Enhancing the Patient’s Role: Exploring patient influence in acceptance-based cognitive behavior therapy delivered via internet

Abstract

Background: The global primary health care declaration emphasizes empowering patients to exert influence over their own health. A person-centered approach to care involves a shift from the traditional passive patient role to active involvement in health care decisions. Internet-delivered cognitive behavioral therapy (ICBT) increases access to care and is effective for various mental health conditions.

Aims: The overarching aim of this doctoral thesis was to enhance the patient’s role by exploring how patient influence can be conceptualized and integrated into acceptance-based transdiagnostic ICBT for anxiety disorders treated in Swedish primary care.

Results: Four studies were performed within the scope of this doctoral dissertation. Study I used mixed methods to investigate patient experiences and the feasibility and acceptability of adding peer support workers (PSWs) into acceptance-influenced ICBT for anxiety disorders. Incorporating PSWs into ICBT was practically feasible and well received by participants in a small sample of primary care patients (n=9). The qualitative results emphasized the personal relationship in therapeutic guidance and the sense of empowerment from sharing experiences. Study II was an RCT investigating a patient-driven acceptance-influenced ICBT for patients with anxiety disorders treated in primary care (n=55). Participants in the patient-driven intervention chose and self-tailored their treatment, resulting in greater perceived control and reduced anxiety symptoms compared to standard treatment. A medium-sized association was observed between changes in anxiety symptoms and empowerment. Study III assessed the effectiveness of an internet-delivered acceptance and commitment therapy (ACT) for adolescents with anxiety disorders in an RCT. Participants (n=52) were a self-selected group recruited from all over Sweden. The treatment was effective in increasing quality of life and psychological flexibility and had a positive effect on post-treatment diagnoses. A strong association was found between changes in psychological flexibility and anxiety symptoms. Study IV was a psychometric evaluation of the Swedish version of the Empowerment Scale – Making Decisions conducted on clinical patients in primary care (n=210) and psychiatric care (n=221) using confirmatory factor analysis (CFA). Results showed that none of the previously suggested factor solutions, tested through CFA, could be confirmed in our samples of primary care and psychiatric care patients and that it is doubtful whether the scale represents a single empowerment construct.

Conclusions: This doctoral thesis contributes to the field of internet-delivered mental health interventions by exploring the integration of patient influence through acceptance and commitment therapy, incorporating patient-driven components, and making patients’ experiences part of treatment. The research underscores the potential for improving treatment outcomes and quality of life, promoting psychological flexibility, belonging, and a sense of control over one’s care. The studies serve as a foundation for future research and development, paving the way for person-centered and tailored approaches in digital mental health treatments