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E-Mental-Health (Andrews (2010) (Effective treatments for anxiety og major…

- - - - Significantly more client participation in videoconferencing than in in-person settings
      - Clients were found to be more active, with higher levels of initiative, spontaneity, trust and disinhibition
- - - - Firs, sensitivity to 'who I am' as a patient, including different clinical needs and personal preferences
      - Secondly, sensitivity to 'how I feel', recognizing the demands of depression on the user:
      - Currently it is the absence of self which is most prominent in user experience of computerised therapy: programmes should sensitively (computers as social agents)
    - - Pattern of dichotomies or contradictions were present in user experience regarding the level of support and contact with others when using technology delivered therapy: related to level of support and level of contact to others
      - Completers tended to tailor programmes to their own needs by selecting only those components perceived as beneficial, again reflecting a sense of ownership or control, placing great demands on user, need for human interaction to support use of program, advantages of engaging in therapy without direct or face-to-face contact, conflicting need to be dependent and treated as a patient
      - Contrary to the different responses reflecting different patients' experiences, it may be that the same patients could experience both aspects of programmes depending on the specific interface of the programme or potentially varying due to clinical factors, such as mood
      - Clear that the same aspects of computerised therapy could be portrayed as both positive and negative experiences, rather than there being exclusive barriers or facilitators
      - The greater level of contact confers benefits of interpersonal interaction, but can also be threatening; a lower level of contact provides safety and privacy, but can also feel isolating and lonely
      - The grater level of independence is perceived as empowering, but can also be too demanding; a lower level means more support is experienced, but current systems limits role of the user as active agent, making them more passive
      - Characteristics of system that could balance competing needs
        
        Foster an experience of collaboration between user and system: autonomy support emphasises need to foster individual action to encourage self-motivation, rather than providing solely external motivations or pressures, but also distinct from a feeling of 'enforced autonomy', where users felt abandoned
        
        Programme encourage connection, balancing need for contact with others, with our intruding private experience of user: allow greater distance and even anomaly but also greater interaction through connection with online networks or through supporting synchronous and non synchronous communication with therapists through ubiquitous technology
      - Distinct benefits that computerised therapies: more privacy and greater sense of mastery and control, but also demonstrates that benefits can be perceived as limitation in contrast to face-to-face therapies
      - Balancing the perceived competing needs of support or independence and privacy or interconnectedness could enable more users to exploit unique benefits of computerised therapy whilst maintaining gains in access and cost effectiveness
      - Importance of systems being sensitive to users, tailoring and personalising content to be most relevant for them, and indicated that this in itself could enhance feelings of connection and collaboration
      - cCBT may be changing role pf patients in own treatment, which can have both positive and negative consequences: negotiation new ways of providing peer or professional support and better understanding role of patient identities in interacting with computerised therapies may be critical
      - Absence of common factors: cCBT have additional and unique common factors themselves, relating to the particular properties of therapy delivered by technology such as privacy and control
      - Focusing on what technology can provide that is novel to the medium rather than trying to replicate what human therapists would do: support the framing of computerised therapy as complementary to face-to-face support, rather than replacing it
      - Greater connection and collaboration could be achieved through achieving a balance of independent computerised therapy with some level of professional support: computerised therapies require a more active involvement and motivation to engage in therapy at all
      - The finding that users experience the computer as a social agent does however suggest that collaboration and connection may be possible through improved interfaces - that patients may be able to achieve a collaborative relationship and connect with the computer therapy itself: need to be targeted and matched to specific users depending on patient preferences or aptitudes