Service Users' Experience of Computerised Cognitive Behavioural Therapy: An Interpretative Phenomenological Study

Background: Computerised Cognitive Behavioural Therapy (CCBT) is used within the
NHS to treat anxiety and mild to moderate depression. Research has quantitatively
demonstrated the efficacy of CCBT but has neglected to examine its use from patients'
perspectives or the processes which contribute to success in practice. Therefore this study
aimed to qualitatively explore users' subjective experience of CCBT. This was contrasted
with Therapist-led CBT (TCBT) to gain understanding through evaluation of similarities
and differences. Method: Semi-structured interviews were conducted with eight
participants who had received CCBT and eight TCBT, within a Primary Care
Psychological Therapy Service. These were analysed using Interpretative
Phenomenological Analysis (IPA). Results: Findings demonstrate participants perceive
CCBT as insufficient in delivering CBT techniques without therapeutic interaction and
interpersonal elements. The lack of these had a severely disabling effect upon
'Engagement' and 'Deep-Processing', which emerged as superordinate themes. Areas
described as lacking in CCBT and in contrast enhanced engagement in TCBT included
characteristics of a therapeutic relationship, e.g. being heard, therapist qualities,
acceptance and empathic genuine feedback which promoted expectations and motivation.
Deep-Processing was reliant upon engagement and encompassed utilisation of specific
CBT techniques, through emotional exposure, personalisation and agency. This led to
deeper understanding, meaningful processing, significant cognitive change and
development of self-efficacy for the future. Conclusions: The limitations of CCBT
highlights a disparity between current CCBT research and users views, whilst confirming
the role of non-specific factors in therapeutic interventions. This suggests the necessity for
critical appraisal of the evidence-base. Future research recommendations include
incorporating and integrating qualitative and mixed-method research with empiricallysupported
research paradigms, to ensure patient's experience, views and expectations are
considered and practice-based process research also informs clinical practice.

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