Gullickson Kirsten M, Hadjistavropoulos Heather D, Dear Blake F, Titov Nickolai
Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada.
eCentreClinic, Department of Psychology, Macquarie University, Balaclava Road, North Ryde, NSW, Australia.
Internet Interv. 2019 Sep 4;18:100278. doi: 10.1016/j.invent.2019.100278. eCollection 2019 Dec.
Internet-delivered cognitive behaviour therapy (ICBT) is an efficacious form of treatment for anxiety and depression, yet it is still possible for clients to experience negative effects associated with treatment. In the ICBT literature, the term negative effects is broadly used to refer to all potentially adverse or unwanted events or experiences that are perceived as undesirable by the client and may or may not be associated with long-term symptoms or distress. Previous ICBT studies have asked clients to retrospectively describe negative effects at post-treatment; however, no research has examined the content of clients' emails to their therapist to see whether clients are reporting negative effects as they arise. In the current study, 96 clients (80 completers; 16 non-completers) were randomly selected from a published ICBT trial and directed content analysis was used to examine client emails for mention of negative effects. In addition, correlational analyses were used to examine the relationship between negative effects and: 1) demographic characteristics; 2) treatment engagement; 3) treatment satisfaction; 4) working alliance; and 5) symptom outcomes among completers. The results indicated that 61.5% of clients experienced at least one negative effect during treatment, although total number of negative effects was not significantly correlated with client demographic characteristics, lessons completed, working alliance, treatment satisfaction, or symptom outcomes. Among completers, , , and were the most commonly reported negative effects, whereas was the most commonly reported negative effect by non-completers. Negative effects that have been identified in previous research, such as symptom deterioration, novel symptoms, and severe adverse events, were not identified in client emails. The high incidence of negative effects in the current study suggests there may be value in systematically monitoring client emails for negative effects throughout treatment as a supplement to retrospective post-treatment reports. This will give therapists the opportunity to intervene as negative effects occur and potentially mitigate any impact they have on treatment outcomes. Future research, both qualitative and quantitative, is needed to gain a more nuanced understanding of negative effects associated with ICBT.
互联网认知行为疗法（ICBT）是治疗焦虑症和抑郁症的一种有效形式，但客户仍有可能经历与治疗相关的负面影响。在ICBT文献中，“负面影响”一词被广泛用于指代所有潜在的不良或 unwanted 事件或经历，这些事件或经历被客户视为不受欢迎的，并且可能与长期症状或困扰有关，也可能无关。以前的ICBT研究要求客户在治疗后回顾性描述负面影响；然而，没有研究检查客户给治疗师的电子邮件内容，以了解客户是否在负面影响出现时进行报告。在本研究中，从一项已发表的ICBT试验中随机选择了96名客户（80名完成者；16名未完成者），并采用定向内容分析法检查客户电子邮件中提及的负面影响。此外，还进行了相关分析，以检查负面影响与以下因素之间的关系：1）人口统计学特征；2）治疗参与度；3）治疗满意度；4）工作联盟；5）完成者的症状结果。结果表明，61.5%的客户在治疗期间经历了至少一种负面影响，尽管负面影响的总数与客户人口统计学特征、完成的课程、工作联盟、治疗满意度或症状结果没有显著相关性。在完成者中， 、 和 是最常报告的负面影响，而 是未完成者最常报告的负面影响。以前研究中确定的负面影响，如症状恶化、新症状和严重不良事件，在客户电子邮件中未被发现。本研究中负面影响的高发生率表明，在整个治疗过程中系统地监测客户电子邮件中的负面影响作为对治疗后回顾性报告的补充可能有价值。这将使治疗师有机会在负面影响出现时进行干预，并可能减轻它们对治疗结果的任何影响。需要进行未来的定性和定量研究，以更细致地了解与ICBT相关的负面影响。
