“Computerised cognitive behaviour therapy

The aim of this quantitative study on “Computerised cognitive behaviour therapy, CCBT and older people”, is too firstly measure if the group of older people are interested in using computerised therapy, and are they willing to learn computer skills needed for computerised therapy. Other factors were also taken into the results, such as if the group being studied had previous experience of self-help and therapy, and if they had any experience on computers. A small scale study took place with a short questionnaire, of nine questions, and given to 60 people using a mental health service. Participants were aged 65 plus, some who regularly attended day hospital, fewer who were inpatients, however the majority of users were outpatients. Out of the 60 questionnaires given out, 38 were completed. This study was mainly of a quantitative approach, as this enables a larger group of people to be studied, and better generalisations can be applied to more people, however there was a section on the questionnaires for the participants to write further comments.

This part of the questionnaire would use the qualitative method and were analysed using thematic analysis, to detect common themes among the comments given, which provided good insight to the reasons for and against using ccbt. Not much research has been taken into older people and computer use, as most studies do not use older participants. As the Department of Health (DOH) quote “older adults have not benefited from the same development as young people” DOH (2005). So it seems that this area has not been researched extensively. An assumption from Kaltenthaler et al (2004) ‘that older people may find computers unacceptable’, proving that more research is to be considered in this age group. As there is evidence base and practice base, that traditional CBT can help older people. The aims of this study us to gather evidence from this group termed ‘older people’, which has otherwise been overlooked. As more technology based counselling is developing now, and that 61% of homes in 2007 had internet access (office for national statistics 2007), this is an area which can open up more freedom, to those older people who use a therapy service, who find it hard to travel to places.

The response rate was 63.3%, and from the results nearly half would be interested in using CCBT. This was not limited to any one age group, as there were different age ranges within the older participants, 19 between 65-75, 14 between 76-85 and five were 86 plus, and mostly half of all age ranges said they would use CCBT, so age was not an obvious deterrent. The response from the willingness to learn computer skills, again nearly half said they would, with less saying no and less again who weren’t sure. In the interest in CCBT and previous experience of computers, the results show only 6 out of 38, had used a computer with half saying they would use CCBT, one wouldn’t and one unsure, displaying that confidence in computer skills was not a factor when asked if they would use CCBT. The last question was asking that of previous experience of self- help and therapy, the results show more of the participants that had used self-help before were more interested in using CCBT, than those who have had previous therapy and not self- help had less willingness to use CCBT.

The results were shown in bar graphs, and discussed in figures, other than the qualitative data, which were put into coded categories, then using thematic analyses, to see if a common theme occurred. However this showed an equal response to a positive and a negative theme, even though there were more negative common themes. It concludes with the consideration that more research still needs to be done, as there is a research practice gap (Williams and Irving 1999), quote ‘some participants are reluctant to research as regarded difficult or irrelevant’, which may be why there is limited evidence for this, and if further research could be studied, then larger participation from older people is required to ascertain what needs are to be tailored, for all the different user’s needs.

The research for this study in the article ‘CCBT and older people’ is using the quantitative approach. Therefore relating to outcome research, to determine how much something is helpful or unhelpful. Quantitative is measurement in the form of numbers, to reveal facts and in this article, it was to measure how many people would be willing to use CCBT, with three columns, yes, no and unsure. These measures were displayed on a bar chart, and are very clear when looking at the results, how much of one response there is. As with quantitative research you can study a much larger group of people, to then make a possible generalisation, as more people studied. However the article study, there were only 60 users identified as participants and only 38 of them completed and sent back the questionnaires, so the study scale was small. There have been 14 other studies into computerised coginitive behaviour therapies, and its management in depression and anxiety, including randomised control trials, in people age 61 years and younger.

Therefore Elsegood and Powell research of ‘ccbt and older people’ are one of the very few with older participants. RCT (randomised control trials) are conducted to ascertain whether funding by the government is suitable, in the area of therapy for psychological problems, and in this study depression and anxiety. Evidence from the trials on different therapies, is used to select the efficacy of the approach studied is effective. Efficacy research is otherwise known as evidence based practice and effectiveness research as practice based evidence. A model of practice based evidence by Barkham et el (2010) produces a circle of continuous activity, showing the complementary relationship of practice based studies (does this work in practice?). Then onto RCT to then evidence based practice. So then it is implemented into policy, and so forth. For therapies such as ccbt ready for practioners to use, there must be evidence of effectiveness.

Therefore the research conducted was to get an idea of numbers of interest; however no RCT’S were put into place, which may have provided clearer results, as if ccbt is effective. Due to the small sample size, this would be a weakness, as with the results it would be difficult to generalise. The results from the question ‘interest in computerised therapy?’ show 17 said yes, 13 no and 8 not sure, so the difference between the amount of people saying yes to no, is not a clear indictor, therefore unable to conclude that the older people would. Again with the results from question ‘would they be willing to learn the necessary computer skills?’ 17 said yes, 12 no and 9 not sure, so not a significant difference to make a decision. I think another weakness in this approach was, how the questions were worded, and if they contained an explanation for example, the users are asked would they be interested in ccbt, as this did not provide any clarification of what ccbt is, and if the participants do not have any background knowledge, then this would have influenced their true answer.

By providing an explanation of what exactly ccbt is, would have been a factor in their decision. Even though under the method heading, that there was an opportunity for participants to ask questions, as 41 of the participants were outpatients and received their questionnaire by post, could have affected whether they would have questioned the information. As they would have had to make a phone call or go into the clinic, again affecting their answer. As with CORE-OM forms, which stands for clinical, outcome, routine, evaluation- outcome measure. These are questionnaires that are used to measure someone’s anxiety and depression. They include statements like ‘tension and anxiety have prevented me from doing important things’ (ch4 Understanding counselling and psychotherapy 2010), as with the questionnaires for the article studied, there were not any questions to ask about the participants mental health, like the statement above.

Again their mental health could affect their answer, as if they are being treated for feelings of hopelessness and disinterest, then they may generally feel less interested in using ccbt. So maybe some questions regarding this area could have been added, to get a general feel for the participants used. This then goes back to RCTS and the key feature to these are that there are participants randomly allocated to a group and a control group, to measure any differences between groups. The questionnaires were only given to participants who used this one located mental health service, and not various services. They were not given out to the general public randomly, whether or not they had mild anxiety or depression. This may also be a weakness as the questions were only responded by older people with mild anxiety or depression; however the response could also be indicative from general groups.

Strengths are shown by using three different age ranges, as responses are from people with at least twenty years between theme 65-75 and aged 86 plus. By using these age ranges, it can help give a generalised conclusion, as it would then be clear if age was a factor, particularly if the results showed that the older they get, then the less interested they become, as quoted by Kaltenthaler et el (2004) earlier. The question regarding previous experience using computers, and previous experience of self- help and therapy, were strength to categorise the participants of what factors could influence them.

The qualitative data from the findings, which were taken from the ‘ further comments’ box, were a strength, as the themes both negative and positive, from the thematic analyses, provided more meaning, to what their personal reasons are to have , an interest or a lack of interest into ccbt. The freedom of language that qualitative data gives proved most helpful to determine the factors of willingness, just as the measurements from the quantitative data did. Qualitative data is more subjective and reflective, however the strengths from qualitative research provide a deeper insight and more phemenlogical, whereas quantitative research cannot provide the same evidence of meanings attached to decisions, or answers. As in Elsegood and Powell research article, they concluded that ccbt may be a viable option for the older group of people, with the need for further research as this was limited. I think that the qualitative data was strength for further indication.

From the different approaches, I feel more drawn to the cognitive behavioural approach (cbt), this is because cbt is predominately about changing the behaviour pattern of the way we think and how we attach meanings to things (Beck 1976). This is mostly a technique based approach, however I feel that a collaborative exploration between two adults help achieve effectiveness. Lambert cited (Lambert and Asay 1999) “suggest that approx 30% of effective outcomes is due to the therapeutic relationship”. Even though cbt is a structured based approach with psycho- educational elements, where the client is helped to identify where they are stuck, and then to learn other ways of attaching positive meanings to the situations, a good therapeutic relationship is needed, to form a shared understanding.

Cooper (2008) cites that the strongest evidence so far in research findings, is in cbt, and the relationship between the client and therapist are both key for positive outcomes. Therefore if cbt is as affective, then the relationship between the two people involved must be fundamental in cbt. As when listening to excerpt 11 audio, there is an explanation of a cognitive behaviour therapy session, with a lady suffering from anxiety, and it is quoted by Ann Garland a counsellor, that you need to build a rapport and trust with your client, and reassurance from the therapist helps make this an effective approach. I would like to take a mixture of cbt with the person centered approach, if I were a counsellor, as I feel they both are equal, as an adult to adult relationship is taken, with no power imbalance.

I try to relate to people equally, and would prefer not to be counselled or counsel as a parent- child relationship. As with the humanistic and existential approach, this is an adult to adult relationship, in particular Carl Rogers (1902-1987) the humanistic approach was non directive and client centred. Carl Rogers developed three core conditions, into his humanistic approach, congruence, empathy and unconditional positive regard. As quoted on the audio excerpt 9, Jane Diben and Maureen Moore are discussing the importance of the relationship between the two people. Rogers quotes “The more the therapist is himself or herself in the relationship, putting up no professional front, the greater is the likehood that the client will change and grow in a constructive manner” Rogers (1980).

SELF REFLECTION

I liked writing this assignment on the basis of the article, for part one, as it was interesting to read about ccbt, and reference it to the online counselling section in the module books, I did struggle more with part two discussing strengths and weakness, as I don’t think I provided enough evidence as I find it difficult to write critically.

REFERENCES

Elsegood K and Powell D (2008) Computerised cognitive behaviour therapy (ccbt) and older people: A pilot study to determine factors that influence willingness to engage with ccbt. Department of Health (2005). Counselling and psychotherapy research. The Open university course material vol 8 no 3 pp189-192. Computerised cognitive behaviour therapy (ccbt) and older people: A pilot study to determine factors that influence willingness to engage with ccbt. Department of Health (2005). Counselling and psychotherapy research. The Open university course material vol 8 no 3 pp189-192. Office for
national statistics (2007) Computerised cognitive behaviour therapy (ccbt) and older people: A pilot study to determine factors that influence willingness to engage with ccbt. Department of Health (2005). Counselling and psychotherapy research. The Open university course material vol 8 no 3 pp189-192.

Williams and Irving (1999) Ch13, Understanding counselling and psychotherapy, Barker M, Langdridge D, Vossler A (2010) The Open University , Milton Keynes. Barkham et al (2010) Ch13, Understanding counselling and psychotherapy, Barker M, Langdridge D, Vossler A (2010) The Open University , Milton Keynes.

Core-Om forms, Ch13, Understanding counselling and psychotherapy, Barker M, Langdridge D, Vossler A (2010) The Open University , Milton Keynes.

Lambert and Asay (1999) Understanding counselling and psychotherapy, Barker M, Langdridge D, Vossler A (2010) The Open University , Milton Keynes.

Cooper (2008) Understanding counselling and psychotherapy, Barker M, Langdridge D, Vossler A (2010) The Open University , Milton Keynes.

Excerpt 9 audio dvd, excerpt 11 audio dvd, course materials. Understanding counselling and psychotherapy, Barker M, Langdridge D, Vossler A (2010) The Open University , Milton Keynes.

Rogers C (1980) Understanding counselling and psychotherapy, Barker M, Langdridge D, Vossler A (2010) The Open University , Milton Keynes.