Do you know why your patients don't adhere to the online therapy programs you recommend?

One of the biggest challenges of internet-based therapy is to improve the poor rates of adherence. An article by Johansson et al published in 2015 in the journal Internet Interventions reported a small study (n=7) of Swedish patients who had previously failed to complete an iCBT intervention for generalised anxiety disorder. The program involved had 8 weekly CBT modules and weekly telephone reminders from a therapist.

Analysis of the results revealed that a mixture of issues related to the program itself and to individual patient centred concerns contributed to the non-adherence. 

Problems included:

• Too much text to read requiring too much concentration

• Reading level too difficult for the patient’s abilities

• Lack of flexibility in the program to do it at own pace

• Perception that the information given was too difficult to understand

• The therapy itself was perceived to be stressful and triggered anxiety

• Perception that the therapist contact was only about encouragement to continue the program with no personal concern about the user and no opportunity to talk about personal issues

• Complaints that they were given no information about program content in advance

The researchers state that “It is important to note that an aspect of treatment only caused problems if a certain characteristic of the patient was present and vice versa.”

Perhaps we can learn something about improving our practice from these results.

It sounds like we might start by:

• matching the patient with the program as best we can  (in terms of literacy levels, length of modules, flexibility of the program)

• showing patients the content of programs we recommend to reduce their anxiety about them

• seeing patients face-to-face while they are doing the programs to maintain some personal contact

Maybe we can ask our own patients about their own barriers to adherence as well?

Reference

Olaf Johanssson, Teresa Mitchell, Gerhard Andersson, Bjorn Paxling Experiences of non-adherence to Internet delivered cognitive behaviour therapy: A qualitative study. Internet Interventions 2 (2015) 137-142 http://dx.doi.org/10.1016/j.invent.2015.02.006