The experience of guided online therapy: A longitudinal, qualitative analysis of client feedback in a naturalistic RCT

Abstract

Internet-delivered Cognitive Behavioural Therapy (iCBT) is an effective treatment for depression and anxiety disorders. However longitudinal qualitative research into the client’s subjective experience of this form of treatment ‘in the wild’ is relatively scarce. We present an analysis of secondary outcomes in a naturalistic RCT conducted within the UK’s Improving Access to Psychological Therapies programme. We evaluated clients’ expectations, experience, and context of usage of iCBT, across three timepoints. Results are discussed in terms of the creation of a therapeutic space online, the impact of hope, expectations and personal factors on the therapeutic experience, iCBT as “therapy on the go” and developing skills for life. While iCBT on the whole provides a positive, supportive and therapeutic experience for clients, the study identified managing expectations, polarized preferences, momentary help-seeking and long-term support as important aspects of the experience to consider in future design.