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Therapists’ perceptions and acceptability of providing internet-delivered guided self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS): a qualitative study

Published online by Cambridge University Press:  15 December 2021

Milena Contreras ,
Elien Van Hout ,
Morag Farquhar ,
Rebecca L. Gould ,
Lance M. McCracken ,
Michael Hornberger ,
Erica Richmond  and
Naoko Kishita Open the ORCID record for Naoko Kishita [Opens in a new window]
Milena Contreras
Affiliation:
School of Health Sciences, University of East Anglia, Norwich, UK
Elien Van Hout
Affiliation:
School of Health Sciences, University of East Anglia, Norwich, UK
Morag Farquhar
Affiliation:
School of Health Sciences, University of East Anglia, Norwich, UK
Rebecca L. Gould
Affiliation:
Division of Psychiatry, University College London, London, UK
Lance M. McCracken
Affiliation:
Department of Psychology, Uppsala University, Uppsala, Sweden
Michael Hornberger
Affiliation:
Norwich Medical School, University of East Anglia, Norwich, UK
Erica Richmond
Affiliation:
Older People’s Community Team, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
Naoko Kishita*
Affiliation:
School of Health Sciences, University of East Anglia, Norwich, UK
*
*Corresponding author. Email: N.Kishita@uea.ac.uk
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Abstract

This study aimed to explore therapists’ perceptions and acceptability of providing internet-delivered, therapist-guided, self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS). To achieve this, a qualitative approach with semi-structured interviews was employed with eight novice therapists recruited from primary and secondary care services taking part in a feasibility study of iACT4CARERS. The interviews were audio-recorded, transcribed, and analysed using thematic analysis. Four over-arching themes were identified: (1) positive attitudes towards the intervention, (2) therapists’ workload, (3) therapists’ confidence to perform their role, and (4) connecting with family carers in a virtual context. Theme 1 included seeing their involvement as an opportunity for personal growth and perceiving benefits to the family carers, which contributed to greater acceptability. Theme 2 reflected that while workload and the user-friendliness of the online platform were highly acceptable among the therapists, there were also time-consuming cases that increased therapists’ burden. Theme 3 revealed that practical resources provided during the training, continued supervision, and opportunities to learn from other therapists, increased therapist confidence and facilitated greater acceptability. Finally, Theme 4 highlighted that improving the connection between therapists and carers was critical in a virtual context and strategies to improve the therapist–carer relationship were recommended. The implementation of iACT4CARERS was largely acceptable for the therapists involved in the trial. Ways to strengthen the therapeutic relationship in the virtual context and practical strategies to deal with common problems may enhance therapist experience and delivery in a full-scale effectiveness trial.

Key learning aims

  1. (1) To understand which factors facilitated therapists’ positive perceptions and acceptability of providing internet-delivered guided self-help ACT (iACT4CARERS).

  2. (2) To understand what challenges acted as barriers to therapists’ positive perceptions and acceptability of providing iACT4CARERS.

  3. (3) To learn what aspects of the training and the intervention can be refined to improve the acceptability to therapists in trials involving internet-delivered guided self-help interventions for family carers.

Keywords

acceptabilityinformal caregiversonline therapypsychological interventionstherapeutic relationshiptherapists
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 14 , 2021 , e38
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

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References

Further reading

Geller, S. (2020). Cultivating online therapeutic presence: strengthening therapeutic relationships in teletherapy sessions. Counselling Psychology Quarterly, 1–17. https://doi.org/10.1080/09515070.2020.1787348 Google Scholar
Thew, G. R. (2020). IAPT and the internet: the current and future role of therapist-guided internet interventions within routine care settings. The Cognitive Behaviour Therapist, 13, e4. https://doi.org/10.1017/S1754470X20000033 CrossRefGoogle ScholarPubMed

References

Alzheimer’s Society (2018). Dementia-friendly rural communities guide. Alzheimer’s Society. https://www.alzheimers.org.uk/sites/default/files/2019-07/AS_DF_NEW_Rural_Guide_Online_09_07_19.pdf Google Scholar
Andersson, G., Bergström, J., Buhrman, M., Carlbring, P., Holländare, F., Kaldo, V., Nilsson-Ihrfelt, E., Paxling, B., Ström, L., & Waara, J. (2008). Development of a new approach to guided self-help via the internet: the Swedish experience. Journal of Technology in Human Services, 26, 161–181. https://doi.org/10.1080/15228830802094627 CrossRefGoogle Scholar
Andersson, G., Paxling, B., Wiwe, M., Vernmark, K., Felix, C. B., Lundborg, L., Furmark, T., Cuijpers, P., & Carlbring, P. (2012). Therapeutic alliance in guided internet-delivered cognitive behavioural treatment of depression, generalized anxiety disorder and social anxiety disorder. Behaviour Research and Therapy, 50, 544–550. https://doi.org/10.1016/j.brat.2012.05.003 CrossRefGoogle ScholarPubMed
Bengtsson, J., Nordin, S., & Carlbring, P. (2015). Therapists’ experiences of conducting cognitive behavioural therapy online vis-à-vis face-to-face. Cognitive Behaviour Therapy, 44, 470–479. https://doi.org/10.1080/16506073.2015.1053408 CrossRefGoogle ScholarPubMed
Biliunaite, I., Kazlauskas, E., Sanderman, R., Truskauskaite-Kuneviciene, I., Dumarkaite, A., & Andersson, G. (2021). Internet-based cognitive behavioral therapy for informal caregivers: randomized controlled pilot trial. Journal of Medical Internet Research, 23, e21466. https://doi.org/10.2196/21466 CrossRefGoogle Scholar
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101. https://doi.org/10.1191/1478088706qp063oa CrossRefGoogle Scholar
Braun, V., & Clarke, V. (2013). Successful Qualitative Research: A Practical Guide for Beginners . SAGE Publications. https://doi.org/10.1191/1478088706qp063oa Google Scholar
Brown, M., Glendenning, A., Hoon, A. E., & John, A. (2016). Effectiveness of web-delivered acceptance and commitment therapy in relation to mental health and well-being: a systematic review and meta-analysis. Journal of Medical Internet Research, 18, e221. https://doi.org/10.2196/jmir.6200 CrossRefGoogle ScholarPubMed
Buhrman, M., Skoglund, A., Husell, J., Bergström, K., Gordh, T., Hursti, T., Bendelin, N., Furmark, T., & Andersson, G. (2013). Guided internet-delivered acceptance and commitment therapy for chronic pain patients: a randomized controlled trial. Behaviour Research and Therapy, 51, 307–315. https://doi.org/10.1016/j.brat.2013.02.010 CrossRefGoogle ScholarPubMed
Collins, R., & Kishita, N. (2020). Prevalence of depression and burden among informal caregivers of people with dementia: a meta-analysis. Ageing and Society, 40, 2355–2392. https://doi.org/10.1017/S0144686X19000527 CrossRefGoogle Scholar
Donovan, C. L., Poole, C., Boyes, N., Redgate, J., & March, S. (2015). Australian mental health worker attitudes towards cCBT: What is the role of knowledge? Are there differences? Can we change them? Internet Interventions, 2, 372–381. https://doi.org/10.1016/j.invent.2015.09.001 CrossRefGoogle Scholar
Fauth, E. B., Novak, J. R., & Levin, M. E. (2021). Outcomes from a pilot online Acceptance and Commitment Therapy program for dementia family caregivers. Aging & Mental Health, 1–10. https://doi.org/10.1080/13607863.2021.1942432 CrossRefGoogle ScholarPubMed
Folker, A. P., Mathiasen, K., Lauridsen, S. M., Stenderup, E., Dozeman, E., & Folker, M. P. (2018). Implementing internet-delivered cognitive behavior therapy for common mental health disorders: a comparative case study of implementation challenges perceived by therapists and managers in five European internet services. Internet Interventions, 11, 60–70. https://doi.org/10.1016/j.invent.2018.02.001 CrossRefGoogle ScholarPubMed
Geller, S. (2020). Cultivating online therapeutic presence: strengthening therapeutic relationships in teletherapy sessions. Counselling Psychology Quarterly, 1–17. https://doi.org/10.1080/09515070.2020.1787348 Google Scholar
Giebel, C., Lord, K., Cooper, C., Shenton, J., Cannon, J., Pulford, D., Shaw, L., Gaughan, A., Tetlow, H., Butchard, S., Limbert, S., Callaghan, S., Whittington, R., Rogers, C., Komuravelli, A., Rajagopal, M., Eley, R., Watkins, C., Downs, M., Reilly, S., Ward, K., Corcoran, R., Bennett, K., & Gabbay, M. (2021). A UK survey of COVID-19 related social support closures and their effects on older people, people with dementia, and carers. International Journal of Geriatric Psychiatry, 36, 393–402. https://doi.org/10.1002/gps.5434 CrossRefGoogle ScholarPubMed
Guay, C., Auger, C., Demers, L., Mortenson, W. B., Miller, W. C., Gélinas-Bronsard, D., & Ahmed, S. (2017). Components and outcomes of internet-based interventions for caregivers of older adults: systematic review. Journal of Medical Internet Research, 19, e313. https://doi.org/10.2196/jmir.7896 CrossRefGoogle ScholarPubMed
Hayes, S. C., Levin, M. E., Plumb-Vilardaga, J., Villatte, J. L., & Pistorello, J. (2013). Acceptance and commitment therapy and contextual behavioral science: examining the progress of a distinctive model of behavioral and cognitive therapy. Behavior Therapy, 44(2), 180– 198. https://doi.org/10.1016/j.beth.2009.08.002 CrossRefGoogle ScholarPubMed
Hughes, A., Campbell, M., & Byrne, M. (2015). Profiling assistant psychologist experiences in Ireland and the United Kingdom. The Irish Psychologist, 4, 107–112. https://doi.org/http://hdl.handle.net/10147/550449 Google Scholar
Jutkowitz, E., Scerpella, D., Pizzi, L. T., Marx, K., Samus, Q., Piersol, C. V., & Gitlin, L. N. (2019). Dementia family caregivers’ willingness to pay for an in-home program to reduce behavioral symptoms and caregiver stress. PharmacoEconomics, 37, 563–572. https://doi.org/10.1007/s40273-019-00785-6 CrossRefGoogle ScholarPubMed
Kaddour, L., & Kishita, N. (2020). Anxiety in informal dementia caregivers: a meta-analysis of prevalence. Journal of Geriatric Psychiatry and Neurology, 33, 161–172. https://doi.org/10.1177/0891988719868313 CrossRefGoogle Scholar
Kishita, N., Contreras, M., West, J., & Mioshi, E. (2020). Exploring the impact of carer stressors and psychological inflexibility on depression and anxiety in family carers of people with dementia. Journal of Contextual Behavioral Science, 17, 119–125. https://doi.org/10.1016/j.jcbs.2020.07.005 CrossRefGoogle Scholar
Kishita, N., Gould, R. L., Farquhar, M., Contreras, M., Van Hout, E., Losada, A., Cabrera, I., Hornberger, M., Richmond, E., & McCracken, L. M. (2021). Internet-Delivered guided self-help acceptance and commitment therapy for family carers of people with dementia (iACT4CARERS): a feasibility study. Aging & Mental Health, 1–9. https://doi.org/10.1080/13607863.2021.1985966 CrossRefGoogle ScholarPubMed
Lappalainen, P., Pakkala, I., Lappalainen, R., & Nikander, R. (2021). Supported web-based acceptance and commitment therapy for older family caregivers (CareACT) compared to usual care. Clinical Gerontologist, 1–17. https://doi.org/10.1080/07317115.2021.1912239 CrossRefGoogle ScholarPubMed
Losada, A., Márquez-González, M., Romero-Moreno, R., Mausbach, B. T., López, J., Fernández-Fernández, V., & Nogales-González, C. (2015). Cognitive-behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for dementia family caregivers with significant depressive symptoms: results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 83, 760–772. https://doi.org/10.1037/ccp0000028 CrossRefGoogle Scholar
Malterud, K., Siersma, V. D., & Guassora, A. D. (2016). Sample size in qualitative interview studies: guided by information power. Qualitative Health Research, 26, 1753–1760. https://doi.org/10.1177/1049732315617444 CrossRefGoogle ScholarPubMed
Marquez-Gonzalez, M. A.-O., Romero-Moreno, R., Cabrera, I., Olmos, R., Perez-Miguel, A., & Losada, A. (2020). Tailored versus manualized interventions for dementia caregivers: the functional analysis-guided modular intervention. Psychology and Aging, 35, 41–45. https://doi.org/10.1037/pag0000412 CrossRefGoogle ScholarPubMed
McCormack, H. M., MacIntyre, T. E., O’Shea, D., Herring, M. P., & Campbell, M. J. (2018). The prevalence and cause(s) of burnout among applied psychologists: a systematic review. Frontiers in Psychology, 9, 1897. https://doi.org/10.3389/fpsyg.2018.01897 CrossRefGoogle ScholarPubMed
Meisel, S. F., Drury, H., & Perera-Delcourt, R. P. (2018). Therapists’ attitudes to offering eCBT in an inner-city IAPT service: a survey study. The Cognitive Behaviour Therapist, 11, e11. https://doi.org/10.1017/S1754470X18000107 CrossRefGoogle Scholar
Mol, M., van Genugten, C., Dozeman, E., van Schaik, D. J. F., Draisma, S., Riper, H., & Smit, J. H. (2020). Why uptake of blended internet-based interventions for depression is challenging: a qualitative study on therapists’ perspectives. Journal of Clinical Medicine, 9, 91. https://doi.org/10.3390/jcm9010091 CrossRefGoogle Scholar
Morris, E. M. J., & Bilich-Eric, L. (2017). A framework to support experiential learning and psychological flexibility in supervision: SHAPE. Australian Psychologist, 52, 104–113. https://doi.org/10.1111/ap.12267 CrossRefGoogle Scholar
NHS Digital (2017). Personal Social Services Survey of Adult Carers in England, 2016–17. Adult Social Care Statistics Team. https://files.digital.nhs.uk/publication/a/o/sace_report_2016-17.pdf Google Scholar
Ottaviani, A. C., Monteiro, D. Q., Oliveira, D., Gratão, A. C. M., Jacinto, A. F., Campos, C. R. F., Barham, E. J., de Souza Orlandi, F., da Cruz, K. C. T., Corrêa, L., Zazzetta, M. S., & Pavarini, S. C. I. (2021). Usability and acceptability of internet-based interventions for family carers of people living with dementia: systematic review. Aging & Mental Health, 1–11. https://doi.org/10.1080/13607863.2021.1975095 CrossRefGoogle ScholarPubMed
Pappa, S., Barnett, J., Berges, I., & Sakkas, N. (2021). Tired, worried and burned out, but still resilient: a cross-sectional study of mental health workers in the UK during the COVID-19 pandemic. International Journal of Environmental Research and Public Health, 18, 4457. https://doi.org/10.3390/ijerph18094457 CrossRefGoogle ScholarPubMed
Rees, C. S., & Stone, S. (2005). Therapeutic alliance in face-to-face versus videoconferenced psychotherapy. Professional Psychology: Research and Practice, 36, 649–653. https://doi.org/10.1037/0735-7028.36.6.649 CrossRefGoogle Scholar
Rodda, S. N., Merkouris, S., Lavis, T., Smith, D., Lubman, D. I., Austin, D., Harvey, P., Battersby, M., & Dowling, N. A. (2019). The therapist experience of internet delivered CBT for problem gambling: service integration considerations. Internet Interventions, 18, 100264. https://doi.org/10.1016/j.invent.2019.100264 CrossRefGoogle ScholarPubMed
Samia, L. W., Aboueissa, A.-M., Halloran, J., & Hepburn, K. (2014). The Maine Savvy Caregiver Project: translating an evidence-based dementia family caregiver program eithin the RE-AIM framework. Journal of Gerontological Social Work, 57, 640–661. https://doi.org/10.1080/01634372.2013.859201 CrossRefGoogle Scholar
Sekhon, M., Cartwright, M., & Francis, J. J. (2017). Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Services Research, 17, 88. https://doi.org/10.1186/s12913-017-2031-8 CrossRefGoogle ScholarPubMed
Smith, I. C., Huws, J. C., Appleton, K., Cooper, S.-A., Dagnan, D., Hastings, R. P., Hatton, C., Jones, R. S. P., Melville, C., Scott, K., Williams, C., & Jahoda, A. (2021). The experiences of therapists providing psychological treatment for adults with depression and intellectual disabilities as part of a randomised controlled trial. Journal of Applied Research in Intellectual Disabilities. https://doi.org/10.1111/jar.12886 CrossRefGoogle ScholarPubMed
Sucala, M., Schnur, J. B., Constantino, M. J., Miller, S. J., Brackman, E. H., & Montgomery, G. H. (2012). The therapeutic relationship in E-therapy for mental health: a systematic review. Journal of Medical Internet Research, 14, e110. https://doi.org/10.2196/jmir.2084 CrossRefGoogle ScholarPubMed
Sun, Y., Song, H., Liu, H., Mao, F., Sun, X., & Cao, F. (2020). Occupational stress, mental health, and self-efficacy among community mental health workers: a cross-sectional study during COVID-19 pandemic. International Journal of Social Psychiatry, 0020764020972131. https://doi.org/10.1177/0020764020972131 Google ScholarPubMed
Thew, G. R. (2020). IAPT and the internet: the current and future role of therapist-guided internet interventions within routine care settings. The Cognitive Behaviour Therapist, 13, e4, Article e4. https://doi.org/10.1017/S1754470X20000033 CrossRefGoogle ScholarPubMed
Thompson, E. M., Destree, L., Albertella, L., & Fontenelle, L. F. (2021). Internet-based acceptance and commitment therapy: a transdiagnostic systematic review and meta-analysis for mental health outcomes. Behavior Therapy, 52, 492–507. https://doi.org/10.1016/j.beth.2020.07.002 CrossRefGoogle Scholar
Wehmann, E., Köhnen, M., Härter, M., & Liebherz, S. (2020). Therapeutic alliance in technology-based interventions for the treatment of depression: systematic review. Journal of Medical Internet Research, 22, e17195. https://doi.org/10.2196/17195 CrossRefGoogle ScholarPubMed
Wolff, J. L., Mulcahy, J., Huang, J., Roth, D. L., Covinsky, K., & Kasper, J. D. (2017). Family caregivers of older adults, 1999–2015: trends in characteristics, Circumstances, and role-related appraisal. The Gerontologist, 58, 1021–1032. https://doi.org/10.1093/geront/gnx093 CrossRefGoogle Scholar
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