Remote delivery of psychological interventions : Impact and acceptability of preventive strategies to improve risk factors associated with coronary heart disease

Abstract: Depression, anxiety and excessive weight are public health concerns that have been associated with an increased risk and worse prognosis of coronary heart disease. Remote delivery of psychological interventions may be an effective preventive strategy to improve these lifestyle-related risk factors as treatment may be delivered to many people at a low cost and reduce stigma related to seeking help. The general contribution of this thesis is to investigate the impact and indicators of treatment acceptability in contexts where this type of delivery may improve access to psychological interventions. The aim of Study I was to investigate whether stigma predicts the intention to seek help via the Internet compared to face to face among undergraduate students (N=267) and primary care patients (N=195). The results indicate that Internet-based interventions may improve intentions to seek help among individuals who are reluctant to seek psychological treatment face to face due to stigma. In Study II, the effect of a guided Internet-based Cognitive Behavior Therapy (iCBT) and Treatment-As-Usual (TAU) was compared to TAU only to reduce symptoms of depression and anxiety among patients with a recent myocardial infarction (N=239) in a randomized controlled trial. The results indicate no difference in symptoms of depression and anxiety between the groups. Study III describe treatment activity among participants allocated to the iCBT intervention in Study II (N=117). Furthermore, user experiences were explored using a semi-structured interview with 21 of these participants. The results indicate overall low treatment activity and different preferences regarding the web-based portal, treatment program and therapist communication. The aim of Study IV was to evaluate the impact and investigate indicators of treatment acceptability of a guided Acceptance and Commitment Therapy (ACT) self-help intervention to improve value attainment related to health and reduce experiential avoidance among individuals with overweight or obesity using a multiple baseline design (N=13). The results indicate that theACT intervention may be an acceptable intervention to improve value attainment related to health and decrease experiential avoidance. In conclusion, the studies in this thesis illustrate several challenges related to the willingness to seek and engage in Internet-based interventions. Furthermore, the results indicate varying responses to the remote delivery of ACT. The principal findings are discussed in relation to methodological limitations. Possible strategies to improve the take-up rates, adherence and treatment satisfaction are suggested as well as areas of future research.