title: Patients' experiences of helpfulness in guided internet-based treatment for depression: qualitative study of integrated therapeutic dimensions.
abstract: BACKGROUND
  Quantitative research on Internet-based cognitive behavioral therapy (ICBT) has collected substantial evidence for the effectiveness of this treatment approach on health outcomes. Less is known about how patients find ICBT to be generally meaningful and helpful for treating depression.
  
  
  OBJECTIVE
  To explore patients' experiences of being in ICBT treatment with a focus on the treatment dimensions that they considered helpful.
  
  
  METHODS
  Choosing a phenomenological-hermeneutical approach, 14 patients were interviewed with semistructured qualitative interviews to elicit their understanding of using ICBT. The patients took part in a clinical trial using ICBT with MoodGYM, which also featured brief consultations with a clinical psychologist. The interviews were transcribed and analyzed according to the chosen methodology and organized into significant themes.
  
  
  RESULTS
  The phenomenological-hermeneutical analysis identified 5 themes relating overall to the meaning of this mode of treatment in terms of helpfulness. Two related to treatment in general: (1) taking action to address one's problems and (2) the value of talking to a professional. The next two themes specifically addressed guided self-help using the MoodGYM program: (3) acquiring relevant knowledge, and (4) restructuring the new knowledge acquired through ICBT. A fifth theme concerned (5) actual changes in patients' perceptions and interactions, related to either the self-help material or the face-to-face consultations with the therapist.
  
  
  CONCLUSIONS
  Three important dimensions were made explicit: the active engagement of the patient, the guidance of the therapist, and the content of the treatment program. The findings pointed to (1) the role of MoodGYM as a source of new knowledge providing patients with a structured approach to work with their depression, (2) the patient's role as the primary agent of change through adapting relevant knowledge from MoodGYM to their situation, and (3) the dialogue with the therapist as a trusting relationship in which to share thoughts and feelings, receive feedback and advice, and to assist the patient in making use of the MoodGYM content.
authors.affiliation: Department of Psychology, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway. kjersti.lillevoll@uit.no
authors.forename: Kjersti R
authors.initials: KR
authors.lastname: Lillevoll
authors.forename: Maja
authors.initials: M
authors.lastname: Wilhelmsen
authors.forename: Nils
authors.initials: N
authors.lastname: Kolstrup
authors.forename: Ragnhild Sørensen
authors.initials: RS
authors.lastname: Høifødt
authors.forename: Knut
authors.initials: K
authors.lastname: Waterloo
authors.forename: Martin
authors.initials: M
authors.lastname: Eisemann
authors.forename: Mette Bech
authors.initials: MB
authors.lastname: Risør
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: ICBT; Internet-based cognitive behavioral therapy; depression; guided self-help; qualitative