مقاله انگلیسی رایگان در مورد پذیرش یک مداخله آنلاین با روانشناسی مثبت برای افسردگی – الزویر 2018

Background: Positive psychology interventions may usefully treat depression and can be delivered online to reduce the treatment gap. However, little is known about how acceptable patients find this approach. To address this, the present study interviewed recent users of a positive psychology self-help website. Methods: In-depth semi-structured interviews explored the experiences of twentythree participants from a larger feasibility study. A stratified purposive sampling strategy selected participants with varying intervention experience according to their intervention logins, as well as varying age, gender and depressive symptoms. Framework analysis was used to explore patterns and linkages within and between participants’ accounts. Results: Acceptability varied between participants. Those who found it more acceptable felt it was relevant to their depression and reported feeling empowered by a self-help approach. Conversely, participants for whom it was less acceptable perceived the positive focus irrelevant to their depression and found the emphasis on self-action unsupportive. Conclusions: The acceptability of an online positive psychology intervention may be facilitated by a patients’ preference for a psychological focus on the positive. However, patients may also have distinct preferences for online self-help. Future research should investigate the importance of the therapeutic orientation of online self-help interventions and whether patients’ preferences for these can be reliably identified. This could help to target online self-help in clinical practice.

Introduction

Positive psychology interventions are brief cognitive and behavioural exercises that aim to increase positive feelings, behaviours, and thoughts. Evidence suggests that such interventions may improve wellbeing and reduce symptoms of depression (Bolier, Haverman, Westerhof, et al., 2013; Sin & Lyubomirsky, 2009). Increasingly online means, e.g. smartphones and websites, are used to disseminated packages of positive psychology interventions as self-help for people with clinical and subclinical depression (Bolier, Haverman, Kramer, et al., 2013; Roepke et al., 2015; Schueller & Parks, 2012). Such online dissemination is a strategy to sustainably improve access to mental health interventions (Bolier, Haverman, Kramer, et al., 2013; Bolier & Abello, 2014) in response to the vast numbers of people globally experiencing depression (World Health Organization, 2009). It reflects a general trend in the use of online means to make low-intensity psychological interventions more available to help bridge the treatment gap (Department of Health, 2014; Hollis et al., 2015; Mental Health Network NHS Confederation, 2014; Mental Health Taskforce, 2016) A second reason positive psychology interventions are deemed suitable for online dissemination is that they are viewed as inherently more appealing and may have fewer barriers to entry, compared to accessing traditional forms of therapy, or socalled problem-focused approaches (Layous, Chancellor, Lyubomirsky, Wang, & Doraiswamy, 2011; Schueller & Parks, 2012; Seligman, Rashid, & Parks, 2006). Anecdotal reports suggest such interventions generate overwhelmingly positive feedback even with patients with clinical depression (Seligman et al., 2006). However, others have suggested that people with depression may find positive psychology interventions inappropriate or unattractive (Kaczmarek et al., 2013) as, by its nature, depression is associated with reduced interest in previously enjoyable activities and deficits in motivation (Bylsma, Morris, & Rottenberg, 2008). It has also been argued that for people experiencing psychosocial difficulties a focus on the positive might be exhausting and stressful (La Torre, 2007) and may not help people cope with the real and complex issues they face (Moskowitz et al., 2012). To date however, few studies have investigated the acceptability of delivering positive psychology online. One study reported that almost 60% of participants with depression were indifferent to, or dissatisfied with, an online intervention using components of positive psychology however, this study did not collect data on reasons for dissatisfaction (Bolier, Haverman, Kramer, et al., 2013). These researchers suggested that participants might have been dissatisfied with the intervention content, and felt unable to complete it, or that the intervention website may have lacked suitably attractive design. The lack of acceptability data limits the development, evaluation and implementation of potentially effective interventions for people with depression. Qualitative studies are a useful way of exploring patient experiences of interventions and have often be used to understand acceptability of and engagement with other therapeutically oriented online interventions (Knowles et al., 2014). The aim of this study was to explore the views of participants who had recently used an online positive psychology intervention within a feasibility study, to address the research question: What is the acceptability of an online positive psychology intervention for depression?