“Unrigging the support wheels” - a qualitative study on patients’ experiences with and perspectives on low-intensity CBT
Open accessAbstract
BACKGROUND: Low-intensity treatments imply reduced therapist contact due to an emphasis on self-help and the use of technologies to deliver treatment. The role of the remoteness, the reduced therapist contact, and the interplay of these components has not been differentiated from a patients' perspective so far. This study's purpose is to capture patients' experiences with telephone-based self-help cognitive behavioural therapy (tel-CBT). METHODS: A subsample of mildly to moderately depressed patients (N = 13) who finished tel-CBT as part of a larger randomised controlled trial (RCT) in routine care were interviewed using a semi-structured questionnaire. Interviews were audiotaped, transcribed verbatim, and independently coded by two coders blind to treatment outcome. Using qualitative content analysis with deductive and inductive procedures, a two-level category system was established. RESULTS: The category system contains four category clusters regarding expectations, self-help related aspects, telephone-related aspects, and implications for patients' treatment pathway, and subsumes a total of 15 categories. Self-help related aspects circulate around the interplay between written materials and professional input, trust and support in the therapeutic relationship and its relation to the initial personal contact, as well as CBT principles. Telephone-related aspects entail perceived advantages and disadvantages of the telephone on an organisational and content level as well as a discourse around distance and closeness in the interaction. Although patients raised doubts regarding the long-term effect of the intervention on symptomatology, patients expressed satisfaction with the treatment and reported an immediate as well as a longer lasting personal impact of the treatment. These results indicate user acceptance with tel-CBT. CONCLUSIONS: This qualitative analysis captures patients' experiences with tel-CBT and the perceived helpfulness of the diverse treatment components. This can facilitate refining aspects of low-intensity treatments and might improve dissemination. TRIAL REGISTRATION: ClinicalTrials.gov NCT02667366. Registered on 3 December 2015.
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Participants in studies of telephone-delivered cognitive behavioral therapy for major depression report initial doubt about effectiveness, technical problems, and lack of visual feedback as disadvantages.
“Participants in these studies also report an initial doubt about the effectiveness, technical problems, and lack of visual feedback as disadvantages of telephone-administered CBT.”
From How to promote usage of telehealth interventions for farmers' mental health? A qualitative study on supporting and hindering aspects for acceptance and satisfaction with a personalized telephone coaching for depression prevention (2023) · cites this paper as Haller et al., 2019
The Results (Expectations and fears towards low-intensity CBT; page unavailable) report initial skepticism about whether telephone therapy would work and concern about missing visual cues. The Results (Perceived difficulties with telephone; page unavailable) describe practical issues such as finding a location and keeping a phone charged, but do not report technical malfunctions. The Discussion says communication difficulties from missing visual cues did not materialize, so the paper supports that concern as an initial expectation, not an experienced disadvantage. (LLM, conf=0.85)
Experimental — accuracy not yet measuredReported patient experiences with telephone-delivered cognitive behavioral therapy for major depression highlight overall acceptance of the intervention, the convenience of remote delivery, and a good therapeutic relationship.
“Reported patient experiences with telephone-delivered cognitive behavioral therapy (CBT5) for MDD highlight overall acceptance of the intervention, the convenience of remote delivery, and a good therapeutic relationship (Bee et al., 2010; Haller et al., 2019).”
The described participants' experiences with personalized telephone coaching are very similar to earlier studies reporting experiences by MDD patients with more standardized CBT over telephone.
“The described participants' experiences with personalized telephone coaching are very similar to earlier studies reporting experiences by MDD patients with more standardized CBT over telephone.”
The good therapeutic relationship reported in our and earlier studies is in line with studies reporting no difference in therapeutic relationship in telephone- or face-to-face therapy.
“Despite sporicidal skepticism, the good therapeutic relationship reported in our and earlier studies (Bee et al., 2010; Haller et al., 2019) is in line with studies reporting no difference in therapeutic relationship in telephone- or face-to-face therapy (Irvine et al., 2020; Stiles-Shields et al., 2014).”
Evidence for clinical effectiveness and acceptability of the telephone as a mode of treatment has been established, but challenges remain around uptake and engagement.
“The evidence for clinical effectiveness and acceptability of the telephone as a mode of treatment has been established [13, 30]; challenges, however, remain around uptake and engagement.”
From 'I didn't know what to expect': Exploring patient perspectives to identify targets for change to improve telephone-delivered psychological interventions (2020) · cites this paper as [30]
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- Authors
- Haller, E., Besson, N., & Watzke, B.
- Affiliations
- University of Zurich (CH)
- Corresponding author
- Haller, Elisa
- Venue
- BMC Health Services Research
- Published
- 2019-10-09
- Volume
- 19
- Issue
- 1
- Pages
- 686-686
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC6784338
- OpenAlex
- W2979932941
- Cited by
- 13
- References
- 43
- Citations by year
- 2026: 1 · 2023: 6 · 2022: 3 · 2021: 2 · 2020: 1
- FWCI
- 1.69
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- edoc (University of Basel) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by)
- Zurich Open Repository and Archive (University of Zurich)
- 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
- low-intensity treatment, self-help, depression, patient experience, user acceptance, therapeutic relationship, trust, remote therapy
- MeSH terms
- Adult, Aged, Attitude to Health, Depressive Disorder, Female, Humans, Male, Middle Aged, Professional-Patient Relations, Research Design, Telephone, Cognitive Behavioral Therapy, Treatment Outcome, Telemedicine, Internet, Qualitative Research
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