Negative effects in internet-based interventions for depression: A qualitative content analysis

Friederike Fenski; Alexander Rozental; Manuel Heinrich; Christine Knaevelsrud; Pavle Zagorscak; Johanna Boettcher

doi:10.1016/j.invent.2021.100469

Negative effects in internet-based interventions for depression: A qualitative content analysis

Internet Interv. 2021 Oct 14:26:100469. doi: 10.1016/j.invent.2021.100469. eCollection 2021 Dec.

Authors

Friederike Fenski¹, Alexander Rozental², Manuel Heinrich¹, Christine Knaevelsrud¹, Pavle Zagorscak¹, Johanna Boettcher^{3

4}

Affiliations

¹ Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany.
² Department of Psychology, Upsala University, Von Kraemers allé 1A, 752 37 Uppsala, Sweden.
³ Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Am Köllnischen Park 1, 10179 Berlin, Germany.
⁴ Division of Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany.

Abstract

An increasing number of studies is proving the efficacy of Internet-based interventions (IBI) for treating depression. While the focus of most studies is thereby lying on the potential of IBI to alleviate emotional distress and enhance well-being, few studies are investigating possible negative effects that might be encountered by participants. The current study was therefore exploring self-reported negative effects of participants undergoing a cognitive-behavioral IBI targeting mild to moderate depression over 6 weeks. Data from the client pool of a German insurance company (n = 814, 68% female) revealed that 8.6% of the participants reported the experience of negative effects. Qualitative content analysis yielded two broad categories and five subcategories for the nature of participants' experiences of negative effects: participant-related negative effects (insight and symptom) and program-related negative effects (online format, contact, and implementation). By using both, qualitative and quantitative methods, results did not only shed light on the characteristics of negative effects but analyses also found that working alliance was a predictor for the experience of negative effects. Monitoring the occurrences of negative effects as well as working alliance throughout treatment was considered essential to help prevent negative effects and attrition among participants undergoing IBI for depression.

Keywords: Cognitive-behavioral therapy; Depression; IBI, Internet-based interventions; Internet-based interventions; Negative effects; Qualitative research.