Therapist behaviours in internet-delivered cognitive behaviour therapy: analyses of e-mail correspondence in the treatment of generalized anxiety disorder.
BACKGROUND
Internet-delivered cognitive behaviour therapy (iCBT) has been found to be an effective way to disseminate psychological treatment, and support given by a therapist seems to be important in order to achieve good outcomes. Little is known about what the therapists actually do when they provide support in iCBT and whether their behaviour influences treatment outcome.


OBJECTIVE
This study addressed the content of therapist e-mails in guided iCBT for generalized anxiety disorder.


METHODS
We examined 490 e-mails from three therapists providing support to 44 patients who participated in a controlled trial on iCBT for generalized anxiety disorder.


RESULTS
Through content analysis of the written correspondence, eight distinguishable therapist behaviours were derived: deadline flexibility, task reinforcement, alliance bolstering, task prompting, psychoeducation, self-disclosure, self-efficacy shaping, and empathetic utterances. We found that task reinforcement, task prompting, self-efficacy shaping and empathetic utterances correlated with module completion. Deadline flexibility was negatively associated with outcome and task reinforcement positively correlated with changes on the Penn State Worry Questionnaire.


CONCLUSIONS
Different types of therapist behaviours can be identified in iCBT, and though many of these behaviours are correlated to each other, different behaviours have an impact on change in symptoms and module completion.
Linköping University, Sweden and Vrije Universiteit, Amsterdam, Netherlands.
Björn
B
Paxling
Susanne
S
Lundgren
Anita
A
Norman
Jonas
J
Almlöv
Per
P
Carlbring
Pim
P
Cuijpers
Gerhard
G
Andersson
D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D034742:Electronic Mail; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011369:Professional-Patient Relations; D012054:Reinforcement, Psychology; D012944:Social Support; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome