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Therapists' Role in Patient Adherence to Internet-Based Cognitive Behavioral Therapy: Qualitative Study
Henriikka Anne-Mari Seittu1,2, Tomas Falk2,3, Kushagra Bhatnagar2
1Department of Public Health, University of Helsinki, PO BOX 20 (Tukholmankatu 8 B), Helsinki, 00014, Finland, 358 505729645.
Journal of Medical Internet Research
|September 10, 2025
Summary
Therapist support in internet-based cognitive behavioral therapy (iCBT) is crucial for patient adherence. Key elements include strengthening autonomy, therapeutic alliance, and emotion regulation, even through simple text messages.
Area of Science:
- Digital mental health
- Clinical psychology
- Psychotherapy research
Background:
- Internet-based cognitive behavioral therapies (iCBTs) are effective for various mental health conditions.
- Therapist-assisted iCBTs show lower dropout rates than self-guided versions.
- The specific role of therapist support in iCBT adherence is underexplored.
Purpose of the Study:
- To explore patient experiences with therapist-assisted iCBT.
- To identify factors perceived as important for treatment adherence.
- To clarify the role of therapist support in the iCBT process.
Main Methods:
- Qualitative study involving 89 semistructured interviews with iCBT users.
- Interviews analyzed using the qualitative Gioia method.
- Participants engaged in various therapist-assisted iCBT programs for conditions like depression and anxiety.
Main Results:
- Therapist support enhances adherence through strengthening individual autonomy.
- Therapist commitment to the therapeutic alliance is vital for adherence.
- Assistance with emotion regulation, often via text-based interactions, significantly impacts adherence.
Conclusions:
- Human support remains critical in digital mental health interventions.
- The role of therapists should not be diminished in the digitalization of mental healthcare.
- Text-based therapist interactions can be highly impactful in iCBT.
Keywords:
adherenceinternet-based cognitive behavioral therapiesmental healthqualitativetherapist-assisted internet-based cognitive behavioral therapiesMore Related Videos
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