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Primary‐care patients’ expectations and experiences of online cognitive behavioural therapy for depression: a qualitative study
Open accessAbstract
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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“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]
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“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].”
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“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].”
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“Although it is relatively well established that mental health service users highly value the personal component of face-toface therapy [21], it is possible that the high importance ratings found in this study are somewhat an artefact of directly comparing self-help treatments against face-toface therapy.”
BackgroundResult
Metadata
- Authors
- Beattie, A., Shaw, A., Kaur, S., & Kessler, D.
- Affiliations
- University of Bristol (GB)
- National Institute for Health and Care Research (GB)
- Venue
- Health Expectations
- Publisher
- Wiley
- Published
- 2009-02-27
- Volume
- 12
- Issue
- 1
- Pages
- 45-59
- ISSN
- 1369-6513 (ISSN-L)
- 1369-7625
- 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
- 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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