The Effectiveness OF Online CBT Critical Thinking Samples
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In March of 2009, a Dutch online mental health clinic sponsored an uncontrolled before- and after-study on the effectiveness of online cognitive-behavioral therapy (CBT). The efficacy of such psychological treatment had only been tested in controlled studies up to that point in time. The use of online therapy raises legal, ethical, and professional issues, as it is a very different method from the traditional uses of psychotherapy. However, supporters of the cause bring to attention the increase in accessibility it brings to the realm of psychology.
One-thousand fifty-hundred adults were screened from a total of three-thousand three patients that belonged to the aforementioned clinic. The sample of individuals were mostly female, with a median age of 40 years. Such individuals that were screened out of participation for the study included those that “showed heightened risk of dissociation, psychosis, suicidal ideation, alcohol or drug dependence; were recently hospitalized because of mental health problem; used neuroleptic medication; used unstable doses of other psychoactive medication; or suffered from a prevailing disorder for which the clinic could not provide treatment” (Ruwaard, 2012, p. 2). The individuals that were deemed eligible for the online study had one of four psychological illnesses: depression, panic disorder, post-traumatic stress disorder, and burnout. The patients were then screened even further by way of self-reported questionnaires and phone interview. Lastly, the subjects needed a referral for psychotherapy from some other health care practitioner.
The treatment was carried out online over a secure network. Subjects talked with their therapists via online text-message, with no face-to-face contact during the entire study. Most therapists were highly trained junior therapists who were advised by two licensed clinical psychologists. Junior therapists was a term used to describe therapists employed by the clinic shortly after graduation. Psychiatric consult was also available, if needed. As in traditional face-to-face CBT, subjects introduced themselves to their therapist, the therapist assigned homework assignment for the subject, and the therapist would respond to the homework with thorough, motivating feedback. The time period of treatment was specific to each of the four illnesses.
Self-report questionnaires were used to gather data on how the subjects progressed through the treatment program. These questionnaires were administered before treatment (baseline), at the end of treatment, at a 6 week follow up, and at a 1 year follow up. Such questionnaires that were used included Beck Depression Inventory, Impact of Event Scale, Panic Disorder Severity Scale, Oldenburg Burnout Inventory, and Depression Anxiety Stress Scales. The attrition rate for the entire study, from baseline to the 1 year follow up, was reported to be 71%. The attrition increased as the questionnaires were administered later and later from the treatment date. The most successful completion rate was from the burnout population while the lowest completion rate was from the depression population. In addition to these forms, patients were asked to rate their therapists as well as the experience. On average, patients gave their therapists an 8.5 out of 10 and said they were very satisfied with the overall treatment. Additionally, patients reported that 30% of them had missed the traditional face-to-face contact but over 80% of patients would recommend online CBT.
The journal article was very well written and clearly outlined the experiment. The abstract section of the paper gave a great synopsis of the study to attract the reader before delving into the meat of the paper. The abstract also very adequately described what was to be expected of the article, in which I was very satisfied. After the abstract, the introduction provided adequate background information into the reason for the study. However, the hypothesis was never specifically stated. It was inferred from the reading and the purpose of the study that the researchers expected the online CBT study to yield positive results and allow psychology to pursue online therapy.
In final, I think that the study was interesting and well-made and explained. However, the authors make the assumption it will work and provide positive evidence of online therapy. In addition, the authors do not take into account cultural differences. To the Dutch community, this study was well accepted. However, to other cultures and communities it may not be. Other populations may very much prefer the one-on-one personal connection to another person during therapy. Additionally, I don’t think online therapy can be used for every psychological condition and the researchers do not acknowledge this fact. I don’t believe this was well explained either. However, the researchers did make it a point to study both their limitations and strengths of the study. It is very important to look at the limitations so researchers can work on perfecting the study to use with the larger population and thoroughly helping their patients.
Ruwaard, J., Lange, A., Schrieken, B., Dolan, C., Emmelkamp, P., & Botbol, M. (2012). The
Effectiveness of Online Cognitive Behavioral Treatment in Routine Clinical Practice. PLoS ONE, 7(7), e400989. doi:10.1371/journal/pone.0040089
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