Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
BMC Psychiatry. 2013 Nov 7;13:296. doi: 10.1186/1471-244X-13-296.
The prevalence of depression is high and results in huge costs for society. Internet-based cognitive behavioural treatment (ICBT) has been suggested for use in primary care and has been shown to be more effective when combined with human support. However, non-completion rates remain a challenge. Current recommendations state that steps to improve persistence with ICBT should be determined and the impact of therapist support on persistence explored. A few earlier studies have explored motivations to persist with ICBT without face-to-face therapist support. The present study explored the motivation to persist as experienced by a group of patients who sought help in primary care and used "blended care", i.e. ICBT supported by short face-to-face consultations.
To elucidate motivation in an everyday context and the meaning of patients' experiences we chose a phenomenological hermeneutical approach. We interviewed participants in the intervention group of a randomized controlled trial that evaluated the efficacy of an ICBT programme called MoodGYM, an eHealth intervention used to treat depression. Fourteen participants, both completers and non-completers, went through individual, semi-structured interviews after they ended their treatment.
Hope of recovery and a desire to gain control of one's life were identified as intrinsic motivators. The feeling of being able to freely choose how, when and where to complete the ICBT modules was identified as an important supporting condition and satisfied the participants' need for autonomy. Furthermore, the importance of a sense of belonging towards partners, friends or family was essential for motivation as was the ability to identify with ICBT content. Another supporting condition was the experience of connectedness when met with acknowledgement, flexibility and feedback from a qualified therapist in the face-to-face consultations.
A key finding was that participants were motivated to persist with ICBT when their overall need for relatedness was satisfied. This was achieved through a sense of belonging towards partners, friends and family. Connectedness with the therapist and the participant's ability to identify with the ICBT modules also gave a sense of relatedness. Improving these motivational aspects may increase patients' persistence with ICBT.
抑郁症的患病率很高，给社会带来了巨大的成本。基于互联网的认知行为治疗（ICBT）已被建议用于初级保健，并已被证明与人类支持相结合时更有效。然而，非完成率仍然是一个挑战。目前的建议指出，应确定提高 ICBT 坚持率的步骤，并探讨治疗师支持对坚持率的影响。一些早期的研究已经探讨了在没有面对面治疗师支持的情况下坚持 ICBT 的动机。本研究探讨了寻求初级保健帮助并使用“混合护理”（即由短期面对面咨询支持的 ICBT）的一组患者坚持治疗的动机。
为了阐明日常背景下的动机以及患者体验的意义，我们选择了现象学解释学方法。我们对一项随机对照试验的干预组进行了访谈，该试验评估了一种名为 MoodGYM 的 ICBT 计划的疗效，这是一种用于治疗抑郁症的电子健康干预措施。14 名参与者（完成者和未完成者）在结束治疗后接受了个体半结构化访谈。
康复的希望和获得对生活控制的渴望被确定为内在动机。能够自由选择何时何地完成 ICBT 模块的感觉被确定为一个重要的支持条件，满足了参与者对自主性的需求。此外，与伴侣、朋友或家人的归属感以及认同 ICBT 内容的能力对于动机至关重要。另一个支持条件是在面对面咨询中，从合格的治疗师那里获得认可、灵活性和反馈时的联系感。
一个关键发现是，当参与者的相关性总体需求得到满足时，他们有动力坚持使用 ICBT。这是通过与伴侣、朋友和家人的归属感来实现的。与治疗师的联系感和参与者认同 ICBT 模块的能力也给予了一种相关性的感觉。改善这些动机方面可能会提高患者对 ICBT 的坚持率。
