title: Improving adherence and effectiveness of computerised cognitive behavioural therapy without support for depression: a qualitative study on patient experiences.
abstract: BACKGROUND
  Several studies have evaluated the efficacy and effectiveness of computerized cognitive behavioural therapy (CCBT) for depression, but research on the patient perspective is limited.
  
  
  OBJECTIVE
  To gain knowledge on patient experiences with the online self-help CCBT program Colour Your Life (CYL) for depression, and find explanations for the low treatment adherence and effectiveness.
  
  
  METHODS
  Qualitative data were collected through semi-structured interviews with 18 patients. Interviewees were selected from a CCBT trial. An inductive, content analysis of the interviews was performed.
  
  
  RESULTS
  The main theme throughout the interviews concerns barriers and motivators experienced with CCBT. The most important barriers included experiences of a lack of identification with and applicability of CCBT-CYL, lack of support to adhere with the program or to gain deeper understanding, and inadequate computer/Internet skills, equipment, or location. Confusion between CCBT and Internet questionnaires resulted in no CCBT uptake of some study participants. Motivators included experiencing self-identification and improvement through CCBT-CYL, participating in a scientific study, and the freedom and anonymity associated with online computer self-help. The addition of support to CCBT was suggested as an improvement towards adherence and the course content.
  
  
  CONCLUSIONS
  The CCBT program CYL in its current form does not work for a large group of people with depressive symptoms. More tailoring, the provision of support (professional or lay) and good computer conditions could improve CCBT.
authors.affiliation: Department of Clinical Psychological Science, Faculty of Psychology, Maastricht University, The Netherlands. S.Gerhards@maastrichtuniversity.nl
authors.forename: S A H
authors.initials: SA
authors.lastname: Gerhards
authors.forename: T A
authors.initials: TA
authors.lastname: Abma
authors.forename: A
authors.initials: A
authors.lastname: Arntz
authors.forename: L E
authors.initials: LE
authors.lastname: de Graaf
authors.forename: S M A A
authors.initials: SM
authors.lastname: Evers
authors.forename: M J H
authors.initials: MJ
authors.lastname: Huibers
authors.forename: G A M
authors.initials: GA
authors.lastname: Widdershoven
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003197:Computer Literacy; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010349:Patient Compliance / Q000523:psychology; D017060:Patient Satisfaction; D013813:Therapy, Computer-Assisted; D016896:Treatment Outcome