What therapists do during guidance in individually tailored internet-based cognitive behavioral therapy for depressive symptoms: A content analysis.

Introduction Therapist-supported internet-based cognitive behavioral therapy (ICBT) can be effective for individuals with depressive symptoms. However, it remains unclear how therapists act when guiding individually tailored ICBT. This study examined therapist behaviors in guided ICBT where therapists choose participant modules, focusing on the proportions of behaviors and behaviors' associations with depressive symptoms and negative treatment effects.Methods Content analysis was employed to examine 1055 messages sent from six therapists to 62 participants. Z-tests for proportions were used to compare therapist behaviors in the current study to those reported in studies on non-tailored ICBT. The association between therapist behavior frequencies and changes in depressive symptoms and negative effects were assessed using Spearman's rho correlation. Residual change scores were calculated for depressive symptoms.Results All but two therapist behaviors identified in prior research on non-tailored ICBT were observed in this study. Certain behaviors such as clarifying the framework and administrative aspects were more common than in non-tailored ICBT for depressive symptoms. Other behaviors, such as empathetic utterances, were less common. The frequency of reinforcing correlated significantly with a decrease in depressive symptoms (r s = -0.33, p = .033) and unsupportive tone correlated significantly with negative effects (r s = 0.35, p = .022).Discussion Almost all therapist behaviors observed in previous studies on non-tailored ICBT are also present in individually tailored ICBT, although the proportions of behaviors differ. Furthermore, the results indicate that reinforcing may be associated with improved treatment outcomes, while therapist unsupportive tone could be linked to negative effects.