Cognitive Behaviour Therapy for Depression and Anxiety
RESULTS OF BLUES BEGONE RESEARCH – PART 2
Welcome to the second part of the research results for cognitive behaviour therapy for depression and anxiety program Blues Begone. This the fifth article in a series about the Blues Begone User Experience.
THE MEANINGFUL RELATIONSHIP
This section will focus on the nature, pattern and degree of the participant’s relationship with the self-help material and its impact on the participant’s psychological process.
Cognitive behaviour therapy for depression and anxiety: The virtual therapist
For five of the seven participants who used this programme, the figures and voices of the programme’s cartoon characters or “talking heads” assumed a reality that was described with warmth, enthusiasm, and humour. Participants referred to these figures at length, seemingly so engaged within this “relationship” that they were able to feel genuinely encouraged, praised and thus motivated by the programme.
Caroline reflected the views of Jane, Grace, Teresa and Frank when she said:
“It sounds silly but you felt as if someone was on your side.
The talking heads cheered you on and erm it did feel as
Though there was support, despite the fact that they were
invented” (Caroline, 6. 1-3)
For some of the participants, the “virtual relationship” even offered advantages over a real one. Frank identified the “standard approach” of the virtual therapist as a potential benefit; whilst Caroline seemed to find a virtual relationship less demanding as she did not have to concern herself with the reactions of a human being sitting opposite her:
“If you compared it to a human being being in front of you…I mean in a way it took out some of the problems of communication with a human being. Erm ….but I did find it, it felt…I had er the sound turned up loud and I didn’t have to worry about what they were thinking” (Caroline, 7. 19-23)
Cognitive behaviour therapy for depression and anxiety: The nature of the relationship
As is often the case with face to face therapy, participants needed to build up trust in the Blues Begone programme. Grace, Teresa, Frank and Jane all described initial concerns as to the confidentiality of personal information being entered into the computer.
However, narratives showed that as participants became more involved in the programme, such concerns largely disappeared. Caroline seemed to summarise the majority of participants’ views when she commented:
“The fact that the talking heads looked so real erm…and sounded real and always talked good sense, you know I wasn’t able to sort of…erm sort of trip them up if you know what I mean. I felt that everything they were saying made sense … I came to trust it, the programme” (Caroline, 4. 15-18 and 22)
Cognitive behaviour therapy for depression and anxiety: Trust
Caroline’s words not only reflected a growing trust in the programme but also introduced the importance of the programme’s credibility for participants’ successful engagement and sustained activity. Grace described other aspects of the material that afforded the programme credibility in her eyes:
“…those guys are so confident about everything they say. Because there’s research behind it all, they’re not a pair of whacko new age people are they, they’re scientists and being a scientist myself, if there’s proper research behind it then that’s good” (Grace, 5. 38-42)
Participants’ continued engagement with the Blues Begone programme seemed reinforced further by the personalised nature of the computerised response. For Jane having the computer use her name signified familiarity and care:
“It’s already become something that seems to know you and also in some electronic way, some computerised way to care about you” (Jane, 11. 33-35)
Cognitive behaviour therapy for depression and anxiety: Roadmap
The format of the Blues Begone programme provided a “tailored” approach to therapy or “Road Map” in order to try and address users’ individual issues.
“…the Roadmap to Recovery is individual, it’s personal to me and that felt good actually” (Teresa 5. 4-6)
Cognitive behaviour therapy for depression and anxiety: CCBT
Whilst users were positive in the main about the flexibility of the Blues Begone programme, the inability (as yet) of the computer to replicate the complexity, immediacy and specificity of human responsiveness understandably prevented the exchange between participant and virtual therapist moving to a deeper level.
Thus in some respects, the ways in which participants were able to make use of the virtual relationship were inevitably limited. Nevertheless, whilst on occasions this was frustrating for some users who had become engaged and “wanted more”, in the main participants seemed to understand and accept the limitations of the medium they were using.
In accurately reflecting participants’ experience and the realities of computerised self-help, it should also be noted that four participants experienced some problems of a technical nature in installing and accessing certain aspects of the programme. From their accounts, all reported strong feelings of frustration, further evidenced by their emotive narratives on this subject. For Shelley, frustration arose out of an inability to understand what had happened and her apparent lack of power to rectify the situation:
“I found it frustrating because I didn’t, I couldn’t understand…it wasn’t the fact that I had a relationship or a commitment issue with the programme, it was why is it not working? And why has it done this and what can I do to fix it?” (Shelley, 9. 15-18)
For Caroline, as with a face to face therapeutic relationship, this “rupture” in the process seemed to dent her trust in the material and the credibility of the programme. Speaking about the technical failure, she said:
“I didn’t like it… (Voiced very sternly). And I can remember when it came back, erm…not quite wondering whether it was worth starting again. I knew I was going to do it, carry on, but wondering whether it was as good as I thought it was” (Caroline, 7. 33 and 8. 1-4)
Nevertheless, despite these issues, participants’ seemed to have become sufficiently engaged with the programme and motivated by the self-help process to persevere. Having liaised with the researcher for advice, they made determined efforts to rectify the problem and continue.
Cognitive behaviour therapy for depression and anxiety: Ending the relationship
And finally, as with face to face therapy, the “ending of the relationship” was also commented upon by some participants. Jane, Monica, Grace, and Caroline voiced some regret that the programme had finished, making reference to having worked through the episodes quickly and wishing they had made it last longer.
However reports indicated that due to the format of the self-help material, participants were indeed able to prolong their experience by revisiting areas of interest at their convenience. Unlike face to face therapy, it appeared that participants’ relationship with the self-help material did not actually end but was able to continue as a means of ongoing support.
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