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Understanding therapeutic change: The impact of early change, dropout and adherence on treatment outcome in internet interventions

  • Internet interventions have gained popularity and the idea is to use them to increase the availability of psychological treatment. Research suggests that internet interventions are effective for a number of psychological disorders with effect sizes comparable to those found in face-to-face treatment. However, when provided as an add-on to treatment as usual, internet interventions do not seem to provide additional benefit. Furthermore, adherence and dropout rates vary greatly between studies, limiting the generalizability of the findings. This underlines the need to further investigate differences between internet interventions, participating patients, and their usage of interventions. A stronger focus on the processes of change seems necessary to better understand the varying findings regarding outcome, adherence and dropout in internet interventions. Thus, the aim of this dissertation was to investigate change processes in internet interventions and the factors that impact treatment response. This could help to identify important variables that should be considered in research on internet interventions as well as in clinical settings that make use of internet interventions. Study I (Chapter 5) investigated early change patterns in participants of an internet intervention targeting depression. Data from 409 participants were analyzed using Growth Mixture Modeling. Specifically a piecewise model was applied to model change from screening to registration (pretreatment) and early change (registration to week four of treatment). Three early change patterns were identified; two were characterized by improvement and one by deterioration. The patterns were predictive of treatment outcome. The results therefore indicated that early change should be closely monitored in internet interventions, as early change may be an important indicator of treatment outcome. Study II (Chapter 6) picked up on the idea of analyzing change patterns in internet interventions and extended it by using the Muthen-Roy model to identify change-dropout patterns. A sligthly bigger sample of the dataset from Study I was analyzed (N = 483). Four change-dropout patterns emerged; high risk of dropout was associated with rapid improvement and deterioration. These findings indicate that clinicians should consider how dropout may depend on patient characteristics as well as symptom change, as dropout is associated with both deterioration and a good enough dosage of treatment. Study III (Chapter 7) compared adherence and outcome in different participant groups and investigated the impact of adherence to treatment components on treatment outcome in an internet intervention targeting anxiety symptoms. 50 outpatient participants waiting for face- to-face treatment and 37 self-referred participants were compared regarding adherence to treatment components and outcome. In addition, outpatient participants were compared to a matched sample of outpatients, who had no access to the internet intervention during the waiting period. Adherence to treatment components was investigated as a predictor of treatment outcome. Results suggested that especially adherence may vary depending on participant group. Also using specific measures of adherence such as adherence to treatment components may be crucial to detect change mechanisms in internet interventions. Fostering adherence to treatment components in participants may increase the effectiveness of internet interventions. Results of the three studies are discussed and general conclusions are drawn. Implications for future research as well as their utility for clinical practice and decision- making are presented.

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Metadaten
Author:Alice Arndt
URN:urn:nbn:de:hbz:385-1-13575
DOI:https://doi.org/10.25353/ubtr-xxxx-4e46-d21a
Referee:Julian Rubel
Advisor:Wolfgang Lutz
Document Type:Doctoral Thesis
Language:English
Date of completion:2020/01/31
Date of publication:2020/02/10
Publishing institution:Universität Trier
Granting institution:Universität Trier, Fachbereich 1
Date of final exam:2019/10/02
Release Date:2020/02/10
Tag:adherence; dropout; early change; internet intervention
GND Keyword:Angststörung; Depression; Internet; Therapieabbruch; Therapieerfolg; psychologische Beratung
Number of pages:160
Institutes:Fachbereich 1
Dewey Decimal Classification:1 Philosophie und Psychologie / 15 Psychologie / 150 Psychologie
Licence (German):License LogoCC BY-NC-ND: Creative-Commons-Lizenz 4.0 International

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