Bücker Lara, Berger Thomas, Bruhns Alina, Westermann Stefan
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
JMIR Form Res. 2022 Sep 13;6(9):e37287. doi: 10.2196/37287.
The low level of adherence in internet-based self-help interventions for depression suggests that in many existing programs, the motivational fit between the program and the user is unsatisfactory (eg, the user seeks autonomy, but the program provides directive guidance). Personalized, motive-oriented, self-help interventions could enable participants who interact with a program and its contents to have more engaging and less aversive experiences and thus increase adherence.
In an experimental study with a nonclinical analogue sample, we aimed to test the hypotheses that a better motivational person-program fit is linked with higher anticipated adherence, working alliance, and satisfaction with the program.
Motivational person-program fit was examined with respect to the 2 contrasting motives being autonomous and being supported. The hypotheses were tested by specifically varying the motivational person-program fit in a nonclinical sample (N=55), where participants were asked to work on, and subsequently evaluate, a limited set of individual pages of a self-help program with guidance (in the form of text messages) for depression. The sections of the self-help program were redesigned to either particularly address the autonomy motive or the support motive. For the quasi-experimental variation of the motivational person-program characteristics, we divided the 55 participants into 2 groups (autonomy group: n=27, 49%; support group: n=28, 51%) by screening method (using the Inventory of Approach and Avoidance Motivation), corresponding to the 2 motives. Both groups evaluated (in randomized order) 2 excerpts of the program-one that matched their motive (fit) and one that was contrary to it (no fit). Immediately after the evaluation of each excerpt, anticipated adherence, working alliance, and treatment satisfaction were assessed.
Regarding being supported, the satisfaction with or violation of this motive had an impact on (optimal) anticipated adherence as well as working alliance and satisfaction with the intervention; a congruent person-program fit resulted in significantly higher anticipated adherence (t=3.00; P=.006), working alliance (t=3.20; P=.003), and satisfaction (t=2.86; P=.008) than a noncongruent fit. However, a similar impact could not be found for the motive being autonomous. Several correlations were found that supported our hypotheses (eg, for the congruent person-program fit autonomy motive and autonomy group, support satisfaction negatively correlated with optimal anticipated adherence).
This first experimental study gives reason to assume that motive orientation may have a positive influence on adherence, working alliance, and satisfaction in internet-based self-help interventions for depression and other mental disorders. Future studies should conduct randomized controlled trials with clinical samples and assess clinical outcomes.
基于互联网的抑郁症自助干预措施的依从性较低，这表明在许多现有项目中，项目与用户之间的动机匹配度不尽人意（例如，用户追求自主性，但项目提供指导性引导）。个性化的、以动机为导向的自助干预措施可以使与项目及其内容互动的参与者获得更有吸引力且不那么反感的体验，从而提高依从性。
在一项针对非临床模拟样本的实验研究中，我们旨在检验以下假设：更好的动机与项目匹配度与更高的预期依从性、工作联盟以及对项目的满意度相关。
从自主和受支持这两种对比动机的角度检验动机与项目的匹配度。通过在一个非临床样本（N = 55）中特意改变动机与项目的匹配度来检验假设，在该样本中，参与者被要求在有针对抑郁症的指导（以短信形式）的情况下，处理并随后评估自助项目的一组有限的个人页面。自助项目的各部分被重新设计，以特别满足自主动机或支持动机。为了对动机与项目特征进行准实验性改变，我们通过筛选方法（使用趋近和回避动机量表）将55名参与者分为两组（自主组：n = 27，49%；支持组：n = 28，51%），分别对应两种动机。两组（按随机顺序）评估项目的两个节选部分——一个与他们的动机相匹配（匹配），另一个与之相反（不匹配）。在对每个节选部分评估后，立即评估预期依从性、工作联盟和治疗满意度。
关于受支持这一动机，对该动机的满足或违背会影响（最佳）预期依从性以及工作联盟和对干预的满意度；动机与项目的匹配一致会导致预期依从性（t = 3.00；P = 0.006）、工作联盟（t = 3.20；P = 0.003）和满意度（t = 2.86；P = 0.008）显著高于不匹配的情况。然而，对于自主动机，未发现类似影响。发现了一些支持我们假设的相关性（例如，对于动机与项目匹配一致的自主动机和自主组，支持满意度与最佳预期依从性呈负相关）。
这项首次实验研究有理由假设，动机导向可能会对基于互联网的抑郁症及其他精神障碍自助干预措施中的依从性、工作联盟和满意度产生积极影响。未来的研究应该对临床样本进行随机对照试验并评估临床结果。
