Internet-delivered Cognitive Behaviour Therapy for Depressive Symptoms: An Exploratory Examination of Therapist Behaviours and their Relationship to Outcome and Therapeutic Alliance
Abstract
Background: A previous study of therapist-assisted Internet-delivered cognitive behaviour therapy (ICBT) for generalized anxiety (Paxling et al., 2013) identified eight distinct therapist behaviours in ICBT (task reinforcement, self-efficacy shaping, task prompting, alliance bolstering, psychoeducation, empathetic utterances, deadline flexibility, and self-disclosure). It is unknown how generalizable these behaviours are across ICBT programs. Aims: We systematically examined the frequency of these eight therapist behaviours and additional newly identified behaviours in e-mails sent to patients during the course of ICBT for depressive symptoms. We also conducted exploratory analyses to examine relationships between therapist behaviours, symptom improvement, and therapeutic alliance. Method: Data was obtained from a previously published open trial (Hadjistavropoulos et al., 2014). A total of 1013 e-mails sent from therapists (n = 24) to patients (n = 41) during ICBT for depressive symptoms were analyzed. Therapist behaviours were correlated with symptom change scores and ratings of therapeutic alliance at mid- and post-treatment. Results: Therapist behaviours described by Paxling et al. were reliably identified in the e-mails using qualitative content analysis; the frequencies of these behaviours differed, however, from the Paxling et al. study and three additional therapist behaviours were identified (administrative statements, questionnaire feedback, asking clarifying questions). Several therapist behaviours (e.g. administrative statements, task prompting) were associated with lower symptom improvement at post-treatment. Questionnaire feedback and task reinforcement were associated with higher patient ratings of therapeutic alliance. Conclusions: The study provides partial support for the generalizability of therapist-assistance across ICBT programs. Experimental research is needed to examine the impact of varying therapist-assistance on patient outcomes.
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What the therapist does is not irrelevant in ICBT.
“studies also show that what the therapist does is not irrelevant 31”
From Internet-delivered psychological treatments: from innovation to implementation (2019) · cites this paper as [31]
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- Authors
- Schneider, L. H., Hadjistavropoulos, H. D., & Faller, Y. N.
- Affiliations
- University of Regina (CA)
- Corresponding author
- Hadjistavropoulos, Heather D.
- Venue
- Behavioural and Cognitive Psychotherapy
- Publisher
- Cambridge University Press (CUP)
- Published
- 2016-06-15
- Volume
- 44
- Issue
- 6
- Pages
- 625-639
- ISSN
- 1352-4658 (ISSN-L)
- 1469-1833
- OpenAlex
- W2437925593
- Cited by
- 38
- References
- 20
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 4 · 2022: 7 · 2021: 4 · 2020: 3 · 2019: 4 · 2018: 7 · 2017: 4
- FWCI
- 7.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behavioural and Cognitive Psychotherapy (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Psychological Association
- Division of Materials Research
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- internet-based cognitive behavioral therapy, depressive symptoms, therapeutic relationship, self-disclosure, psychoeducation, symptom improvement
- MeSH terms
- Adult, Anxiety, Anxiety Disorders, Attitude of Health Personnel, Depression, Female, Humans, Male, Middle Aged, Pilot Projects, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Treatment Outcome, Internet
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