van Dooren Marierose M M, Visch Valentijn, Spijkerman Renske, Goossens Richard H M, Hendriks Vincent M
Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands.
Parnassia Addiction Research Centre, Brijder Addiction Care, Parnassia Group, The Hague, Netherlands.
JMIR Form Res. 2020 May 6;4(5):e15568. doi: 10.2196/15568.
Electronic health (eHealth) programs are often based on protocols developed for the original face-to-face therapies. However, in practice, therapists and patients may not always follow the original therapy protocols. This form of personalization may also interfere with the intended implementation and effects of eHealth interventions if designers do not take these practices into account.
The aim of this explorative study was to gain insights into the personalization practices of therapists and patients using cognitive behavioral therapy, one of the most commonly applied types of psychotherapy, in a youth addiction care center as a case context.
Focus group discussions were conducted asking therapists and patients to estimate the extent to which a therapy protocol was followed and about the type and reasons for personalization of a given therapy protocol. A total of 7 focus group sessions were organized involving therapists and patients. We used a commonly applied protocol for cognitive behavioral therapy as a therapy protocol example in youth mental health care. The first focus group discussions aimed at assessing the extent to which patients (N=5) or therapists (N=6) adapted the protocol. The second focus group discussions aimed at estimating the extent to which the therapy protocol is applied and personalized based on findings from the first focus groups to gain further qualitative insight into the reasons for personalization with groups of therapists and patients together (N=7). Qualitative data were analyzed using thematic analysis.
Therapists used the protocol as a "toolbox" comprising different therapy tools, and personalized the protocol to enhance the therapeutic alliance and based on their therapy-provision experiences. Therapists estimated that they strictly follow 48% of the protocol, adapt 30%, and replace 22% by other nonprotocol therapeutic components. Patients personalized their own therapy to conform the assignments to their daily lives and routines, and to reduce their levels of stress and worry. Patients estimated that 29% of the provided therapy had been strictly followed by the therapist, 48% had been adjusted, and 23% had been replaced by other nonprotocol therapeutic components.
A standard cognitive behavioral therapy protocol is not strictly and fully applied but is mainly personalized. Based on these results, the following recommendations for eHealth designers are proposed to enhance alignment of eHealth to therapeutic practice and implementation: (1) study and copy at least the applied parts of a protocol, (2) co-design eHealth with therapists and patients so they can allocate the components that should be open for user customization, and (3) investigate if components of the therapy protocol that are not applied should remain part of the eHealth applied. To best generate this information, we suggest that eHealth designers should collaborate with therapists, patients, protocol developers, and mental health care managers during the development process.
电子健康（eHealth）项目通常基于为原始面对面治疗制定的协议。然而，在实践中，治疗师和患者可能并不总是遵循原始治疗协议。如果设计者没有考虑到这些做法，这种个性化形式也可能会干扰电子健康干预措施的预期实施和效果。
本探索性研究的目的是深入了解在青少年成瘾护理中心这一案例背景下，使用认知行为疗法（最常用的心理治疗类型之一）的治疗师和患者的个性化做法。
进行焦点小组讨论，要求治疗师和患者估计遵循治疗协议的程度，以及给定治疗协议的个性化类型和原因。总共组织了7次焦点小组会议，涉及治疗师和患者。我们使用青少年心理健康护理中常用的认知行为治疗协议作为治疗协议示例。第一次焦点小组讨论旨在评估患者（N = 5）或治疗师（N = 6）对协议的调整程度。第二次焦点小组讨论旨在根据第一次焦点小组的结果估计治疗协议的应用和个性化程度，以便与治疗师和患者群体一起进一步定性了解个性化的原因（N = 7）。使用主题分析对定性数据进行分析。
治疗师将协议用作包含不同治疗工具的“工具箱”，并根据治疗联盟以及他们的治疗提供经验对协议进行个性化。治疗师估计他们严格遵循协议的48%，调整30%，并用其他非协议治疗成分替代22%。患者对自己的治疗进行个性化，以使任务符合他们的日常生活和习惯，并减轻他们的压力和担忧程度。患者估计治疗师严格遵循所提供治疗的29%，调整48%，并用其他非协议治疗成分替代23%。
标准的认知行为治疗协议并未得到严格和充分的应用，而是主要进行了个性化。基于这些结果，为电子健康设计者提出以下建议，以加强电子健康与治疗实践和实施的一致性：（1）至少研究并复制协议的应用部分，（2）与治疗师和患者共同设计电子健康，以便他们能够分配应开放供用户定制的组件，（3）调查未应用的治疗协议组件是否应保留在应用的电子健康中。为了最好地生成此信息，我们建议电子健康设计者在开发过程中应与治疗师、患者、协议开发者和心理健康护理管理者合作。
