118 Chapter 6. <strong>Online</strong> <strong>CBT</strong> in Routine Clinical PracticeTable 6.6: Patient satisfaction.Depression Panic PTS BurnoutAspect a n = 296 n = 108 n = 380 n = 323Satisfaction with therapist 8.4 1.5 8.7 1.6 8.6 1.5 8.6 1.2(M SD)Do you consider online therapyan effective method?Yes 240 81% 90 83% 298 78% 289 89%No 30 10% 7 6% 29 8% 6 2%Don’t know 26 9% 11 10% 53 14% 28 9%Did you miss face-to-face contact?Yes 35 33% 35 32% 110 29% 87 26%No 163 55% 64 59% 231 61% 189 59%Don’t know 35 12% 9 8% 39 10% 47 47%Would you recommend onlinetreatment to others?Yes 260 88% 95 88% 339 89% 292 90%No 18 6% 3 3% 18 5% 12 4%Don’t know 18 6% 10 9% 23 6% 19 6%a Depression: n = 296; Panic Disorder: n = 108; Posttraumatic Stress: n = 380; Burnout: n = 323.6.2.6 Patient satisfactionPosttest evaluation data, which were available for n = 1107 patients, are summarizedin Table 6.6. Patient satisfaction was high, with little variance between treatmentsamples. Patients gave high ratings to their therapists (M = 8.5 on a 1-10 scale; SD= 1.5). Although 30% (n = 330) <strong>of</strong> the patients indicated that they had missedface-to-face contact during therapy, 83% evaluated online therapy as effective, <strong>and</strong>89% would recommend web-based treatment to others.6.3 Discussion6.3.1 Key findingsWe assessed the effectiveness <strong>of</strong> online <strong>CBT</strong> in routine clinical practice among 1500patients, who suffered from symptoms <strong>of</strong> depression, panic disorder, posttraumaticstress, or burnout. We found that effect sizes <strong>and</strong> recovery rates were comparable to,or somewhat better than, those observed in previous controlled trials (Lange et al.,
6.3. Discussion 1192001; Lange, van de Ven, & Schrieken, 2003; Knaevelsrud & Maercker, 2007, 2009;Wagner et al., 2006; Wagner & Maercker, 2007; <strong>Ruwaard</strong> et al., 2007, 2009, 2010),<strong>and</strong> comparable to those <strong>of</strong> face-to-face routine practice <strong>CBT</strong> (Westen & Morrison,2001; Cahill et al., 2003; Hunsley & Lee, 2007; Minami et al., 2008). Post-treatmentreductions <strong>of</strong> specific <strong>and</strong> general psychopathology were large (pooled d = 1.4/1.2;P < .001), about 50% <strong>of</strong> the patients recovered, <strong>and</strong> patient satisfaction was high.Our findings suggest that online <strong>CBT</strong> may be as effective in routine practice as it is inclinical trials.While high dropout is a common problem in studies <strong>of</strong> online interventions,(Eysenbach, 2005; Farvolden et al., 2005; de Graaf, Huibers, Riper, Gerhards, & Arntz,2009), our data show that acceptable adherence can be achieved with online treatment.We found that 79% <strong>of</strong> the patients completed post-treatment measurements, <strong>and</strong> that71% completed every step <strong>of</strong> treatment. Although adherence rates were somewhatbetter in the controlled trials (83%), these findings still compare well to publishedadherence rates <strong>of</strong> Dutch routine practice mental healthcare, which tend to varybetween 60% to 70% (GGZ Nederl<strong>and</strong>, 2010).As previously shown by Titov, Andrews, Kemp, <strong>and</strong> Robinson (2010), patients whoseek online treatment have substantial disorders, <strong>and</strong> are not necessarily young ortechnologically sophisticated. Our data confirm <strong>and</strong> extend this finding. In terms<strong>of</strong> demographic characteristics <strong>and</strong> presenting problems, the patients <strong>of</strong> the onlineclinic are comparable to the patients that are generally seen in Dutch specializedmental healthcare. Our results indicate that online treatment provides an appropriateintervention for these patients.6.3.2 Strengths & limitationsThis study has several strengths. First, the treatments had been carried out before thestudy was planned. Treatment outcomes were routinely assessed as part <strong>of</strong> every-daypractice. Accordingly, therapists <strong>and</strong> staff were not influenced by their participationin the evaluation study (the so-called Hawthorne effect; Leonard & Masatu, 2006).Second, the size <strong>of</strong> the sample is much larger than the sample sizes <strong>of</strong> previouseffectiveness studies <strong>of</strong> therapist-assisted online <strong>CBT</strong>. Third, the sample includedevery patient who had started treatment in the studied timeframe. Thus, our results
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References 171of change in psycholo
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DankwoordAlleen mijn naam staat op
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178 Curriculum VitaeLange, A., & Ru