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Qualitative meta-synthesis of user experience of computerised therapy for depression and anxiety

Knowles, Sarah; Toms, Gill; Sanders, Caroline; Bee, Penny; Lovell, Karina; Rennick-Egglestone, Stefan; Coyle, David; Kennedy, Catriona M.; Littlewood, Elizabeth; Kessler, David; Gilbody, Simon; Bower, Peter

Authors

Sarah Knowles sarah.knowles@man.ac.uk

Gill Toms gill.toms@gmail.com

Caroline Sanders

Penny Bee penny.bee@man.ac.uk

Karina Lovell

Stefan Rennick-Egglestone stefan.egglestone@nottingham.ac.uk

David Coyle

Catriona M. Kennedy

Elizabeth Littlewood

David Kessler

Simon Gilbody

Peter Bower peter.bower@man.ac.uk

Abstract

Objective: Computerised therapies play an integral role in efforts to improve access to psychological treatment for patients with depression and anxiety. However, despite recognised problems with uptake, there has been a lack of investigation into the barriers and facilitators of engagement. We aimed to systematically review and synthesise findings from qualitative studies of computerised therapies, in order to identify factors impacting on engagement.
Method: Systematic review and meta-synthesis of qualitative studies of user experiences of computer delivered therapy for depression and/or anxiety.
Results: 8 studies were included in the review. All except one were of desktop based cognitive behavioural treatments. Black and minority ethnic and older participants were underrepresented, and only one study addressed users with a comorbid physical health problem. Through synthesis, we identified two key overarching concepts, regarding the need for treatments to be sensitive to the individual, and the dialectal nature of user experience, with different degrees of support and anonymity experienced as both positive and negative. We propose that these factors can be conceptually understood as the ‘non-specific’ or ‘common’ factors of computerised therapy, analogous to but distinct from the common factors of traditional face-to-face therapies.
Conclusion: Experience of computerised therapy could be improved through personalisation and sensitisation of content to individual users, recognising the need for users to experience a sense of ‘self’ in the treatment which is currently absent. Exploiting the common factors of computerised therapy, through enhancing perceived connection and collaboration, could offer a way of reconciling tensions due to the dialectal nature of user experience. Future research should explore whether the findings are generalisable to other patient groups, to other delivery formats (such as mobile technology) and other treatment modalities beyond cognitive behaviour therapy. The proposed model could aid the development of enhancements to current packages to improve uptake and support engagement.

Journal Article Type Article
Journal PLoS ONE
Electronic ISSN 1932-6203
Publisher Public Library of Science
Peer Reviewed Peer Reviewed
Volume 9
Issue 1
Article Number e84323
Institution Citation Knowles, S., Toms, G., Sanders, C., Bee, P., Lovell, K., Rennick-Egglestone, S., …Bower, P. (in press). Qualitative meta-synthesis of user experience of computerised therapy for depression and anxiety. PLoS ONE, 9(1), doi:10.1371/journal.pone.0084323
DOI https://doi.org/10.1371/journal.pone.0084323
Publisher URL http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0084323
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0




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