoint (2019) · cites this paper as [45]
Cites
Wagner, H. R., Glaser, B. G., & Strauss, A. L. (1968) · Social Forces · doi:10.2307/2575405 · Cited by 46,470 · see citing works
(2006) · Cited by 18,730 · see citing works
A new depression scale designed to be sensitive to change
Montgomery, S. A., & Åsberg, M. (1979) · British Journal of Psychiatry · doi:10.1192/bjp.134.4.382 · Cited by 13,962 · see citing works
Constructing grounded theory. A practical guide through qualitative analysis
Brink, E., Dellve, L., Hallberg, U. E., Abrahamsson, K. H., Klingberg, G., & Wentz, K. (2006) · International Journal of Qualitative Studies on Health and Well-Being · doi:10.3402/qhw.v1i3.4932 · Cited by 6,909 · see citing works
Development and validation of the Penn State Worry Questionnaire
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990) · Behaviour Research and Therapy · doi:10.1016/0005-7967(90)90135-6 · Cited by 5,099 · see citing works
Eysenbach, G. (2005) · Journal of Medical Internet Research · doi:10.2196/jmir.7.1.e11 · Cited by 2,524 · see citing works
Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: A meta-analysis
SPEK, V., CUIJPERS, P., NYKLÍČEK, I., RIPER, H., KEYZER, J., & POP, V. (2007) · Psychological Medicine · doi:10.1017/s0033291706008944 · Cited by 1,586 · see citing works
Persuasive System Design Does Matter: a Systematic Review of Adherence to Web-based Interventions
Kelders, S. M., Kok, R. N., Ossebaard, H. C., & Van Gemert-Pijnen, J. E. (2012) · Journal of Medical Internet Research · doi:10.2196/jmir.2104 · Cited by 1,308 · see citing works
Adherence in Internet Interventions for Anxiety and Depression
Christensen, H., Griffiths, K. M., & Farrer, L. (2009) · Journal of Medical Internet Research · doi:10.2196/jmir.1194 · Cited by 1,133 · see citing works
A meta-analysis of psychotherapy dropout
Wierzbicki, M., & Pekarik, G. (1993) · Professional Psychology: Research and Practice · doi:10.1037/0735-7028.24.2.190 · Cited by 1,118 · see citing works
Andersson, G., Cuijpers, P., Carlbring, P., Riper, H., & Hedman, E. (2014) · World Psychiatry · doi:10.1002/wps.20151 · Cited by 1,077 · see citing works
Self-citationData analysis 2Preprint
Wagemans, F. M. A., Brandt, M. J., & Zeelenberg, M. (2016) · Cited by 952 · see citing works
Dropout from Internet‐based treatment for psychological disorders
Melville, K. M., Casey, L. M., & Kavanagh, D. J. (2010) · British Journal of Clinical Psychology · doi:10.1348/014466509x472138 · Cited by 597 · see citing works
Early withdrawal from mental health treatment: Implications for psychotherapy practice.
Barrett, M. S., Chua, W.-J., Crits-Christoph, P., Gibbons, M. B., & Thompson, D. (2008) · Psychotherapy: Theory, Research, Practice, Training · doi:10.1037/0033-3204.45.2.247 · Cited by 564 · see citing works
Using the Internet to provide cognitive behaviour therapy
Andersson, G. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.01.010 · Cited by 560 · see citing works
Self-citationNewman, M. G., Zuellig, A. R., Kachin, K. E., Constantino, M. J., Przeworski, A., Erickson, T., & Cashman-McGrath, L. (2002) · Behavior Therapy · doi:10.1016/s0005-7894(02)80026-0 · Cited by 553 · see citing works
Psychotherapy and Bulimia Nervosa
Fairburn, C. G. (1993) · Archives of General Psychiatry · doi:10.1001/archpsyc.1993.01820180009001 · Cited by 550 · see citing works
van Ballegooijen, W., Cuijpers, P., van Straten, A., Karyotaki, E., Andersson, G., Smit, J. H., & Riper, H. (2014) · PLoS ONE · doi:10.1371/journal.pone.0100674 · Cited by 409 · see citing works
Self-citationWaller, R., & Gilbody, S. (2009) · Psychological Medicine · doi:10.1017/s0033291708004224 · Cited by 393 · see citing works
Clarke, G., Eubanks, D., Reid, E., Kelleher, C., O'Connor, E., DeBar, L. L., Lynch, F., Nunley, S., & Gullion, C. (2005) · Journal of Medical Internet Research · doi:10.2196/jmir.7.2.e16 · Cited by 372 · see citing works
Consensus statement on defining and measuring negative effects of internet interventions
Rozental, A., Andersson, G., Boettcher, J., Ebert, D. D., Cuijpers, P., Knaevelsrud, C., Ljótsson, B., Kaldo, V., Titov, N., & Carlbring, P. (2014) · Internet Interventions · doi:10.1016/j.invent.2014.02.001 · Cited by 371 · see citing works
Self-citationGlass, C. R., Arnkoff, D. B., & Shapiro, S. J. (2001) · Psychotherapy · doi:10.1037/0033-3204.38.4.455 · Cited by 279 · see citing works
Computerised cognitive-behavioural therapy for depression: systematic review
Kaltenthaler, E., Parry, G., Beverley, C., & Ferriter, M. (2008) · British Journal of Psychiatry · doi:10.1192/bjp.bp.106.025981 · Cited by 206 · see citing works
Hilvert-Bruce, Z., Rossouw, P. J., Wong, N., Sunderland, M., & Andrews, G. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.04.001 · Cited by 193 · see citing works
Rozental, A., Boettcher, J., Andersson, G., Schmidt, B., & Carlbring, P. (2015) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2015.1008033 · Cited by 189 · see citing works
Self-citationAndersson, G., Paxling, B., Roch-Norlund, P., Östman, G., Norgren, A., Almlöv, J., Georén, L., Breitholtz, E., Dahlin, M., Cuijpers, P. J., et al. (2012) · Psychotherapy and Psychosomatics · doi:10.1159/000339371 · Cited by 181 · see citing works
Bendelin, N., Hesser, H., Dahl, J., Carlbring, P., Nelson, K. Z., & Andersson, G. (2011) · BMC Psychiatry · doi:10.1186/1471-244x-11-107 · Cited by 173 · see citing works
Self-citationBeumont, P. J. (1993) · The Lancet · doi:10.1016/0140-6736(93)90769-d · Cited by 167 · see citing works
Bewick, B. M., Trusler, K., Mulhern, B., Barkham, M., & Hill, A. J. (2008) · Addictive Behaviors · doi:10.1016/j.addbeh.2008.05.002 · Cited by 157 · see citing works
Paxling, B., Almlöv, J., Dahlin, M., Carlbring, P., Breitholtz, E., Eriksson, T., & Andersson, G. (2011) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2011.576699 · Cited by 147 · see citing works
Self-citationFarrer, L., Christensen, H., Griffiths, K. M., & Mackinnon, A. (2011) · PLoS ONE · doi:10.1371/journal.pone.0028099 · Cited by 140 · see citing works
Predictors of outcome of group and internet-based cognitive behavior therapy
Spek, V., Nyklíček, I., Cuijpers, P., & Pop, V. (2008) · Journal of Affective Disorders · doi:10.1016/j.jad.2007.05.001 · Cited by 134 · see citing works
Effect of time-limited psychotherapy on patient dropout rates
Sledge, W. H., Moras, K., Hartley, D., & Levine, M. (1990) · American Journal of Psychiatry · doi:10.1176/ajp.147.10.1341 · Cited by 131 · see citing works
Iacoviello, B., McCarthy, K., Barrett, M. S., Rynn, M., Gallop, R., & Barber, J. (2007) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.75.1.194 · Cited by 128 · see citing works
Linke, S., Murray, E., Butler, C., & Wallace, P. (2007) · Journal of Medical Internet Research · doi:10.2196/jmir.9.2.e10 · Cited by 127 · see citing works
Internet‐Based Treatment for Panic Disorder: Does Frequency of Therapist Contact Make a Difference?
Klein, B., Austin, D., Pier, C., Kiropoulos, L., Shandley, K., Mitchell, J., Gilson, K., & Ciechomski, L. (2009) · Cognitive Behaviour Therapy · doi:10.1080/16506070802561132 · Cited by 123 · see citing works
Attrition in web-based treatment for problem drinkers
Postel, M. G., de Haan, H. A., ter Huurne, E. D., van der Palen, J., Becker, E. S., & de Jong, C. A. (2011) · Journal of Medical Internet Research · doi:10.2196/jmir.1811 · Cited by 87 · see citing works
Clinicians' Perspectives on Negative Effects of Psychological Treatments
Bystedt, S., Rozental, A., Andersson, G., Boettcher, J., & Carlbring, P. (2014) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2014.939593 · Cited by 78 · see citing works
Self-citationHalmetoja, C. O., Malmquist, A., Carlbring, P., & Andersson, G. (2014) · Internet Interventions · doi:10.1016/j.invent.2014.08.001 · Cited by 46 · see citing works
Oxford Guide to Low Intensity CBT Interventions
(2015) · Oxford Clinical Psychology · doi:10.1093/med:psych/9780199590117.001.0001 · Cited by 40 · see citing works
Barrett, M. S., Chua, W.-J., Crits-Christoph, P., Gibbons, M. B., Casiano, D., & Thompson, D. (2009) · Psychotherapy: Theory, Research, Practice, Training · doi:10.1037/a0016184 · Cited by 26 · see citing works
Vandereycken, W., & Devidt, K. (2010) · Eating Disorders · doi:10.1080/10640260903585557 · Cited by 24 · see citing works
Dunn, T. L., Casey, L. M., Sheffield, J. K., Newcombe, P. A., & Chang, A. B. (2011) · Journal of Health Psychology · doi:10.1177/1359105311415558 · Cited by 22 · see citing works
The effect of noncontingent feedback on attributional style.
Martin, M., Buckhalt, J., Pipes, R., Nivens, M. K., & Katz, J. A. (1987) · Journal of Clinical Psychology · doi:10.1002/1097-4679(198709)43:5 · Cited by 5 · see citing works
Flagged first, then by citations
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Perski, O., Blandford, A., West, R., & Michie, S. (2017) · Translational Behavioral Medicine · doi:10.1007/s13142-016-0453-1 · Cited by 1,193 · see citing works
“Professional support features , which include features that enable remote contact with a clinician via e-mail, telephone or text messages, have been found to positively influence engagement with DBCIs [20, 25, 26, 63, 68, 70, 73, 77, 88, 90, 95, 120, 131 – 134].”
BackgroundInfluentialInternet interventions: Past, present and future
Andersson, G. (2018) · Internet Interventions · doi:10.1016/j.invent.2018.03.008 · Cited by 315 · see citing works
“…al., 2011), long-term memories of ICBT for social anxiety disorder (Olsson Halmetoja et al., 2014), experiences of people who drop out from treatment (Johansson et al., 2015), clients who use smartphone as delivery mode (Ly et al., 2015a), and also negative effects of ICBT (Rozental et al., 2015a).”
BackgroundSieverink, F., Kelders, S. M., & van Gemert-Pijnen, J. E. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.8578 · Cited by 331 · see citing works
“Out of the 62 included articles, 34 reported adherence only in terms of how often the technology was used (Category A operationalization) [7,18-50].”
BackgroundPatel, S., Akhtar, A., Malins, S., Wright, N., Rowley, E., Young, E., Sampson, S., & Morriss, R. (2020) · Journal of Medical Internet Research · doi:10.2196/16228 · Cited by 190 · see citing works
“Incorporating some form of support to enhance commitment and motivation was highlighted in 17 papers [35,37,38,41,43-51,53-55,57].”
BackgroundInfluentialScholten, H., & Granic, I. (2019) · Journal of Medical Internet Research · doi:10.2196/11528 · Cited by 138 · see citing works
“Many DMH interventions are based on a one-size-fits-all approach (eg, a linear progression with content released to all participants using time-based rules [44]), which has its advantages because it is systematic, but remains problematic because of its perceived inflexibility [45].”
Boersma, K., Södermark, M., Hesser, H., Flink, I. K., Gerdle, B., & Linton, S. J. (2019) · Pain · doi:10.1097/j.pain.0000000000001575 · Cited by 123 · see citing works
Alfonsson, S., Olsson, E., & Hursti, T. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.5352 · Cited by 118 · see citing works
“is possible that Internet-based interventions simply suit some participants better than others and that the focus should be on identifying these participants early [59].”
Skea, Z., Newlands, R. S. N., & Gillies, K. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-021959 · Cited by 95 · see citing works
“problems and limited reading and writing skills as a reason for withdrawing from internet delivered cognitive behavioural therapy(24) or as a reason for non-response to follow-up questionnaires,(31) with participants in one of these studies stating that they felt unintelligent because of their inability to understand.…”
BackgroundLöbner, M., Pabst, A., Stein, J., Dorow, M., Matschinger, H., Luppa, M., Maroß, A., Kersting, A., König, H.-H., & Riedel-Heller, S. G. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.06.008 · Cited by 72 · see citing works
Gamifying CBT to deliver emotional health treatment to young people on smartphones
Christie, G. I., Shepherd, M., Merry, S. N., Hopkins, S., Knightly, S., & Stasiak, K. (2019) · Internet Interventions · doi:10.1016/j.invent.2019.100286 · Cited by 81 · see citing works
Deterioration rates in Virtual Reality Therapy: An individual patient data level meta-analysis
Fernández-Álvarez, J., Rozental, A., Carlbring, P., Colombo, D., Riva, G., Anderson, P. L., Baños, R. M., Benbow, A. A., Bouchard, S., Bretón-López, J. M., et al. (2019) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2018.06.005 · Cited by 79 · see citing works
Lappalainen, R., Lappalainen, P., Puolakanaho, A., Hirvonen, R., Eklund, K., Ahonen, T., Muotka, J., & Kiuru, N. (2021) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.01.007 · Cited by 69 · see citing works
Fernández-Álvarez, J., Díaz-García, A., González-Robles, A., Baños, R., García-Palacios, A., & Botella, C. (2017) · Internet Interventions · doi:10.1016/j.invent.2017.09.001 · Cited by 60 · see citing works
“Although scant research has examined specifically non-adherence from a qualitative perspective, prior research also emphasized expectations, suggesting that they may have an influence on adherence (Johansson et al., 2015).”
BackgroundSpanhel, K., Schweizer, J. S., Wirsching, D., Lehr, D., Baumeister, H., Bengel, J., & Sander, L. (2019) · Internet Interventions · doi:10.1016/j.invent.2019.100252 · Cited by 46 · see citing works
Cross, S. P. M., & Álvarez‐Jiménez, M. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1382726 · Cited by 41 · see citing works
Tulbure, B. T., Rusu, A., Sava, F. A., Sălăgean, N., & Farchione, T. J. (2018) · JMIR Mental Health · doi:10.2196/mental.8901 · Cited by 43 · see citing works
“In this context, low adherence could represent a mismatch between one or more of the aforementioned factors (see also [69,70]).”
Arnold, C., Williams, A., & Thomas, N. (2020) · JMIR Mental Health · doi:10.2196/16730 · Cited by 42 · see citing works
“As with previous research, participants who did not receive email support found that their motivation to persist with the intervention waned quickly [23,42].”
BackgroundResultLawler, K., Earley, C., Timulák, L., Enrique, Á., & Richards, D. (2021) · JMIR Formative Research · doi:10.2196/26221 · Cited by 38 · see citing works
Adaptive Elements in Internet-Delivered Psychological Treatment Systems: Systematic Review
Mukhiya, S. K., Wake, J. D., İnal, Y., Pun, K. I., & Lamo, Y. (2020) · Journal of Medical Internet Research · doi:10.2196/21066 · Cited by 32 · see citing works
“According to a survey done by Johansson et al [21], participants chose not to adhere to the treatment when they were unable to perceive a compatible correlation between the length of weekly text modules and the conditions in their personal life.”
InfluentialAn, J., Kwak, H., Qureshi, H. M., & Weber, I. G. (2021) · JMIR Formative Research · doi:10.2196/22313 · Cited by 37 · see citing works
“Arguably, the inflexibility of the traditional approach to public health campaigns [9] decreases campaign effectiveness by making the audience feel less engaged [10,11].”
BackgroundBendelin, N., Björkdahl, P., Risell, M., Nelson, K. Z., Gerdle, B., Andersson, G., & Buhrman, M. (2020) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-020-03198-1 · Cited by 33 · see citing works
“For some, deadlines were found stressful, also previously seen [34] and led to negative emotions of guilt, nevertheless motivating them to complete.”
BackgroundBeukes, E. W., Manchaiah, V. K. C., Davies, A. S. A., Allen, P. M., Baguley, D., & Andersson, G. (2018) · International Journal of Audiology · doi:10.1080/14992027.2018.1514538 · Cited by 31 · see citing works
Renfrew, M. E., Morton, D. P., Morton, J. K., Hinze, J. S., Przybylko, G., & Craig, B. A. (2020) · Journal of Medical Internet Research · doi:10.2196/19945 · Cited by 31 · see citing works
“…with personal values [8], motivation factors [6,22], focus on immediate benefit rather than long-term goals, perceived treatment credibility [13,27], receiving preferences [28], health status, psychological vulnerability [21-23], user expectations [6,13,23], gender [13,21], and age [17,21].”
Abrahamsson, N., Ahlund, L., Ahrin, E., & Alfonsson, S. (2018) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2018.06.010 · Cited by 30 · see citing works
Negative effects in internet-based interventions for depression: a qualitative content analysis
Fenski, F., Rozental, A., Heinrich, M., Knaevelsrud, C., Zagorscak, P., & Boettcher, J. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100469 · Cited by 28 · see citing works
Hallberg, J., Kaldo, V., Arver, S., Dhejne, C., Piwowar, M., Jokinen, J., & Öberg, K. G. (2020) · The Journal of Sexual Medicine · doi:10.1016/j.jsxm.2020.07.018 · Cited by 28 · see citing works
Amanvermez, Y., Karyotaki, E., Cuijpers, P. J., Salemink, E., Spinhoven, P., Struijs, S. Y., & de Wit, L. M. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100369 · Cited by 28 · see citing works
“…to the internet-based interventions was associated with lower dropout rates (Richards and Richardson, 2012), participants may discontinue the program for different reasons such as finding the program complicated, lack of time, or feeling a need for face-to-face contact (Johansson et al., 2015).”
BackgroundComputer-based self-help therapy: A qualitative analysis of attrition
Hermes, E. D. A., Merrel, J. D., Clayton, A. R., Morris, C., & Rowe, M. (2016) · Health Informatics Journal · doi:10.1177/1460458216683536 · Cited by 25 · see citing works
“11,20,21 Limiting attrition will be important to improving cCBT effectiveness and dissemination in out-patient care.”
BackgroundInfluentialMutter, A., Küchler, A., Idrees, A. R., Kählke, F., Terhorst, Y., & Baumeister, H. (2023) · BMC Psychology · doi:10.1186/s40359-023-01312-1 · Cited by 22 · see citing works
“Furthermore, a large number of participants had the feeling that they did not benefit from the intervention, what might be a further reason for low adherence [80].”
BackgroundThe development and initial psychometric validation of the eHealth readiness scale
Bhalla, A., Durham, R. L., Al-Tabaa, N., & Yeager, C. M. (2016) · Computers in Human Behavior · doi:10.1016/j.chb.2016.09.015 · Cited by 19 · see citing works
Capriotti, M. R., & Donaldson, J. M. (2021) · Journal of Applied Behavior Analysis · doi:10.1002/jaba.884 · Cited by 18 · see citing works
Quero, S., Rachyla, I., Molés, M., Mor, S., Tur, C., Cuijpers, P. J., López-Montoyo, A., & Botella, C. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16203842 · Cited by 18 · see citing works
“Literature on self-help interventions, such as Internet-delivered interventions, suggests the existence of lower treatment adherence when the intervention represents an important workload for the patient [31].”
BackgroundTur, C., Campos, D., Suso‐Ribera, C., Kazlauskas, E., Castilla, D., Zaragozá, I., García‐Palacios, A., & Quero, S. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100558 · Cited by 17 · see citing works
Johansson, P., Svensson, E., Andersson, G., & Lundgren, J. (2020) · European Journal of Cardiovascular Nursing · doi:10.1177/1474515120947250 · Cited by 18 · see citing works
Pérez, J. C., Fernández, O., Cáceres, C., Carrasco, A. S., Moessner, M., Bauer, S., Espinosa-Duque, D., Gloger, S., & Krause, M. (2021) · JMIR Mental Health · doi:10.2196/26814 · Cited by 20 · see citing works
Coumans, J. M. J., Bolman, C. A. W., Oenema, A., & Lechner, L. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100537 · Cited by 17 · see citing works
“…participant's prerequisites or that the participants were already satisfied with the first parts of the intervention, such as feedback on their behavior or creating an action plan, and did not expect to further benefit from the intervention (Johansson et al., 2015; Vandereycken and Devidt, 2010).”
BackgroundJohnsen, H., & Haddeland, K. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100389 · Cited by 11 · see citing works
“The effect of therapist-guided ICBT has been investigated in many randomized controlled trials (Ciuca et al., 2018; Jones et al., 2016; Andersson et al., 2012), as attested by systematic reviews and metaanalyses (Polak et al., 2021; Andrews et al., 2018; Carlbring et al., 2018; Olthuis et al.,…”
MethodEffectiveness of an App-Based Short Intervention to Improve Sleep: Randomized Controlled Trial
Vollert, B., Müller, L. K., Jacobi, C., Trockel, M., & Beintner, I. (2022) · JMIR Mental Health · doi:10.2196/39052 · Cited by 13 · see citing works
“The number of pages per chapter and the amount of plain text per page were kept to a minimum as factors such as extensive text content and text content complexity are likely to increase the risk of nonadherence [78].”
Patient experience of supported computerized CBT in an inner-city IAPT service: a qualitative study
Perera-Delcourt, R. P., & Sharkey, G. (2019) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x18000284 · Cited by 14 · see citing works
“…on depression and generalized anxiety disorder in particular, found that patients can experience the treatment as demanding (in terms of content and concentration requirements); difficult without face-to-face support; and as lacking sufficient introductory information (Johansson et al. , 2015).”
BackgroundResultInfluentialMeyers, M., Margraf, J., & Velten, J. (2022) · The Journal of Sex Research · doi:10.1080/00224499.2022.2056565 · Cited by 14 · see citing works
“Based on the existing literature, a set of expected themes and codes was created for hypothesized experiences reported in other trials (Brotto & Basson, 2014; Brotto et al., 2017; Fleischmann et al., 2018; Johansson et al., 2015).”
MethodAlfonsson, S., Olsson, E. M. G., & Hursti, T. J. (2015) · Internet Interventions · doi:10.1016/j.invent.2015.07.005 · Cited by 14 · see citing works
Linardon, J., Messer, M., Reid, R., Bolger, T., & Andersson, G. (2025) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2025.2542364 · Cited by 16 · see citing works
“Understanding the underlying reasons for dropout is critical, as it can inform targeted strategies to reduce premature discontinuation and enhance the clinical efficacy of CBT (Johansson et al., 2015; Schmidt et al., 2019).”
Bendelin, N., Gerdle, B. U. C., Blom, M., Södermark, M., & Andersson, G. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10245872 · Cited by 12 · see citing works
“However, an assessment of a patients’ initial expectations might indicate the appropriate combination of IACT added to MMRP [72,73].”
BackgroundSayar, H., Vøllestad, J., & Nordgreen, T. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.990833 · Cited by 12 · see citing works
Kalde, J., Atik, E., Stricker, J. H., Schückes, M., Neudeck, P., Pittig, A., & Pietrowsky, R. (2023) · Psychotherapy Research · doi:10.1080/10503307.2023.2277866 · Cited by 12 · see citing works
“Additionally, patients are less likely to adhere to the suggested course of treatment if they believe the intervention will require a substantial amount of work and if the treatment requirements conflict with their daily schedules (Johansson et al., 2015).”
Tutus, D., Niemitz, M., Plener, P. L., Fegert, J. M., Lehmann, C., Weiss, C., Knaevelsrud, C., Biehl, L., & Rassenhofer, M. (2024) · Orphanet Journal of Rare Diseases · doi:10.1186/s13023-024-03029-9 · Cited by 15 · see citing works
“…the child’s illness, the high workload and daily treatment routine in general, text-content complexity, discrepancy between participants’ expectations of the treatment process and the actual experiences of it, and benefits of new technologies, should be addressed in future studies [21, 40, 42].”
BackgroundNissling, L., Fahlke, C., Lilja, J. L., Skoglund, I., & Weineland, S. (2020) · JMIR Formative Research · doi:10.2196/19226 · Cited by 12 · see citing works
Braun, L., Freund, J., Thielecke, J., Baumeister, H., Ebert, D. D., & Titzler, I. (2022) · JMIR Mental Health · doi:10.2196/39122 · Cited by 11 · see citing works
Investigating the Role of Individual Differences in Adherence to Cognitive Training
Tullo, D., Feng, Y., Pahor, A., Cote, J. M., Seitz, A. R., & Jaeggi, S. M. (2023) · Journal of Cognition · doi:10.5334/joc.315 · Cited by 11 · see citing works
Thomas, S., Pulman, A., Thomas, P., Collard, S. S., Jiang, N., Doğan, H., Smith, A. D., Hourihan, S. J., Roberts, F., Kersten, P., et al. (2019) · JMIR Formative Research · doi:10.2196/10951 · Cited by 11 · see citing works
“When porting printed materials to a digital environment, both HCPs and pwMS emphasized the importance of ensuring they are structured into small, easily digestible chunks [18].”
Nomeikaitė, A., Geležėlytė, O., Berger, T., Andersson, G., & Kazlauskas, E. (2023) · Internet Interventions · doi:10.1016/j.invent.2023.100686 · Cited by 10 · see citing works
“Nevertheless, the lack of personalization and tailored support in internet interventions can be a drawback for some individuals who require more individualized care (Johansson et al., 2015; Rozental et al., 2015).”
BackgroundMethodInfluentialBiliūnaitė, I., Kazlauskas, E., Sanderman, R., & Andersson, G. (2021) · Frontiers in Medicine · doi:10.3389/fmed.2021.725510 · Cited by 10 · see citing works
“Reducing the Hesitancy by Improving the Instructions Not providing prospective users with enough information prior to the intervention might be one of the initial causes for participant non-engagement (36).”
BackgroundGuided Internet-Delivered Treatment for Depression: Scoping Review
Børtveit, L., Dechsling, A., Sütterlin, S., Nordgreen, T., & Nordahl‐Hansen, A. (2022) · JMIR Mental Health · doi:10.2196/37342 · Cited by 11 · see citing works
“Treatment adherence is considered a challenge for both psychotherapy in general [41] and digital psychotherapeutic treatments [36-39].”
BackgroundCôté‐Allard, U., Pham, M. H., Schultz, A. K., Nordgreen, T., & Tørresen, J. (2022) · IEEE Journal of Biomedical and Health Informatics · doi:10.1109/jbhi.2022.3204737 · Cited by 10 · see citing works
“Thus, despite the effectiveness and availability of G-ICBT, patient adherence to this form of treatment remains an important challenge [19], as participant dropout impacts treatment outcome and results in wasted time for both the patient and clinician.”
Békés, V., Belleville, G., Lebel, J., Ouellet, M., Chen, Z., Morin, C. M., Bergeron, N., Campbell, T. S., Ghosh, S., Bouchard, S., et al. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11154361 · Cited by 9 · see citing works
“Problems with high degrees of non-adherence are common in online interventions [46], and blended interventions’ synchronous therapist support component are aimed to address this; however, our results suggest that, in itself, this might not be enough.”
ResultTowards adaptive technology in routine mental health care
Lamo, Y., Mukhiya, S. K., Rabbi, F., Aminifar, A., Lillehaug, S.-I., Tørresen, J., Pham, M. H., Côté‐Allard, U., Noori, F. M., Guribye, F., et al. (2022) · Digital Health · doi:10.1177/20552076221128678 · Cited by 10 · see citing works
“22 In INTROMAT we will design adaptive IDPTs to reduce dropout and increase adherence and engagement among patients.”
MethodEvaluating the Contribution of New Factors in the Assessment of eHealth Therapeutic Alliance
Ashur, O., Muench, F. J., & Baumel, A. (2023) · Journal of Technology in Behavioral Science · doi:10.1007/s41347-023-00336-z · Cited by 8 · see citing works
“…health patients (Tuerk et al., 2018; Wind et al., 2020), user engagement with EHIs tends to be low, particularly in minimally guided or unguided settings (Bautista & Schueller, 2022; Eysenbach, 2005; Johansson et al., 2015; Käll et al., 2020; Meyerowitz-Katz & Merone, 2020; Sieverink et al., 2017).”
Thapar, S., Nguyen, M., Khan, B. N., Fanaieyan, R., Kishimoto, V., Liu, R. H., Bolea-Alamanac, B. M., Leon-Carlyle, M., O’Riordan, A., Keresteci, M., et al. (2024) · JMIR Formative Research · doi:10.2196/50113 · Cited by 8 · see citing works
“…the discrepancy between the quantitative studies with larger samples and patient experiences reported in qualitative studies suggests that while many patients who do not complete the program report missing face-to-face meetings and synchronous support [46], this may not make a clinical difference.”
ResultLüdtke, T., Rüegg, N., Moritz, S., Berger, T., & Westermann, S. (2021) · Psychiatry Research · doi:10.1016/j.psychres.2021.114223 · Cited by 8 · see citing works
An, J., Kwak, H., Qureshi, H. M., & Weber, I. G. (2021) · JMIR Formative Research · doi:10.2196/33922 · Cited by 8 · see citing works
Simon, L., Steinmetz, L., Bendig, E., Küchler, A., Riemann, D. W., Ebert, D. D., Spiegelhalder, K., & Baumeister, H. (2025) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2025.100598 · Cited by 8 · see citing works
“…are a common symptom of insomnia (Wardle-Pinkston et al. 2019) and that self-help interventions, such as iCBT-I, can place substantial cognitive demands on patients (Johansson et al. 2015), future research should investigate the extent to which cognitive impairments contribute to treatment dropout.”
ICBT in Psychiatry: Generalised Anxiety Disorder
Titov, N., Andersson, G., & Paxling, B. (2016) · Springer eBooks · doi:10.1007/978-3-319-06083-5_5 · Cited by 7 · see citing works
Geerts, J. A., Pieterse, M. E., Laverman, G. D., Waanders, F., Oosterom, N., Slegten, J., Salemink, E., & Bode, C. (2023) · JMIR Formative Research · doi:10.2196/43636 · Cited by 6 · see citing works
“Thus, although neglected by most studies on CBM, patients’ and HCPs’ perspectives are important factors to consider in the development of CBM interventions as they can improve acceptability, usability, and successful implementation [38,39].”
BackgroundDemetry, Y., Wasteson, E., Lindegaard, T., Abuleil, A., Geranmayeh, A., Andersson, G., & Shahnavaz, S. (2023) · JMIR Formative Research · doi:10.2196/46253 · Cited by 6 · see citing works
“Nonadherence to internet interventions is not a novel finding [63].”
BackgroundBasque, D., Talbot, F., & French, D. J. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100458 · Cited by 5 · see citing works
Dahlin, M. (2020) · Linköping studies in behavioural science · doi:10.3384/diss.diva-170049 · Cited by 5 · see citing works
Valla, L., Haga, S. M., Garthus‐Niegel, S., & Drozd, F. (2023) · JMIR Pediatrics and Parenting · doi:10.2196/46982 · Cited by 5 · see citing works
“The literature has previously documented the influence of external factors on treatment dropout [50,51], stating that the demands these factors place on the individual will lead to dropout if they are viewed as an obstacle to the individual’s daily life [51].”
BackgroundMatsumoto, K., Hamatani, S., & Shimizu, E. (2024) · Internet Interventions · doi:10.1016/j.invent.2024.100725 · Cited by 5 · see citing works
“Factors such as literacy skills, concentration, and individual capabilities are considered to be lower in adolescents compared to adults, potentially influencing treatment adherence in ICBT (Johansson et al., 2015).”
BackgroundSieverink, F. (2017) · doi:10.3990/1.9789036544177 · Cited by 5 · see citing works
LeBlanc, J., Talbot, F., Fournier, V., Titov, N., & Dear, B. F. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100529 · Cited by 4 · see citing works
“Paradoxically, strategies aimed at increasing adherence may be, by the individual who does not engage, considered as a factor contributing to the decision to not begin or complete treatment (Johansson et al., 2015).”
BackgroundBendelin, N., Gerdle, B. U. C., & Andersson, G. (2023) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2022-0139 · Cited by 4 · see citing works
“Considering the ongoing digitali-zation of rehabilitation for chronic pain, one way to ease implementation may be to focus on population-speci fi c barriers, especially negative e ff ects of treatment and risks for attrition [38, 62].”
BackgroundBäckman, L., Weineland, S., Vernmark, K., Radvogin, E., Bjälkebring, P., Enbuske, E., Hermansson, I., Johansson, N., Petersen, N., & Hursti, T. (2026) · Scandinavian Journal of Psychology · doi:10.1111/sjop.70045 · Cited by 2 · see citing works
“Complex and unclear materials can diminish the effectiveness and usability of internet-based programs (Johansson et al. 2015).”
Karpov, B., Lipsanen, J. O., Ritola, V., Rosenström, T. H., Saarni, S. E., Pihlaja, S., Stenberg, J., Laizane, P., & Joffe, G. (2023) · Journal of Medical Internet Research · doi:10.2196/45362 · Cited by 3 · see citing works
“In addition, extensive text content of the therapy modules (including long questionnaires), requiring high levels of concentration and reading skills, appears to be an obstacle to successful treatment [40].”
Hatch, S. G., Lobaina, D., & Doss, B. D. (2021) · JMIR Research Protocols · doi:10.2196/33047 · Cited by 1 · see citing works
Rachyla, I., Mor, S., Botella, C., Castilla, D., & Quero, S. (2022) · Frontiers in Virtual Reality · doi:10.3389/frvir.2022.931366 · Cited by 1 · see citing works
“with previous research which found that patients who dropped out from ICBT reported that treatment demands exceeded their capabilities (Johansson et al., 2015).”
MethodExperiences of an internet-delivered treatment of obesity: A qualitative study
Imhagen, A., Jansson, S. P. O., Söderqvist, F., Karlsson, J., Galavazi, M., & Anderzén‐Carlsson, A. (2025) · Internet Interventions · doi:10.1016/j.invent.2025.100876 · Cited by 1 · see citing works
“The therapists may have been insufficiently clear when explaining the program; or, some participants may not have understood the goals of the program, which was a reason for dropout in a study by Johansson et al. (Johansson et al., 2015).”
Egan, S. J., O’Brien, A., Zammit, T., Pauley-Gadd, S. B., Bills, E., Greene, D., MYERS, B. J., Hall, C., Wilson, H., Duffy, M., et al. (2026) · Death Studies · doi:10.1080/07481187.2026.2726889 · Cited by 1 · see citing works
Johansen, H., Vøllestad, J., Sjøbø, T., Nordhus, I. H., Pallesen, S., Havik, O. E., Martinsen, E. W., Nordgreen, T., & Hovland, A. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113381 · Cited by 1 · see citing works
Fernández‐Álvarez, J., Díaz‐García, A., Vara, M. D., Molinari, G., Colombo, D., Riva, G., Baños, R., & Botella, C. (2018) · JMIR Research Protocols · doi:10.2196/resprot.9722
“In particular, qualitative studies have been useful for analyzing clients’ perceptions of a wide range of domains, including facilitators and barriers [19], acceptability [20], nonadherence [21], dropout [22], or negative effects [23] of IBTs.”
Budimir, S., Kuška, M., Spiliopoulou, M., Schlee, W., Pryss, R. C., Andersson, G., Goedhart, H., Harrison, S., Vesala, M., Hegde, G., et al. (2020) · JMIR Formative Research · doi:10.2196/21444
“Specifically, one author (TP) developed items based on the results reported by Johansson et al [13] to investigate reasons for discontinued usage of self-help platforms.”
MethodWestas, M. (2022) · Linköping University medical dissertations · doi:10.3384/9789179293796
Tur, C., & Tur Domenech, C. (2023) · doi:10.6035/14109.2023.433029
Valla, L., Haga, S. M., Garthus‐Niegel, S., & Drozd, F. (2023) · doi:10.2196/preprints.46982
Bendelin, N. (2023) · Linköping University medical dissertations · doi:10.3384/9789180750288
Fernández, O., Pérez, J. C., Fernández, S., Krause, M., Cáceres, C., & Espinosa-Duque, D. (2023) · Digital Health · doi:10.1177/20552076231203920
Tutus, D., Niemitz, M., Plener, P. L., Fegert, J. M., Lehmann, C., Weiss, C., Knaevelsrud, C., Biehl, L., & Rassenhofer, M. (2023) · Research Square · doi:10.21203/rs.3.rs-3289390/v1
Auyeung, L., Tsang, E. Z., & Mak, W. W. S. (2025) · Computers in Human Behavior Reports · doi:10.1016/j.chbr.2025.100695 · Cited by 1 · see citing works
Evidence based consensus statements for digital tools to address youth mental health literacy
Moss, S. J., Siddiqui, S., Chacon, C. Z., Sriskandarajah, C., Stelfox, M., Gaunce, B., Harley, M., Smith, S., Ahmed, S. B., Birnie, K. A., et al. (2025) · Scientific Reports · doi:10.1038/s41598-025-12947-y
“Youth value self-reliance and control when accessing digital mental health tools 140–142 , which are often perceived as impersonal and unresponsive to their individual needs 143,144 .”
Tur, C., Campos, D., Díaz-Sanahuja, L., Fernández-Buendía, S., Grimaldos, J., la Coba-Cañizares, L. D., Kazlauskas, E., & Quero, S. (2025) · Behavioral Sciences · doi:10.3390/bs15101312
“The involvement of a human therapist and the perception of genuine care have been identified as key factors in adherence to online interventions (Andersson, 2009; Christensen et al., 2009; Johansson et al., 2015; Spek et al., 2007).”
The World of E-Therapy And Mental Health Digital Applications
(2024) · Emerald Group Publishing Limited eBooks · doi:10.1108/979-8-88730-594-320251003
Mutter, A., Küchler, A., Idrees, A. R., Kählke, F., Terhorst, Y., & Baumeister, H. (2024) · Figshare · doi:10.6084/m9.figshare.26616967
Bendelin, N., Björkdahl, P., Risell, M., Nelson, K. Z., Gerdle, B., Andersson, G., & Buhrman, M. (2020) · Figshare · doi:10.6084/m9.figshare.12097392
Köksal, B., Korkmaz, M., Özer, Ö., & Kılıçer, K. (2026) · Journal of EMDR Practice and Research · doi:10.34133/jemdr.0029
Lindeberg, T., Patmisari, E., & McLaren, H. (2026) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2026.101001
Experiences From an Internet-Delivered Treatment Program for Individuals With Obesity: Pilot Study
Anderzén‐Carlsson, A., Imhagen, A., Jansson, S. P. O., Galavazi, M., & Karlsson, J. (2026) · JMIR Formative Research · doi:10.2196/79853
“…for dropout identified in this study are broadly consistent with the findings of a qualitative study on nonadherence to iCBT for generalized anxiety disorder [24], as well as with patients’ and therapists’ experiences of challenges related to other internet-delivered interventions [9,27,28].”
InfluentialJabeen, I., Shomik, M. S., Hossain, S., Ara, T., Manna, R. M., Islam, S. M. H., Akter, T., Usmani, N. G., Chandra, P., Ahamed, B., et al. (2026) · BMC Health Services Research · doi:10.1186/s12913-026-15109-6
“Supporting literature emphasizes that satisfaction and alignment of treatment expectations significantly influence continuity of care [35, 40, 41].”
- Authors
- Johansson, O., Michel, T., Andersson, G., & Paxling, B.
- Affiliations
- Lund University (SE)
- Linköping University (SE)
- Corresponding author
- Johansson, Olof
- ORCID
- Andersson, Gerhard
- Venue
- Internet Interventions
- Publisher
- Elsevier BV
- Published
- 2015-05
- Volume
- 2
- Issue
- 2
- Pages
- 137-142
- ISSN
- 2214-7829 (ISSN-L)
- OpenAlex
- W1993492637
- Cited by
- 99
- References
- 45
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 6 · 2023: 16 · 2022: 12 · 2021: 14 · 2020: 13 · 2019: 9 · 2018: 8 · 2017: 3 · 2016: 5 · 2015: 1
- FWCI
- 9.17
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Internet Interventions (publishedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Lund University Publications (Lund University) (submittedVersion)
- Funders
- Swedish Council for Working and Life Research (FAS 2007-0756)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- non-compliance, internet-based cognitive behavioral therapy, generalized anxiety disorder, treatment discontinuation, patient experience, treatment expectations, language skills, daily routine, adherence strategies
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