Hadjistavropoulos Heather D, Hill Taylor G, Philipp-Muller Aaron E, Dear Blake, Titov Nick
Department of Psychology, University of Regina, Regina, Canada.
Online Therapy Unit, University of Regina, Regina, Canada.
Internet Interv. 2023 Nov 25;34:100692. doi: 10.1016/j.invent.2023.100692. eCollection 2023 Dec.
Internet-delivered Cognitive-Behavioural Therapy (ICBT) aims to support people with mental health concerns using online treatment materials. Client stories (either real or a composite based on many clients) are often used in ICBT to facilitate learning. However, these stories remain understudied in terms of how they are perceived by clients, as well as their relationship to ICBT engagement, satisfaction, and outcomes. Among a sample of 324 clients enrolled in transdiagnostic ICBT targeting symptoms of depression and anxiety, we examined client perceptions of stories through mixed-method qualitative (open-ended) and quantitative (closed-ended) data collection. Specifically, 234 (72.22 %) clients responded to questions about stories at 4 weeks and 221 (68.21 %) responded to questions at 8 weeks. Most clients who responded to questions endorsed reviewing at least some stories (79.06 % at 4 weeks, 71.95 % at 8 weeks). Moreover, they rated stories positively in terms of being relatable, making clients feel less alone, increasing knowledge, providing ideas for how to use skills, and motivating clients to use skills. These perceptions of stories remained stable over the course of treatment. Stories were perceived more positively among those with lower symptom severity at 8 weeks as well as those who were more satisfied with ICBT at 8 weeks. Story perceptions at 4 weeks were predictive of decreased post-treatment anxiety symptom severity but not depression while controlling for baseline scores, age, and education. 26.49 % of clients at 4 weeks who reviewed stories and 33.33 % at 8 weeks provided suggestions about how to improve stories. In a qualitative analysis, we found 5 categories of suggestions including increasing the variety of issues and relatability of stories, ensuring the stories are realistic, refining the formatting, and making the stories shorter. Overall, this study provides insights into how client stories could be improved to play a more significant role in future ICBT programs.
互联网认知行为疗法（ICBT）旨在通过在线治疗材料为有心理健康问题的人提供支持。客户故事（真实故事或基于众多客户的综合故事）在ICBT中经常被用来促进学习。然而，这些故事在客户如何看待它们以及它们与ICBT参与度、满意度和治疗效果的关系方面仍未得到充分研究。在324名参加针对抑郁和焦虑症状的跨诊断ICBT的客户样本中，我们通过混合方法的定性（开放式）和定量（封闭式）数据收集来研究客户对故事的看法。具体而言，234名（72.22%）客户在4周时回答了关于故事的问题，221名（68.21%）客户在8周时回答了问题。回答问题的大多数客户认可至少查看了一些故事（4周时为79.06%，8周时为71.95%）。此外，他们对故事给予了积极评价，认为故事具有相关性，让客户感觉不那么孤单，增加了知识，提供了如何运用技能的想法，并激励客户运用技能。在治疗过程中，对这些故事的看法保持稳定。在8周时症状严重程度较低的客户以及对ICBT在8周时更满意的客户中，对故事的看法更为积极。在控制基线分数、年龄和教育程度的情况下，4周时对故事的看法可预测治疗后焦虑症状严重程度的降低，但不能预测抑郁症状严重程度的降低。4周时查看故事的客户中有26.49%，8周时查看故事的客户中有33.33%提供了关于如何改进故事的建议。在定性分析中，我们发现了5类建议，包括增加问题的多样性和故事的相关性、确保故事真实、完善格式以及使故事更简短。总体而言，本研究为如何改进客户故事以在未来的ICBT项目中发挥更重要作用提供了见解。
