Experiences of Individually Tailored Internet-Based Cognitive Behavioral Therapy During the COVID-19 Pandemic: Qualitative Interview Study

TL;DR

This study explores how people experienced online therapy with therapist support during the pandemic, highlighting both benefits and areas for improvement.

Contribution

The study uniquely examines ICBT experiences specifically during the pandemic, revealing pandemic-related well-being changes.

Findings

Participants appreciated the treatment's content and format but suggested improvements.

Changes in well-being related to the pandemic were reported alongside other unrelated symptom improvements.

Four main themes and 10 subthemes were identified from the interviews.

Abstract

During the COVID-19 pandemic, both physical and psychological health were at risk. Internet-based cognitive behavioral therapy (ICBT) is a psychological treatment alternative that does not inherently increase the risk of virus transmission because face-to-face interactions are not required. ICBT has been found to be effective for a variety of mental health problems, both before and during the COVID-19 pandemic. Although the experiences of undergoing ICBT have been investigated in previous studies, the specific experiences of participating in ICBT during the COVID-19 pandemic have been less examined.

This qualitative study aimed to investigate the experiences of participants undergoing individually tailored ICBT with weekly therapist support during the COVID-19 pandemic.

We approached trial participants who had received ICBT for psychological symptoms related to the COVID-19 pandemic during the summer of 2020. A strategic sample, based on the number of log-ins to the treatment platform, among other factors, was selected in an effort to achieve the highest possible variation. Semistructured telephone interviews were conducted 4 to 6 months after treatment completion, depending on whether the participant was initially assigned to the treatment or control group. Data were transcribed and then analyzed based on thematic analysis.

A total of 16 participants aged between 23 and 78 years were interviewed. Four main themes and 10 subthemes were derived from the thematic analysis: (1) functions of the treatment (initiating and motivating, perspective widening), (2) treatment equals work (experience of the treatment as demanding, going from text to action, posttreatment engagement, participant agency), (3) changes experienced (changes in relation to the COVID-19 pandemic, other changes not related to the COVID-19 pandemic), and (4) wishing for something else (individually tailored, contact with the therapist).

The results closely align with those of previous qualitative studies on experiences of ICBT. Participants expressed appreciation of the treatment’s content and format. Suggestions and wishes for changes were also expressed in the interviews. However, a unique finding was that participants described experiencing changes in well-being related to the COVID-19 pandemic. At the same time, there were also reports of changes in other symptoms not related to the pandemic. Further studies are needed on the experiences of participants who drop out of ICBT and the type of therapist contact they prefer.