Treatment Difficulties In Guided Online Therapy

Background While the effectiveness of online therapies is well-documented, only few studies on treatment difficulties exist. Objective The aim of the study was to examine treatment difficulties in a guided cognitive behavioral online therapy for emotional disorders, using quantitative and qualitative methods. Material and methods The frequencies for drop-out, nonresponse, symptom deterioration and self-reported negative effects were determined based on a baseline sample of 116 patients, assessing symptom burden (Brief Symptom Inventory, BSI-18) and negative effects (Negative Effects Questionnaire, NEQ). Furthermore, absent and negative changes as well as hindering aspects were qualitatively investigated based on semistructured patient interviews (Client Change Interview, CCI) with a subsample of 21 patients. In addition, two case studies were selected, which are described in the results section. Results The frequencies of treatment difficulties were 31% for drop-out, 46% for nonresponse and 3% for symptom deterioration. The most commonly reported negative effects were negative memories/feelings and stress. In the CCIs, absence of changes was most frequently reported in the areas of "negative affect" and "global/other", negative changes were most frequently reported in the area of "negative affect". Participants reported formal aspects and external factors to be hinderances. In the case studies, additional treatment barriers appeared in the form of text comprehension problems, negative core assumptions, and therapy skepticism. Conclusion Treatment difficulties occurred primarily in the form of nonresponse and therapy drop-out. In future interventions these could be reduced by achieving a better fit between patients' needs and intervention conditions.