Design considerations for the integrated delivery of cognitive behavioral therapy for depression: a user-centered design study

Stawarz, Katarzyna ORCID: https://orcid.org/0000-0001-9021-0615, Preist, Chris, Tallon, Deborah, Wiles, Nicola, Kessler, David, Turner, Katrina, Shafran, Roz and Coyle, David 2020. Design considerations for the integrated delivery of cognitive behavioral therapy for depression: a user-centered design study. JMIR Mental Health 7 (9) , e15972. 10.2196/15972

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Abstract

Background: Adherence to computerized Cognitive Behavioral Therapy (cCBT) programs in real world settings can be poor and, in the absence of therapist support, effects are modest and short-term. Moreover, because cCBT systems tend towards limited support and thus low-intensity treatment, they are typically most appropriate for people with mild to moderate difficulties. Blended therapy, i.e. combining direct contact with a therapist with cCBT or psychoeducational materials, has been identified as one possible approach to addressing these limitations and widening access to individual CBT for depression. To date research on blended therapy systems is quite limited, particularly in comparison to more widely explored cCBT systems. While the design space and range of potential configurations for blended systems is large, only a small portion of this design space has been investigated to date. Objective: First, to explore patients’ and therapists’ views on using a system for the delivery of individual treatment for depression that integrates face-to-face contact with a therapist with access to online resources and with synchronous online therapy sessions that allow collaborative worksheet editing. Second, to establish design requirements and thus key design considerations for blended systems that further integrate different modes of communication. In particular, we were interested in exploring barriers relating to remote therapy and engagement with this type of treatment, understanding patients’ expectations of technology, and understanding therapists’ experiences of and attitudes towards the use of technology to support their work. Methods: We conducted design workshops and prototype testing sessions with 18 people who had received CBT for depression in the past, and qualitative interviews and role-play sessions with 12 CBT therapists experienced in the treatment of depression. Results: Workshops and prototyping sessions with people who had received CBT identified three important requirements for an integrated platform delivering CBT therapy for depression: 1) features that help to overcome depression-related barriers, 2) features that support engagement, and 3) features that reinforce learning and support the development of new skills. Research with therapists highlighted the importance of the therapist and client working together, the impact of technology on therapists’ workflow and workload, challenges and opportunities related to the use of online resources, and the potential of technology to support patient engagement. We use these findings to inform 12 design considerations for developing integrated therapy systems. Conclusions: To meet clients’ and therapists’ needs, integrated systems need to help retain the personal connection, support both therapist- and patient-led activities, provide access to materials and the ability to monitor progress. However, developers of such systems should be mindful of their capacity to disrupt current work practices and increase therapists’ workload. Future work should evaluate the impact of integrated systems on delivering and receiving therapy in a real-world context.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Computer Science & Informatics
Publisher:	JMIR Publications
ISSN:	2368-7959
Date of First Compliant Deposit:	12 August 2020
Date of Acceptance:	10 August 2020
Last Modified:	07 Nov 2023 17:59
URI:	https://orca.cardiff.ac.uk/id/eprint/134144

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