The Efficacy and Effectiveness of Online CBT - Jeroen Ruwaard

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2 Chapter 1. General Introductionpsychological, social, geographical, and systemic (Collins, Westra, Dozois, & Burns,2004). Internet applications have reduced or removed such barriers in many areasof life. Psychotherapeutic internet interventions may support public mental healthcarein a similar vein (F. Griffiths, Lindenmeyer, Powell, Lowe, & Thorogood, 2006;Emmelkamp, 2005).In the past decade, researchers have developed psychotherapeutic internet interventionsfor a wide variety of mental health disorders (Barak, Hen, Boniel-Nissim, &Shapira, 2008). These interventions vary in terms of the intended purpose (prevention,early intervention, treatment, aftercare), the electronic means that are used to deliverthe intervention (e-mail, e-chat, websites, video-conferencing, mobile applications),and in the level of professional support. In terms of the psychotherapeutic orientation,available interventions are surprisingly homogeneous: the vast majority of existinginternet interventions are based on Cognitive Behavioural Therapy (CBT).CBT is characterized by clear-cut therapeutic procedures, which are relatively easyto translate into an online format. In addition, there is general agreement on theeffectiveness of CBT (Butler, Chapman, Forman, & Beck, 2006). Meta-analyses suggestthat this effectiveness generalizes to internet interventions, although it should benoted that these meta-analyses also reveal significant heterogeneity in study outcomes(Cuijpers et al., 2009; Andersson & Cuijpers, 2009). There is growing consensus thatprofessional guidance is a critical determinant of the efficacy of online CBT (Palmqvist,Carlbring, & Andersson, 2007; Spek et al., 2007).1.1.1 Three types of online CBTSelf-help. Online self-help interventions do not include guidance from a mentalhealth professional. Such interventions allow large-scale, low-cost dissemination ofCBT. Online self-help appears to be effective for a variety of psychological symptoms,although its effects are statistically small and drop-out rates are very high (Kaltenthaleret al., 2006; Foroushani, Schneider, & Assareh, 2011; Spek et al., 2007; Andersson &Cuijpers, 2009). Even so, online self-help interventions are currently implemented inroutine practice for preventive purposes, based on the assumption that interventionswith small effects may have a noticeable impact if available to a large part of thepopulation.
1.2. Interapy 3Guided self-help. Most internet interventions offer a mix of self-help and humanguidance. In guided self-help, mental health professionals support clients in the useof the self-help material, through e-mail, e-chat, telephone support, or face-to-facesessions. This support is intended to be limited to approximately 60-90 minutesper treatment (e.g., Titov et al., 2010). The interventions are therefore alternativelylabelled as ’low-intensity CBT’ (Bennett-Levy et al., 2010). In comparison to online selfhelp,guided self-help is more expensive and less accessible. However, the professionalsupport substantially increases the efficacy of, and adherence to, an intervention(Cuijpers et al., 2009; Andersson & Cuijpers, 2009; Spek et al., 2007).Psychotherapy. Online psychotherapy is an extension of online guided self-help. Likeguided self-help, online psychotherapy promotes self-efficacy through a combination ofhomework assignments and psycho-education. However, the role of the therapist is notlimited to providing support or help if the client gets stuck. The online psychotherapisthas the same role as the regular face-to-face CBT therapist (Barak, Klein, & Proudfoot,2009): to explain each step of treatment, to give tailored feedback to the clientfeedback after each step, and to introduce the next step. Online treatment may behighly manualized, and thus provides therapists with specific guidelines and help intreating patients.1.2 InterapyThe Interapy research program, which we introduced in the beginning of this chapter,represents one of the few systematic attempts to deliver full online psychotherapy, i.e.,online CBT with extended therapist support that does not require any face-to-facecontact between the client and a mental health professional.1.2.1 General characteristicsIn Interapy, clients and therapists work on treatment in convenient locations withinternet access, including the home. The therapeutic procedure is delivered completelythrough a secure website. Clients are assessed in an elaborate online screeningprocedure, in which standardized and validated self-report questionnaires query back-
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62 Chapter 4. Online CBT of Panic S
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86 Chapter 5. Online CBT of Bulimic
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Chapter 7General DiscussionPrevious
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7.1. Key Findings 1277.1.2 The effe
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7.1. Key Findings 129Work−related
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7.2. Strengths and limitations 1317
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7.2. Strengths and limitations 133s
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7.3. Implications for clinical prac
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7.4. Suggestions for future researc
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7.5. Conclusion 139Post-treatment b
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142 Summaryof the introduction prov
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144 Summarythat face-to-face contac
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146 Summarycomplex, routine practic
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SamenvattingIn 1997 ontwikkelden on
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Samenvatting 151startten direct met
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Samenvatting 153up-metingen suggere
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Samenvatting 155ongeveer gelijk zou
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ReferencesAben, I., Verhey, F., Lou
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References 159Bickel, R. (2007). Mu
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References 161apy Research, 1(2), 8
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References 163Hay, P. P., Bacaltchu
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References 165for bulimia nervosa:
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References 167Mond, J. M., Hay, P.
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References 169(2003). The developme
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References 171of change in psycholo
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DankwoordAlleen mijn naam staat op
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Dankwoord 175en Janneke Broeksteeg
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178 Curriculum VitaeLange, A., & Ru
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The Efficacy and Effectiveness of Online CBT - Jeroen Ruwaard

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