Therapists' perceptions and acceptability of providing internet-delivered guided self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS): A qualitative study

Milena Contreras; Elien Van Hout; Morag Farquhar; Rebecca L. Gould; Lance M. McCracken; Michael Hornberger; Erica Richmond; Naoko Kishita

doi:10.1017/S1754470X21000337

Therapists' perceptions and acceptability of providing internet-delivered guided self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS): A qualitative study

Milena Contreras, Elien Van Hout, Morag Farquhar, Rebecca L. Gould, Lance M. McCracken, Michael Hornberger, Erica Richmond, Naoko Kishita^*

^*Corresponding author for this work

School of Philosophy, Psychology and Language Sciences

Research output: Contribution to journal › Article › peer-review

Abstract

This study aimed to explore therapists’ perceptions and acceptability of providing internet-delivered, therapist-guided, self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS). To achieve this, a qualitative approach with semi-structured interviews was employed with eight novice therapists recruited from primary and secondary care services taking part in a feasibility study of iACT4CARERS. The interviews were audio-recorded, transcribed, and analysed using thematic analysis. Four over-arching themes were identified: (1) positive attitudes towards the intervention, (2) therapists’ workload, (3) therapists’ confidence to perform their role, and (4) connecting with family carers in a virtual context. Theme 1 included seeing their involvement as an opportunity for personal growth and perceiving benefits to the family carers, which contributed to greater acceptability. Theme 2 reflected that while workload and the user-friendliness of the online platform were highly acceptable among the therapists, there were also time-consuming cases that increased therapists’ burden. Theme 3 revealed that practical resources provided during the training, continued supervision, and opportunities to learn from other therapists, increased therapist confidence and facilitated greater acceptability. Finally, Theme 4 highlighted that improving the connection between therapists and carers was critical in a virtual context and strategies to improve the therapist–carer relationship were recommended. The implementation of iACT4CARERS was largely acceptable for the therapists involved in the trial. Ways to strengthen the therapeutic relationship in the virtual context and practical strategies to deal with common problems may enhance therapist experience and delivery in a full-scale effectiveness trial.

Original language	English
Article number	e38
Number of pages	17
Journal	Cognitive Behaviour Therapist
Volume	14
DOIs	https://doi.org/10.1017/S1754470X21000337
Publication status	Published - 15 Dec 2021

Keywords / Materials (for Non-textual outputs)

acceptability
informal caregivers
online therapy
psychological interventions
therapeutic relationship
therapists

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10.1017/S1754470X21000337

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Contreras, M., Van Hout, E., Farquhar, M., Gould, R. L., McCracken, L. M., Hornberger, M., Richmond, E., & Kishita, N. (2021). Therapists' perceptions and acceptability of providing internet-delivered guided self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS): A qualitative study. Cognitive Behaviour Therapist, 14, Article e38. https://doi.org/10.1017/S1754470X21000337

@article{5f980a6149c54076a6571d017cdc1fc8,

title = "Therapists' perceptions and acceptability of providing internet-delivered guided self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS): A qualitative study",

abstract = "This study aimed to explore therapists{\textquoteright} perceptions and acceptability of providing internet-delivered, therapist-guided, self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS). To achieve this, a qualitative approach with semi-structured interviews was employed with eight novice therapists recruited from primary and secondary care services taking part in a feasibility study of iACT4CARERS. The interviews were audio-recorded, transcribed, and analysed using thematic analysis. Four over-arching themes were identified: (1) positive attitudes towards the intervention, (2) therapists{\textquoteright} workload, (3) therapists{\textquoteright} confidence to perform their role, and (4) connecting with family carers in a virtual context. Theme 1 included seeing their involvement as an opportunity for personal growth and perceiving benefits to the family carers, which contributed to greater acceptability. Theme 2 reflected that while workload and the user-friendliness of the online platform were highly acceptable among the therapists, there were also time-consuming cases that increased therapists{\textquoteright} burden. Theme 3 revealed that practical resources provided during the training, continued supervision, and opportunities to learn from other therapists, increased therapist confidence and facilitated greater acceptability. Finally, Theme 4 highlighted that improving the connection between therapists and carers was critical in a virtual context and strategies to improve the therapist–carer relationship were recommended. The implementation of iACT4CARERS was largely acceptable for the therapists involved in the trial. Ways to strengthen the therapeutic relationship in the virtual context and practical strategies to deal with common problems may enhance therapist experience and delivery in a full-scale effectiveness trial.",

keywords = "acceptability, informal caregivers, online therapy, psychological interventions, therapeutic relationship, therapists",

author = "Milena Contreras and {Van Hout}, Elien and Morag Farquhar and Gould, {Rebecca L.} and McCracken, {Lance M.} and Michael Hornberger and Erica Richmond and Naoko Kishita",

note = "Acknowledgements: The authors would like to thank patient and public involvement research partners, Ruby Ali-Strayton, Geoff Angel and Peter Davis, for their invaluable insights at every stage of the design and conduct of the research. The authors also would like to thank Norfolk and Suffolk NHS Foundation Trust, Hertfordshire Partnership University NHS Foundation Trust and Octagon Medical Practice for their enormous support even throughout the COVID-19 pandemic. The huge contribution of research staff and principal investigators is duly acknowledged: Amanda Wheeler, Dr James Miller, Dr Aditya Nautiyal and Dr Shaheen Shora. Thank you also to the trial therapists involved with the delivery of the interventions and to the clinical managers who supported staff engagement with the study. Financial support: This project is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (grant reference number PB-PG-0418-20001). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.",

year = "2021",

month = dec,

day = "15",

doi = "10.1017/S1754470X21000337",

language = "English",

volume = "14",

journal = "Cognitive Behaviour Therapist",

issn = "1754-470X",

publisher = "Cambridge University Press",

}

Contreras, M, Van Hout, E, Farquhar, M, Gould, RL, McCracken, LM, Hornberger, M, Richmond, E & Kishita, N 2021, 'Therapists' perceptions and acceptability of providing internet-delivered guided self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS): A qualitative study', Cognitive Behaviour Therapist, vol. 14, e38. https://doi.org/10.1017/S1754470X21000337

Therapists' perceptions and acceptability of providing internet-delivered guided self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS): A qualitative study. / Contreras, Milena; Van Hout, Elien; Farquhar, Morag et al.
In: Cognitive Behaviour Therapist, Vol. 14, e38, 15.12.2021.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Therapists' perceptions and acceptability of providing internet-delivered guided self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS)

T2 - A qualitative study

AU - Contreras, Milena

AU - Van Hout, Elien

AU - Farquhar, Morag

AU - Gould, Rebecca L.

AU - McCracken, Lance M.

AU - Hornberger, Michael

AU - Richmond, Erica

AU - Kishita, Naoko

N1 - Acknowledgements: The authors would like to thank patient and public involvement research partners, Ruby Ali-Strayton, Geoff Angel and Peter Davis, for their invaluable insights at every stage of the design and conduct of the research. The authors also would like to thank Norfolk and Suffolk NHS Foundation Trust, Hertfordshire Partnership University NHS Foundation Trust and Octagon Medical Practice for their enormous support even throughout the COVID-19 pandemic. The huge contribution of research staff and principal investigators is duly acknowledged: Amanda Wheeler, Dr James Miller, Dr Aditya Nautiyal and Dr Shaheen Shora. Thank you also to the trial therapists involved with the delivery of the interventions and to the clinical managers who supported staff engagement with the study. Financial support: This project is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (grant reference number PB-PG-0418-20001). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

PY - 2021/12/15

Y1 - 2021/12/15

N2 - This study aimed to explore therapists’ perceptions and acceptability of providing internet-delivered, therapist-guided, self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS). To achieve this, a qualitative approach with semi-structured interviews was employed with eight novice therapists recruited from primary and secondary care services taking part in a feasibility study of iACT4CARERS. The interviews were audio-recorded, transcribed, and analysed using thematic analysis. Four over-arching themes were identified: (1) positive attitudes towards the intervention, (2) therapists’ workload, (3) therapists’ confidence to perform their role, and (4) connecting with family carers in a virtual context. Theme 1 included seeing their involvement as an opportunity for personal growth and perceiving benefits to the family carers, which contributed to greater acceptability. Theme 2 reflected that while workload and the user-friendliness of the online platform were highly acceptable among the therapists, there were also time-consuming cases that increased therapists’ burden. Theme 3 revealed that practical resources provided during the training, continued supervision, and opportunities to learn from other therapists, increased therapist confidence and facilitated greater acceptability. Finally, Theme 4 highlighted that improving the connection between therapists and carers was critical in a virtual context and strategies to improve the therapist–carer relationship were recommended. The implementation of iACT4CARERS was largely acceptable for the therapists involved in the trial. Ways to strengthen the therapeutic relationship in the virtual context and practical strategies to deal with common problems may enhance therapist experience and delivery in a full-scale effectiveness trial.

AB - This study aimed to explore therapists’ perceptions and acceptability of providing internet-delivered, therapist-guided, self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS). To achieve this, a qualitative approach with semi-structured interviews was employed with eight novice therapists recruited from primary and secondary care services taking part in a feasibility study of iACT4CARERS. The interviews were audio-recorded, transcribed, and analysed using thematic analysis. Four over-arching themes were identified: (1) positive attitudes towards the intervention, (2) therapists’ workload, (3) therapists’ confidence to perform their role, and (4) connecting with family carers in a virtual context. Theme 1 included seeing their involvement as an opportunity for personal growth and perceiving benefits to the family carers, which contributed to greater acceptability. Theme 2 reflected that while workload and the user-friendliness of the online platform were highly acceptable among the therapists, there were also time-consuming cases that increased therapists’ burden. Theme 3 revealed that practical resources provided during the training, continued supervision, and opportunities to learn from other therapists, increased therapist confidence and facilitated greater acceptability. Finally, Theme 4 highlighted that improving the connection between therapists and carers was critical in a virtual context and strategies to improve the therapist–carer relationship were recommended. The implementation of iACT4CARERS was largely acceptable for the therapists involved in the trial. Ways to strengthen the therapeutic relationship in the virtual context and practical strategies to deal with common problems may enhance therapist experience and delivery in a full-scale effectiveness trial.

KW - acceptability

KW - informal caregivers

KW - online therapy

KW - psychological interventions

KW - therapeutic relationship

KW - therapists

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Contreras M, Van Hout E, Farquhar M, Gould RL, McCracken LM, Hornberger M et al. Therapists' perceptions and acceptability of providing internet-delivered guided self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS): A qualitative study. Cognitive Behaviour Therapist. 2021 Dec 15;14:e38. doi: 10.1017/S1754470X21000337