Primary‐care patients’ expectations and experiences of online cognitive behavioural therapy for depression: a qualitative study

Beattie, Angela; Shaw, Alison; Kaur, Surinder; Kessler, David

doi:10.1111/j.1369-7625.2008.00531.x

Cited by 171Digital Mental Health InterventionsTelemedicine and Telehealth ImplementationAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Primary‐care patients’ expectations and experiences of online cognitive behavioural therapy for depression: a qualitative study

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Beattie, Angela, Shaw, Alison, Kaur, Surinder, Kessler, David·2009·Health Expectations

DOI 10.1111/j.1369-7625.2008.00531.xPMC PMC5060477

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Abstract

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 randomized 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 practices in southwest England, 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 practices are appropriately targeted. The results of our main trial will provide evidence regarding the effectiveness and cost‐effectiveness of receiving therapy via this modality.

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Some individuals are more comfortable self-disclosing to therapists via computer-mediated communication than face-to-face communication, as it reduces their fear of being judged.
“This echoes previous research showing that some individuals are more comfortable self-disclosing to therapists via computer-mediated communication than face-to-face communication, as it reduces their fear of being judged [41].”
From User Experiences of Social Support From Companion Chatbots in Everyday Contexts: Thematic Analysis (2020) · cites this paper as [41]
Personal feedback and support are perceived as positive among patients, to optimally use the program and keep them motivated.
“Studies on the experiences of patients with online therapy also show that personal feedback and support are perceived as positive among patients, to optimally use the program and to keep them motivated [12-14].”
From Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study (2014) · cites this paper as [12]

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BackgroundResultInfluential
Mental health related Internet use among psychiatric patients: a cross-sectional analysis
Kalckreuth, S., Trefflich, F., & Rummel-Kluge, C. (2014) · BMC Psychiatry · doi:10.1186/s12888-014-0368-7 · Cited by 86 · see citing works
“They have been explored in prior research, concluding that the negative perception of such programs mainly stems from the lack of immediate patient – therapist interaction [44,45].”
Background
Exploring Patients' Views of a Cognitive Behavioral Therapy-Based Website for the Self-Management of Irritable Bowel Syndrome Symptoms
Tonkin-Crine, S. K., Bishop, F. L., Ellis, M., Moss-Morris, R. E., & Everitt, H. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2672 · Cited by 83 · see citing works
“Previous qualitative work has explored patients’ views of Internet-delivered CBT self-management programs to help management of depression [20-22].”
Background
Web-based versus home-based postnatal psychoeducational interventions for first-time mothers: A randomised controlled trial
Jiao, N., Zhu, L., Chong, Y. S., Chan, W.-C. S., Luo, N., Wang, W., Hu, R., Chan, Y. H., & He, H. G. (2019) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2019.07.002 · Cited by 79 · see citing works
Benefits of Individualized Feedback in Internet-Based Interventions for Depression: A Randomized Controlled Trial
Zagorscak, P., Heinrich, M., Sommer, D., Wagner, B., & Knaevelsrud, C. (2018) · Psychotherapy and Psychosomatics · doi:10.1159/000481515 · Cited by 77 · see citing works
Patient’s experience with blended video- and internet based cognitive behavioural therapy service in routine care
Etzelmueller, A., Radkovsky, A., Hannig, W., Berking, M., & Ebert, D. D. (2018) · Internet Interventions · doi:10.1016/j.invent.2018.01.003 · Cited by 75 · see citing works
“video-based transmission such as the vulnerability to negative thoughts in the absence of immediate response within unguided self-help interventions (Beattie et al., 2009), the data suggested that this limitation to the therapeutic process can be overcome using VTS.”
A Moment of Mindfulness: Computer-Mediated Mindfulness Practice Increases State Mindfulness
Mahmood, L., Hopthrow, T., & Randsley de Moura, G. (2016) · PLOS ONE · doi:10.1371/journal.pone.0153923 · Cited by 75 · see citing works
“The findings from the present research suggests that allowing participants to carry out interventions in their own surroundings, with greater anonymity, may be the cause of increases in the effectiveness of interventions [48, 49] and that this is true even when the practice is very brief, and the participants are not…”
Computerized cognitive behavioural therapy and the therapeutic alliance: A qualitative enquiry
Barazzone, N., Cavanagh, K., & Richards, D. A. (2012) · British Journal of Clinical Psychology · doi:10.1111/j.2044-8260.2012.02035.x · Cited by 67 · see citing works
Therapist behaviours in internet-based cognitive behaviour therapy (ICBT) for depressive symptoms
Holländare, F., Gustafsson, S. A., Berglind, M., Grape, F., Carlbring, P., Andersson, G., Hadjistavropoulos, H., & Tillfors, M. (2016) · Internet Interventions · doi:10.1016/j.invent.2015.11.002 · Cited by 65 · see citing works
“Consistent with this quantitative research, in a qualitative study many participants expressed appreciation for therapist guidance and were surprised by the high quality of the relationship that developed with the therapist during online communication in ICBT (Beattie et al., 2009).”
Result
A qualitative exploration of Internet-based treatment for comorbid depression and alcohol misuse
Darvell, M. J., Kavanagh, D. J., & Connolly, J. M. (2015) · Internet Interventions · doi:10.1016/j.invent.2015.03.003 · Cited by 69 · see citing works
Participatory design of an online therapy for youth mental health
Wadley, G., Lederman, R., Gleeson, J., & Álvarez‐Jiménez, M. (2013) · Australian Conference on Computer-Human Interaction (OzCHI) · doi:10.1145/2541016.2541030 · Cited by 70 · see citing works
“Mediated interaction with health workers can be convenient for patients who are geographically distant from health services, or busy re-engaging with normal life (Beattie et al., 2009).”
Background
No pain, no gain: Depressed clients' experiences of cognitive behavioural therapy
Barnes, M., Sherlock, S., Thomas, L., Kessler, D. S., Kuyken, W., Owen‐Smith, A., Lewis, G., Wiles, N., & Turner, K. M. (2013) · British Journal of Clinical Psychology · doi:10.1111/bjc.12021 · Cited by 63 · see citing works
Self-citation
Patients’ experiences of a computerised self-help program for treating depression – a qualitative study of Internet mediated cognitive behavioural therapy in primary care
Holst, A., Nejati, S., Björkelund, C., Eriksson, M. C. M., Hange, D., Kivi, M., Wikberg, C., & Petersson, E. (2017) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813432.2017.1288813 · Cited by 63 · see citing works
“Only a few similar studies conducted in primary care context have to date been carried out [28,29].”
BackgroundMethodResultInfluential
The Implementation of Internet Interventions for Depression: A Scoping Review
Drozd, F., Vaskinn, L., Bergsund, H. B., Haga, S. M., Slinning, K., & Bjørkli, C. A. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.5670 · Cited by 60 · see citing works
“Only 3 studies using print media appear to have used a more targeted approach [47,59,60].”
Using text-based synchronous chat to offer therapeutic support to students: A systematic review of the research literature
Erşahin, Z., & Hanley, T. (2017) · Health Education Journal · doi:10.1177/0017896917704675 · Cited by 55 · see citing works
“Thus, the online environment might be perceived by some young clients to be more comfortable and controllable than meeting professionals face-to-face (e.g. Beattie et al., 2009; Gibson et al., 2015).”
Background
Internet‐based interventions for postpartum depression: A systematic review and meta‐analysis
Mu, T., Li, Y., Xu, R., Chen, J., Wang, Y., & Shen, C. (2020) · Nursing Open · doi:10.1002/nop2.724 · Cited by 55 · see citing works
Women’s experiences of factors affecting treatment engagement and adherence in internet delivered Behavioural activation for postnatal depression
O'Mahen, H. A., Grieve, H., Jones, J., McGinley, J., Woodford, J., & Wilkinson, E. L. (2015) · Internet Interventions · doi:10.1016/j.invent.2014.11.003 · Cited by 53 · see citing works
“Their relatively anonymous delivery may also overcome women's fears of stigma (Beattie et al., 2009).”
Background
Linguistic Indicators of Severity and Progress in Online Text-based Therapy for Depression
Howes, C., Purver, M., & McCabe, R. (2014) · Workshop on Computational Linguistics and Clinical Psychology (CLPsych) · doi:10.3115/v1/w14-3202 · Cited by 53 · see citing works
“However, this new online setting provides a challenge of evaluation and optimisation (Hanley and Reynolds, 2009; Beattie et al., 2009).”
BackgroundMethod
Patient experiences of psychological therapy for depression: a qualitative metasynthesis
McPherson, S., Wicks, C., & Tercelli, I. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02682-1 · Cited by 52 · see citing works
Effectiveness of blended depression treatment for adults in specialised mental healthcare: study protocol for a randomised controlled trial
Kemmeren, L., van Schaik, A., Riper, H. M., Kleiboer, A. M., Bosmans, J. E., & Smit, J. H. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-0818-5 · Cited by 49 · see citing works
“From a clinical perspective it seems rational that patients with more severe and more complex symptomatology of depression as present in routine care, may need face-toface interaction [22].”
Background
Patients' experiences in a guided Internet- and App-based stress intervention for college students: A qualitative study
Fleischmann, R. J., Harrer, M., Zarski, A.-C., Baumeister, H., Lehr, D., & Ebert, D. D. (2018) · Internet Interventions · doi:10.1016/j.invent.2017.12.001 · Cited by 47 · see citing works
Women’s Experiences of Internet-Based or Postal Treatment for Stress Urinary Incontinence
Björk, A. B., Sjöström, M., Johansson, E. E., Samuelsson, E. C., & Umefjord, G. (2014) · Qualitative Health Research · doi:10.1177/1049732314524486 · Cited by 47 · see citing works
“The lack of face-to-face contact can have a dual impact: It might make it easier to communicate about sensitive issues (Suler, 2004), but the loss of some communicational aspects might lead to a superficial relationship (Beattie et al., 2009).”
Background
A patient <i>post hoc</i> perspective on advantages and disadvantages of blended cognitive behaviour therapy for depression: A qualitative content analysis
Urech, A., Krieger, T., Möseneder, L., Biaggi, A., Vincent, A., Poppe, C., Meyer, B., Riper, H., & Berger, T. (2019) · Psychotherapy Research · doi:10.1080/10503307.2018.1430910 · Cited by 43 · see citing works
Web-based cognitive behavioral therapy blended with face-to-face sessions for major depression: randomized controlled trial
Nakao, S., Nakagawa, A., Oguchi, Y., Mitsuda, D., Kato, N., Nakagawa, Y., Tamura, N., Kudo, Y., Abe, T., Hiyama, M., et al. (2018) · Journal of Medical Internet Research · doi:10.2196/10743 · Cited by 45 · see citing works
Demographic and clinical predictors of response to internet-enabled cognitive-behavioural therapy for depression and anxiety.
Catarino, A., Bateup, S., Tablan, V., Innes, K., Freer, S., Richards, A., Stott, R., Hollon, S. D., Chamberlain, S. R., Hayes, A., et al. (2018) · BJPsych Open · doi:10.1192/bjo.2018.57 · Cited by 40 · see citing works
“9,10 Despite multiple potential advantages, varying degrees of therapist intervention in online CBT can affect clinical outcomes and patient engagement in real-world settings, 5,8,11,12 with therapist-guided online CBT associated with better clinical outcomes and lower drop-out rates than…”
Women’s expectations and experiences regarding e-health treatment: A systematic review
Verhoeks, C. M., Teunissen, D. A. M., van der Stelt-Steenbergen, A., & Lagro-Janssen, A. L. M. (2017) · Health Informatics Journal · doi:10.1177/1460458217720394 · Cited by 43 · see citing works
Treatment Activity, User Satisfaction, and Experienced Usability of Internet-Based Cognitive Behavioral Therapy for Adults With Depression and Anxiety After a Myocardial Infarction: Mixed-Methods Study
Wallin, E., Norlund, F., Olsson, E. M. G., Burell, G., Held, C., & Carlsson, T. (2018) · Journal of Medical Internet Research · doi:10.2196/jmir.9690 · Cited by 36 · see citing works
Religious versus Conventional Psychotherapy for Major Depression in Patients with Chronic Medical Illness: Rationale, Methods, and Preliminary Results
Koenig, H. G. (2012) · Depression Research and Treatment · doi:10.1155/2012/460419 · Cited by 41 · see citing works
“Furthermore, this approach is acceptable to depressed patients, and therapy without face-to-face contact may encourage greater disclosure [24].”
Background
Therapist telephone-delivered CBT and web-based CBT compared with treatment as usual in refractory irritable bowel syndrome: the ACTIB three-arm RCT
Everitt, H., Landau, S., Little, P. S., Bishop, F. L., O’Reilly, G., Sibelli, A., Holland, R., Hughes, S. F., Windgassen, S., McCrone, P., et al. (2019) · Health Technology Assessment · doi:10.3310/hta23170 · Cited by 40 · see citing works
“5) 9 (59) 0 (0) – 0 (0) Social worker 4 (2) 3.”
Experiences of undergoing Internet-based cognitive behavior therapy for procrastination: A qualitative study
Rozental, A., Forsström, D., Tangen, J. A., & Carlbring, P. (2015) · Internet Interventions · doi:10.1016/j.invent.2015.05.001 · Cited by 39 · see citing works
Online Therapy for Depressive Symptoms: An Evaluation of Counselor-Led and Peer-Supported Life Review Therapy
Westerhof, G. J., Lamers, S. M. A., Postel, M. G., & Bohlmeijer, E. T. (2017) · The Gerontologist · doi:10.1093/geront/gnx140 · Cited by 38 · see citing works
“They mentioned reasons to participate in an online intervention that were also found in other studies (Beattie et al., 2009; Cuijpers et al., 2010): the perceived anonymity and the flexibility to carry out assignments in their own time and place.”
A Systematic Review of Technology-Based Prevention and Treatment Interventions for Perinatal Depression and Anxiety in Latina and African American Women
Lara-Cinisomo, S., Olarte, A. R., Rosales, M. F., & Barrera, A. Z. (2021) · Maternal and Child Health Journal · doi:10.1007/s10995-020-03028-9 · Cited by 40 · see citing works
“Internet-based interventions to treat depression have also been shown to offer anonymity when disclosing feelings and thoughts (Beattie et al. 2009).”
Background
Online Counseling
Richards, D., & Viganò, N. (2012) · IGI Global eBooks · doi:10.4018/978-1-4666-0315-8.ch059 · Cited by 38 · see citing works
Suitability of Text-Based Communications for the Delivery of Psychological Therapeutic Services to Rural and Remote Communities: Scoping Review
Dwyer, A., Neto, A. D. A., Estival, D., Li, W., Lam‐Cassettari, C., & Antoniou, M. (2021) · JMIR Mental Health · doi:10.2196/19478 · Cited by 39 · see citing works
“Interviews with 24 patients with depression [54] were used to evaluate an online e-mental health treatment [34].”
BackgroundMethod
Internet-based cognitive behavior therapy for patients with heart failure and depressive symptoms: a proof of concept study
Lundgren, J., Andersson, G., Dahlström, Ö., Jaarsma, T., Köhler, A. K., & Johansson, P. (2015) · Patient Education and Counseling · doi:10.1016/j.pec.2015.04.013 · Cited by 34 · see citing works
“These results are similar to other findings of positive aspects of ICBT programs [41,55].”
Result
Development of an internet-administered cognitive behavior therapy program (ENGAGE) for parents of children previously treated for cancer: participatory action research approach
Wikman, A., Kukkola, L., Börjesson, H., Cernvall, M., Woodford, J., Grönqvist, H., & von Essen, L. (2018) · Journal of Medical Internet Research · doi:10.2196/jmir.9457 · Cited by 32 · see citing works
Facilitating and hindering factors in Internet-delivered treatment for insomnia and depression
Blom, K., Jernelöv, S., Lindefors, N., & Kaldo, V. (2016) · Internet Interventions · doi:10.1016/j.invent.2016.03.004 · Cited by 33 · see citing works
“Some of the previous qualitative studies on ICBT look into motivators and motivations (Donkin and Glozier, 2012), expectations and experiences in primary care (Beattie et al., 2009) and therapist behaviors (Paxling et al.”
Background
Participants’ experiences of an Internet-based cognitive behavioural therapy intervention for tinnitus
Beukes, 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
“Some of these factors have been identified before (Andersson and Titov 2014; Beattie et al. 2009).”
Background
Expectations and Experiences of Couples Receiving Therapy Through Videoconferencing: A Qualitative Study
Kysely, A., Bishop, B. J., Kane, R. T., Cheng, M., Palma, M. D., & Rooney, R. M. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.02992 · Cited by 31 · see citing works
Barriers to Mental Health Care: Perceived Delivery System Differences
Lingley-Pottie, P., McGrath, P. J., & Andreou, P. (2013) · Advances in Nursing Science · doi:10.1097/ans.0b013e31828077eb · Cited by 27 · see citing works
What can low and high technologies do for late-life mental disorders?
Westphal, A., Dingjan, P. G., & Attoe, R. (2010) · Current Opinion in Psychiatry · doi:10.1097/yco.0b013e32833d74d4 · Cited by 27 · see citing works
Experiences and implications of smartphone apps for depression and anxiety
Crosby, L., & Bonnington, O. (2020) · Sociology of Health & Illness · doi:10.1111/1467-9566.13076 · Cited by 27 · see citing works
ICBT program for improving informal caregiver well-being: A qualitative study
Biliunaite, I., Dumarkaite, A., Kazlauskas, E., Sanderman, R., & Andersson, G. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100361 · Cited by 22 · see citing works
Online counseling using email: a qualitative study
Salleh, A. M., Hamzah, R., Nordin, N. M., Ghavifekr, S., & Joorabchi, T. N. (2015) · Asia Pacific Education Review · doi:10.1007/s12564-015-9393-6 · Cited by 27 · see citing works
“As online counseling or therapy has become increasingly accepted by mental health providers (Richards and Viganó 2013; Beattie et al. 2009; Wade 2010), numerous”
BackgroundInfluential
Expectations, experiences and attitudes of patients and primary care health professionals regarding online psychotherapeutic interventions for depression: protocol for a qualitative study
Montero-Marín, J., Carrasco, J. M., Roca, M., Serrano-Blanco, A., Gili, M., Mayoral, F., Luciano, J. V., Lopez-del-Hoyo, Y., Olivan, B., Collazo, F., et al. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-64 · Cited by 26 · see citing works
“To date, research on these issues has been restricted to the perspective of the patient [32-35] without adequately addressing the perspectives of health officials who would be involved in recommending this type of intervention.”
Background
Time to level up: A systematic review of interventions aiming to reduce stigma toward autistic people
Kim, S. Y., Song, D., Bottema‐Beutel, K., & Gillespie‐Lynch, K. (2023) · Autism · doi:10.1177/13623613231205915 · Cited by 30 · see citing works
“This suggests an increase in one-time computerized approaches, likely due to reduced costs, increased convenience for participants, and increased flexibility of time and location as compared with other types of intervention delivery (Beattie et al., 2009; Griffith et al., 2006).”
Background
Computer-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
Design Considerations for the Integrated Delivery of Cognitive Behavioral Therapy for Depression: User-Centered Design Study
Stawarz, K., Preist, C., Tallon, D., Wiles, N., Kessler, D., Turner, K., Shafran, R., & Coyle, D. (2020) · JMIR Mental Health · doi:10.2196/15972 · Cited by 24 · see citing works
Self-citation
The Efficacy of Technology‐Based Interventions for Alcohol and Illicit Drug Use Among Women of Childbearing Age: A Systematic Review and Meta‐Analysis
Hai, A. H., Hammock, K., & Velasquez, M. M. (2019) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.14203 · Cited by 24 · see citing works
Orienting to Emotion in Computer-Mediated Cognitive Behavioral Therapy
Ekberg, S., Shaw, A. R. G., Kessler, D. S., Malpass, A., & Barnes, R. (2016) · Research on Language and Social Interaction · doi:10.1080/08351813.2016.1199085 · Cited by 23 · see citing works
Self-citation
The Experience of Guided Online Therapy: A Longitudinal, Qualitative Analysis of Client Feedback in a Naturalistic RCT
Jardine, J., Earley, C., Richards, D., Timulák, L., Palacios, J. E., Duffy, D. J., Tierney, K., & Doherty, G. J. (2020) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3313831.3376254 · Cited by 22 · see citing works
“that it will be difficult to form a trusting, meaningful relationship online and this will lead to a lack of accountability, or conversely that the anonymity of online treatment will aid their commitment and make it easier to be honest [4].”
Background
A systematic review of technology-based interventions for co-occurring substance use and trauma symptoms
Gilmore, A. K., Wilson, S. M., Skopp, N. A., Osenbach, J. E., & Reger, G. M. (2016) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x16664205 · Cited by 22 · see citing works
Patient and therapist expectations for a blended cognitive behavioral therapy program for depression: qualitative exploratory study
Atik, E., Schückes, M., & Apolinário-Hagen, J. (2022) · JMIR Mental Health · doi:10.2196/36806 · Cited by 22 · see citing works
“According to one interpretation of the data, different patients should not be given identical psychological intervention content or feedback, which is consistent with previous research [26,41,50,53,54].”
Result
How should we evaluate research on counselling and the treatment of depression? A case study on how the National Institute for Health and Care Excellence's draft 2018 guideline for depression considered what counts as best evidence
Barkham, M., Moller, N. P., & Pybis, J. (2017) · Counselling and Psychotherapy Research · doi:10.1002/capr.12141 · Cited by 21 · see citing works
Integrating the Digital and the Traditional to Deliver Therapy for Depression
Stawarz, K., Preist, C., Tallon, D., Thomas, L., Turner, K. M., Wiles, N., Kessler, D. S., Shafran, R., & Coyle, D. (2020) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3313831.3376510 · Cited by 24 · see citing works
“Evidence suggests that including limited electronic contact from a health professional can help to improve patient motivation and completion rates, and increase the effectiveness of cCBT [1, 6, 10, 33, 50, 57].”
BackgroundResultSelf-citation
Managing the therapeutic relationship in online cognitive behavioural therapy for depression: Therapists' treatment of clients' contributions
Ekberg, S., Barnes, R., Kessler, D. S., Malpass, A., & Shaw, A. (2013) · Language Internet · Cited by 21 · see citing works
Self-citation
Experiences and engagement with the design features and strategies of an internet-delivered treatment programme for generalised anxiety disorder: a service-based evaluation
Walsh, A., & Richards, D. (2017) · British Journal of Guidance & Counselling · doi:10.1080/03069885.2016.1153039 · Cited by 20 · see citing works
Adaptation of Relationship Assessment Scale to Turkish Culture: Study of Validity and Reliability
Çeli̇k, E. (2014) · International Journal of Psychology and Educational Studies · doi:10.17220/ijpes.2014.01.001 · Cited by 20 · see citing works
Managing clients’ expectations at the outset of online Cognitive Behavioural Therapy (CBT) for depression
Ekberg, S., Barnes, R., Kessler, D., Malpass, A., & Shaw, A. (2014) · Health Expectations · doi:10.1111/hex.12227 · Cited by 19 · see citing works
“Methods Data This study follows a trial of online CBT for primary care clients diagnosed with depression.(30,31) This study utilises typed transcripts of online CBT sessions from 183 client-therapist dyads.”
MethodSelf-citation
Gamified Cognitive Control Training for Remitted Depressed Individuals: User Requirements Analysis
Vervaeke, J., LOOY, J. V., Hoorelbeke, K., Baeken, C., & Koster, E. H. W. (2018) · JMIR Serious Games · doi:10.2196/games.8609 · Cited by 20 · see citing works
“For instance, previous research has shown beneficial effects of an intuitive and interactive product [53], of reminders and motivational prompts [54], and that presented text should match the individual’s reading and computer skill [55].”
Background
Patients’ Experiences of Telephone-Based and Web-Based Cognitive Behavioral Therapy for Irritable Bowel Syndrome: Longitudinal Qualitative Study
Hughes, S. F., Sibelli, A., Everitt, H., Moss-Morris, R. E., Chalder, T., Harvey, J. M., Falcao, A. V., Landau, S., O’Reilly, G., Windgassen, S., et al. (2020) · Journal of Medical Internet Research · doi:10.2196/18691 · Cited by 19 · see citing works
A guided self-help intervention targeting psychological distress among head and neck cancer and lung cancer patients: motivation to start, experiences and perceived outcomes
Krebber, A.-M. H., van Uden‐Kraan, C. F., Melissant, H. C., Cuijpers, P. J., van Straten, A., Becker‐Commissaris, A., Leemans, C. R., & Leeuw, I. M. V. (2016) · Supportive Care in Cancer · doi:10.1007/s00520-016-3393-x · Cited by 18 · see citing works
“[30], regarding experiences with online CBT for depression in primary care.”
Background
Adherence to a web-based pre-treatment for phobias in outpatient clinics
Kok, R. N., Beekman, A. T. F., Cuijpers, P. J., & van Straten, A. (2017) · Internet Interventions · doi:10.1016/j.invent.2017.05.004 · Cited by 18 · see citing works
“Furthermore, assessment of patient expectations (Greenberg et al., 2006), preferences (Beattie et al., 2009; Boettcher et al., 2013) and intrinsic motivation (Mohr et al., 2011) should be assessed carefully.”
Background
The effectiveness of cognitive-behavioral therapy for heart failure patients: a narrative review
Katta, M. R., Prasad, S., Tiwari, A., Abouzid, M. R. A., & Mitra, S. (2023) · Journal of International Medical Research · doi:10.1177/03000605231198371 · Cited by 17 · see citing works
Experiences and perspectives of patients with post-polio syndrome and therapists with exercise and cognitive behavioural therapy
Bakker, M., Schipper, K., Koopman, F. S., Nollet, F., & Abma, T. (2016) · BMC Neurology · doi:10.1186/s12883-016-0544-0 · Cited by 17 · see citing works
“Most studies that paid attention to the patients’ experiences focused on mental health problems, like depression or psychosis [20, 21].”
Background
‘One man’s medicine is another man’s poison’: a qualitative study of user perspectives on low intensity interventions for Obsessive-Compulsive Disorder (OCD)
Knopp, J., Knowles, S. E., Bower, P., Lovell, K., & Bee, P. (2016) · BMC Health Services Research · doi:10.1186/s12913-016-1433-3 · Cited by 16 · see citing works
“Research in individuals with depression and anxiety [19–22] has identified both perceived advantages and disadvantages of low intensity interventions, highlighting individual differences in the value placed on professional support.”
Background

Patients’ experiences of a computerised self-help program for treating depression – a qualitative study of Internet mediated cognitive behavioural therapy in primary care
Holst, A., Nejati, S., Björkelund, C., Eriksson, M. C. M., Hange, D., Kivi, M., Wikberg, C., & Petersson, E. (2017) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813432.2017.1288813 · Cited by 63 · see citing works
Patients’ reasons for declining a trial evaluating integrated online cognitive behavioural therapy for depression
Fox, F. E., Tallon, D., Jude, B., Lanham, P., Shafran, R., Williams, C. G., Wiles, N., Kessler, D. S., & Turner, K. M. (2023) · Bristol Research (University of Bristol)
Self-citation
Expectations, experiences and attitudes of patients and primary care health professionals regarding online psychotherapeutic interventions for depression: protocol for a qualitative study
Montero-Marín, J., Carrasco, J. M., Roca, M., Serrano-Blanco, A., Gili, M., Mayoral, F., Luciano, J. V., Lopez-del-Hoyo, Y., Olivan, B., Collazo, F., et al. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-64 · Cited by 26 · see citing works
Patient experience of computerised therapy for depression in primary care
Knowles, S. E., Lovell, K., Bower, P., Gilbody, S., Littlewood, E., & Lester, H. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-008581 · Cited by 89 · see citing works
Research focus
Donovan, S. (2010) · Primary Health Care · doi:10.7748/phc.20.5.14.s22

Authors: Beattie, A., Shaw, A., Kaur, S., & Kessler, D.
Affiliations: University of Bristol (GB)
National Institute for Health and Care Research (GB)
ORCID: Shaw, Alison
Kessler, David
Venue: Health Expectations
Publisher: Wiley
Published: 2009-02-27
Volume: 12
Issue: 1
Pages: 45-59
ISSN: 1369-6513 (ISSN-L)
1369-7625
DOI: 10.1111/j.1369-7625.2008.00531.x
PMC: PMC5060477
OpenAlex: W1981927499
Cited by: 170
References: 35
Citations by year: 2026: 2 · 2025: 6 · 2024: 7 · 2023: 6 · 2022: 6 · 2021: 10 · 2020: 16 · 2019: 7 · 2018: 13 · 2017: 10 · 2016: 21 · 2015: 10 · 2014: 18 · 2013: 15 · 2012: 7
FWCI: 9.01
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Health Expectations (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Explore Bristol Research (publishedVersion)
Funders: National Institute for Health and Care Research (CL-2007-25-001)
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 › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: internet-based cognitive behavioral therapy, depression, primary care, patient expectations, patient experience, therapeutic relationship, anonymity, written communication, computer literacy, acceptability, face-to-face interaction
MeSH terms: Adult, Aged, Depression, England, Female, Humans, Interviews as Topic, Male, Middle Aged, Primary Health Care, Cognitive Behavioral Therapy, Patient Satisfaction, Internet, Young Adult

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Primary‐care patients’ expectations and experiences of online cognitive behavioural therapy for depression: a qualitative study

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