By: Ezekiel Gacee
Abstract
Given the profound emergence of the computerized cognitive therapy of various patients across the world, there are certain gaps that exists which needs to be looked into through research. The inadequacy in terms of information on variety of issues affecting the computerized cognitive therapy has made this new invention to have obstacles in its roll out. It is for a fact that there is no optimal method of support delivery that has been stipulated by the researchers. Additionally, there is lack of evidence based therapy that would convince the patients who requires the physical support. There is insufficient information on the critical factors (educational levels, income levels, severity etc.) that are able to predict success in treatment with CCT. It should also be noted with concern that there is ambiguity in comparison of effectiveness with CCT and that d personal treatment. The durability and the effects of treatment using this platform is also not well defined and this calls for more research in this field. A research on the gap that exist on the computerized cognitive therapy is quite essential.
Problem statement
In the recent past CCT as method of treatment has been on the rise. The electronic platform and the changes in the levels of technology has made it possible for most of the people embrace CCT. Given the rapid development, there has been variety of gaps that have existed in this mode of treatment. Some of the pertinent gaps that have theoretically existed are the insufficient information on the profound effect on the access to care by the patients. It is also a fact that the optimal level of therapist intervention and support has not been well defined. Additionally, there is inadequate definition on the most desirable conduit with which the CCT should be conducted. In terms of outcomes from the patients, there is insufficient information on the uncertain effects on the severe events and safety of the patient. It also still a mystery whether the duration of the treatment effects has a substantial bearing even after the treatment is over.
It is therefore quite imperative to check on these supposed gaps and give much attention on whether these gaps needs further study and profound research in order to come up with substantial way of dealing with them. This research is geared towards analyzing the various stances in which gaps exists in the computerized cognitive therapy. The research is keen on bringing on board these distinct gaps and substantiating the fact that there is need for further research on such gaps.
Purpose of the study
The main purpose of the study is to investigate on the gaps that exists in computerized cognitive therapy as a mode of treatment. This notion is deemed to give a clear understanding on whether there should be a further research on the gaps and the magnitude of bridging them. The variables under scrutiny for this research would be; the population (patients), interventions, comparator and lastly the outcome. The in-depth analysis of these variables is with the main aim of finding the inefficiency that they cause which would warrant further research.
Theoretical Foundation/Conceptual Framework
Concern in undertaking CCT could vary significantly across patients. As a measure in implementing CCT, numerous clinics might propose it as a substitute to physical personal therapy, to be designated only by those that prefer the ease of access of CCT. If at all clinics are bearing in mind this implementation technique, it will be helpful to carry out more investigation on the impact of treatment selection on outcomes. This notion could be attained with trial strategies that randomized to choosing in comparison with no-choice situations alternatively, health centers might consider conducting CCT in a stepped-care structure that provides CCT as a fundamental psychotherapy (Freeman, 2013). In this structure, patients that do not depict benefit from the CCT would then be placed for physical therapy. Clinics inculcating CCT also requires to consider the human resource needs of these plan of action. While therapist load is expected to be diminished, at least some point of therapist engagement is substantially reasonable to make sure that patients get reinforcement of treatment presented in CCT. Certain studies I looked into used technicians, instead of clinicians, to offer human support. Whilst few research have compared experts with clinicians, it came out that technicians performed extremely well (Joyce-Beaulieu, & Sulkowski, 2015). Therefore, clinics could contemplate on taking those who are not clinician staffs to be used in deciding questions on procedural stunts with the CCT platform or routine interrogations about treatment package. But, therapists should remain present for consultation, since there will be a potential for emergency issues that requires clinical proficiency.
My theoretical review purports that greater impact for the patients gathering criteria stipulates for full maladies and mild to modest symptom severity. Prompting an identification and clinician transfer to the program might ensure more cautious diagnostic assessments and closer continuation. However, this method could substantially negate some of the merits of CCT program, like overcoming time restraints and travel obstacles and anonymity (Wiederhold, & Riva, 2012). If the VHA are to institute its own CCT platforms, they should exploit the approaches got in the more operative interventions and be more sensitive to end-user interface, which would affect appointment and diagnosis adherence. For serious depression, the review provides provision for a uniform gain from numerous CCT programs, signifying that treatment gain is derived from general philosophies of CBT other than any one detailed CCT program. However, research on patients with anxiety syndromes had more variations in treatment impact, raising the likelihood that effects are definite to the category of program utilized (Wright, 2012).
Another reflection is how much psychotherapist support to give with CCT treatments. Therapy models stereotypically include the satisfying alliance amongst patient and psychotherapists as a vital mechanism of attaining improved psychiatric indications. It is unclear to which degree a rapport with a therapist is desirable to optimize CCT management outcomes, however there is motive to suspect that it will be an imperative consideration. Established on indirect assessments, I found a relatively steady gradient presenting greater handling effects with superior support. Conversely, very few readings evaluated more exhaustive human sustenance for certain circumstances, and I was unable to segregate the specific structures or degree of sustenance associated with dealing benefit . Founded on current substantiation, we summarize that health structures implementing CCT should take account of therapist support through email or transitory telephone periods, or both (Wright, 2014). The readings I reviewed did not offer reliable estimations of the board size that a distinct therapist might support, but constructed on the middle of approximately 15 transcripts devoted to every patient daily, a therapist associating CCT would provide maintenance to a significantly larger regiment than those applying face-to-face rehabilitation.
Operational Definitions
Cognitive therapy (CT): the treatment of emotional, mental, personality and behavioral disorders by the use of methods such as listening discussion and profound counselling. Here there is face to face interaction between the clinician and the patient.
Computerized cognitive therapy (CCT): this is a self-help program that helps in the therapeutic treatments with the use of the electronic platform and technological advancements.
Patients (population): these are the behavioral characteristics and the response of the patients towards the CCT in relation to CT
Comparator: this is the scale of measure used in the comparison of the CCT and CT. here we look into the availability of this measure and how we can improve on it.
Outcomes: these are the expected results after the therapeutic treatment process. Here we look at the possible ways in which these results can be substantiated and gauged in order to form a point of reference.
Interventions: these are the therapist supports that the patients get as they undergo these kinds of therapy. Here we look the optimality of these support in making sure that the patient get the best out of the treatment.
Anxiety disorder: a state of mind where one fear every occasion in life that might frightened them this condition develops after increase in instance of frightening occasions.
Psychotherapy: the treatment of emotional, mental, personality and behavioral disorders by the use of methods such as listening discussion and profound counselling.
Strengths and Limitations of the Study
My research has some strengths, comprising of a protocol-shaped review, an all-inclusive search, a careful excellence assessment, and arduous quantitative scrutiny methods. My report, and the collected works, also has precincts. Imperative limitations of the study include the insufficient studies in situations of high precedence to the VA, few readings with lengthier term conclusions, and few studies unswervingly comparing CCT with divergent levels of psychoanalyst support, such as span of the interaction, promptness of the communication (i.e., immediate messaging vs. electronic mail), and the method of support (electronic mail vs. chat chamber vs. telephone). To more conclusively address CCT efficiency in patients with PTSD, nervousness symptoms, or manifold/comorbid identifies, as well as the connotation between psychiatrist support and management benefit, supplementary carefully intended trials will be necessary.
Further limitations comprise the choice of panels for some judgments, patient conscription through announcement, and relatively high wastage rates in many readings. Selection of the utmost proper control in judgments of treatment is challenging, but waiting list controls can overestimate the management benefit associated with studies which use treatment as common or attention protocols. Patient recruitment via advertisements, principally over the electronic platform, may select patients that are more skillful users of internet know-how but who might not have a homoeopathic home if an emergency arises. Additionally, high dropout amounts, even when suitable statistical correction is used, may bias in the direction of greater treatment outcome. Lastly, I was concerned about lack of methodical reporting of protection data.
Limitations of my review methodology comprises a limited capability to detect script bias due to insignificant numbers of research in the meta-analyses and the challenge of categorizing the levels of CCT support although we used relatively comprehensive categories. We complemented our statistical valuation for publication bias with an examination of http://www.clinicaltrials.gov and didn’t identify a design of completed but unpublished studies. Although we classified studies into broad categories of support that would act to minimalize the association with cure outcomes, our intertwined-treatment effect subcategory analyses realized an important connotation, which recommends that this method did not make the association vague.
Significance of the study
With the analysis of this study one will be able to acknowledge the real existence of the various gaps in the computerized cognitive behavioral therapy that needs to be addressed. It is also through this study that we are able to determine the various research variables on the gaps and know how they affect the efficiency of the implementation of the CCT affectively. This study also forms the foundations for which further analysis on these gaps can be done with keen concern on the variety of elements that can be improved in order to see if this new mode of treatment be acceptable to all.
Research Questions on Research Process
- Is it the use of the survey research design the best way of collecting the data for this research? Are there any advantages that this mode of research study has over the use of secondary data and other techniques?
- Are the variables such as the use of population, the outcome, the interventions, and the comparator, very appropriate in depicting the gap perception that is seen to exist in CCT?
- Does the questions in the survey document well-constructed to suit their purpose of bringing out the real measurement of the gaps existence in the restaurant?
Research questions on the survey data
- How does the mode of the demographic profile of the patients distributed to depict the research gap existence in CCT?
- What is the computerized cognitive therapy performance in terms of the six perceptional performance variables: the therapist support, the severity of the condition, educational level, durability of treatment effects, and lastly, the optimal electronic platform in accordance with the descriptive statistics?
- Is there a statistical difference in the CCT mode of treatment in terms of gender grouping?
- What is the correlation between the CCT mode of treatment and the physical cognitive therapy mode of treatment among patients?
- To what degree can the Durability of treatment effects beyond the end of treatment of the patients be used in predicting the levels of outcome in CCT mode of treatment?
- Is there any significant relationship between durability of treatment effects beyond the end of treatment of the patients and the performance perception indicators such as: the therapist support, the severity of the condition, educational level, durability of treatment effects, and lastly, the optimal electronic platform?
Procedure
The research study will solely be concentrated on the persons of age 12 years to 65 years who are suffering from anxiety disorder and major depression disorder. Here both the primary and secondary sources has been used in the data collection. The primary methods used gather the data are surveys, focus groups, questionnaires, interviews, and the instinctive reviews of retrospective charts. The recruitment for the surveys was done via the internet platform where the participants were allowed to subscribe and the data about their information got. The interview were done the Skype and also via video conferencing. A questionnaire was prepared and was posted into the internet. The respondents were allowed to access the confirmation platform where one was allowed to proceed after putting in their basic data that confirm whether they are sick or not. Similarly, the secondary sources that has been used in this research is deemed to have a closer look at the empirical trends brought forward about the therapist support, the severity of the condition, educational level, durability of treatment effects, and lastly, the optimal electronic platform. Additionally, computerized databases such as the MEDLINE, OVID, and CINAHL will be accessed to get more on the demographics.
To effectively and efficiently deal with the research hypothesis and also give an informed and profound solution to the very vital questions raised about this research, was imperative to use various statistical techniques that would give us good results and better analysis thereof. For that matter, computerized statistical packages like the Microsoft excel and Microsoft database has been used. These two has been used in entering and storing large volumes of data that have been collected from various respondents. The use of SPSS is very vital in getting the correlation coefficients between the dependent variable and independent variables. Given this technique, it is sufficient enough to draw profound conclusions from the study additionally, there are the analysis on the calculations of the, variances, and standard deviations that would be very vital in noting any discrepancies in the data collected. Moreover, hypothesis testing has be done to give proper validity of the data collected and see if the data collected will sufficient for representing the whole population of the patients who requires CCT.
Statistical Analysis and Discussion on the Research Question
RQ1. Is it the use of the survey research design the best way of collecting the data for this research? Are there any advantages that this mode of research study has over the use of secondary data and other techniques?
The research study design is the best way to carry out this study since there is the use of the first information. As the research is carried out it comes out clearly that the data collection is from the recipients who have undergone various types of depression. Getting the first hand information also has the real advent of making the research study very authentic. This coupled with the fact that the authenticity of a given research is mostly driven by the kind of primary data that has been used in the study, the design used has made sure that the research is quite authentic and hence it tends to represent the real advent best results for the study.
RQ2. Are the variables such as the use of population, the outcome, the interventions, and the comparator, very appropriate in depicting the gap perception that is seen to exist in CCT?
The variables use has been used in this research are quite reasonable for the study. In the first case, the variable that explains the population captures the basics on the evaluation of patients which forms one of the engines for the existence of the gap. Again the use of outcome as a variable depicts the advent checking on the performance standards that are being depicted in terms of service delivery of health services to the patients. Again it is worth noting the intervention variable inculcates the connotation of optimal level of therapist support by the clinicians.
RQ3. Does the questions in the survey document well-constructed to suit their purpose of bringing out the real measurement of the perception of the performance of the CCT mode of treatment by patients?
Construct of the questions are seen to be very clear and tries to depict a thorough insight on the every tenet of the mode of treatment. Again it is important to note that the constructs are very precise and quite self-explanatory. The simplicity in the constructs of the questions make the respondent to be plain in his or her answers and this makes them to be very sincere in their answering. Given systematic and the stratified flow of question in the questionnaire, it gives the respondent the ample time in discerning the real advent for making sure that there is prevention of any biasness in answering the questions.
Answers to Research Questions on the Survey Data
RQ4. This research question was destined into knowing how the mode of the demographic profile of the customers is distributed to depict the customer loyalty to the restaurant. The data that has been used for survey here is the nominal data to give a profound distribution on the populations. The calculations that are needed for this research question is the measure of central tendency which of course in this case is the calculation of the mode for the data presented. The variables that have been used here are: the children, the attendance seen in the last 60 days of patients, the age, income levels, the gender and lastly, the severity of the condition. The table below represents the data analysis for the research question 4.
Table 1: A Demographic Description of CCT patients
| The variable | Mode | Meaning |
| x17-Children | 1 | None |
| x18-Attendance | 0 | None |
| x19-Gender | 0 | Male |
| x20-Age | 3 | 35-49 |
| x21-Income level | 2 | 35 – 50 |
| x22- Severity | 1 | Physical CT |
From the analysis table above, it is evident that there are no children that are aligned to being affected by the various types of disorders. It is worth noting also the attendance distribution has little or no effect on the rating of the CCT mode of treatment. Similarly, the male has been seen to be the most affected by the various disorders that requires CCT. The age group that has been seen to be quite loyal to the use of CCT as a mode of treatment is the persons aging between 35 – 49 years old as depicted by the mode of 3 in the table.
Again it is worth noting that the income level of the persons attending the CCT is from those earning between $ 35,000 and $ 50,000. The persons in this area have also proven that they prefer physical cognitive therapy than computerized cognitive therapy.
RQ5.This research question asks on the computerized cognitive therapy performance in terms of the six perceptional performance variables: the therapist support, the severity of the condition, educational level, durability of treatment effects, and lastly, the optimal electronic platform in accordance with the descriptive statistics. The variables used here are: has high therapist support, has low severity of the condition, has high educational, has quick services, has longer durability and lastly, has optimal electronic platform. These variables have been structured in the questionnaire in the section 2 which contains the questions 7 through 12. The data type is arranged in interval type where there is range of values to choose from.
The calculations that have been used here are a further descriptive analysis. This entails the mean and standard deviation which represents the central tendency. The main aim of these calculations is to get to know the deviations from the mean that can be recorded from the information got from the questionnaires. The results of the calculations that align to this research question are as follows.
Table 1.2 CCT six performance variables
| Variable | Mean | Remarks | Standard deviation | range of response | |
| x7-Has high therapist support | 3.265 | slightly below average | 0.910450217 | 2.354549783 | 4.17545022 |
| x8-Has low severity condition | 3.88 | slightly above average | 1.354538249 | 2.525461751 | 5.23453825 |
| x9-Has high educational level | 6.105 | above average | 0.968848978 | 5.136151022 | 7.07384898 |
| x10-Has Quality Services | 3.405 | slightly below average | 1.215881094 | 2.189118906 | 4.62088109 |
| x11-Has longer durability | 5.65 | above average | 1.210299186 | 4.439700814 | 6.86029919 |
| x12-Has optimal electronic platform | 5.335 | above average | 0.809972392 | 4.525027608 | 6.14497239 |
From the table above, it is evident that the mean for the therapist support has a mean that is slightly below average. This standard deviation on the other hand is quite low and this makes the response range to be low and hence considerate. The severity of the condition has a mean that is slightly above average of 3.5. The response however is quite large owing to the high level of standards deviation depicted in the results. The mean educational level is above average which means that the educational level is high for many of those questioned. The response range is also seen to be less and this shows that the educational level is up to date in terms of performance standards of the CCT. The quality of services has a lower average which does not meet the threshold needed this has the transcending effect of making sure that patients get better treatment. The standard deviation of the same is also quite high to mean that the response range for this variable is quite high. The durability mean is above average with high response range as depicted by the high level of standard deviation on the table. On the stance of electronic platform, the mean is above average which means that the experience is presumed to last longer even after the end of treatment. The response range is also quite reasonable which means that this variable is on the right track and needs no adjustment. In general terms the variable used here have rated the performance of the CCT highly with only two variables have issues in its performance.
RQ6. The main purpose of this question was to find out whether there is statistical difference in the CCT mode of treatment in terms of gender grouping. The answer to this question is got by creating a hypothesis testing analysis between the male and the female as follows:
| Ho: There is no significant difference in the response level with CCT mode of treatment by ‘gender choice’ statistically. |
| H1: There is a significant difference in the response level with CCT mode of treatment by ‘gender choice’ statistically. |
The target question from the question is the Gender which is in column W and the response level which is contained in column Q. The type of data used is nominal and interval in nature. The calculation needed is the Z test for two samples for means. The table of calculation is as follows.
Table 1.3 Z test for gender and response levels mean.
| Female Response Rating | Male Response Rating | |
| Mean | 5.390243902 | 5.822033898 |
| Known Variance | 0.78 | 0.95 |
| Observations | 82 | 118 |
| Hypothesized Mean Difference | 0 | |
| Z | -3.258162185 | |
| P(Z<=z) one-tail | 0.000560681 | |
| z Critical one-tail | 1.644853627 | |
| P(Z<=z) two-tail | 0.001121363 | |
| z Critical two-tail | 1.959963985 |
From the analysis table above, it is evident that the p-value is below the alpha value hence we reject the null hypothesis and accept the otherwise. This means that there is significance a significance difference in the satisfaction levels of the CCT mode of treatment by gender.
RQ7. This question was deemed to investigate whether there is correlation between the CCT mode of treatment and the physical cognitive therapy mode of treatment among patients. The variables to be used are the CCT, and the physical CT. The data type is the interval type. The calculation done was the correlation coefficient. The table that shows these calculations is as below.
Table 1.4 correlation between the CCT mode of treatment and the physical CT.
| CCT | CT | |
| CCT | 1 | |
| CT | 0.277701428 | 1 |
From the table above, it is evident that the there is a positive relationship between the between the CCT mode of treatment and the physical CT. However, is imperative to note that this relationship is quite low which means that it is deemed to have less impact.
RQ8. This question looks at the degree with which Durability of treatment effects beyond the end of treatment of the patients be used in predicting the levels of outcome in CCT mode of treatment. The variables to be used are the durability, and the outcome. The data type is the interval type. The calculation done was the coefficient of determination. The table that shows these calculations is as below.
Table 1.4 coefficient of determination between durability and the outcome.
| Durability | Outcome | |
| Durability | 1 | |
| Outcome | 0.277701428 | 1 |
| Calculated the Coefficient of Determination | 0.0784 |
From the above table, the durability can only explain 7.84% of the CCT outcome. The rest of 92.16 cannot be explained by this relationship. This means there is need to improve this stance of relationship by providing quality services through CCT.
RQ9 The purpose of this question is to determine if there any significant relationship between durability of treatment effects beyond the end of treatment of the patients and the performance perception indicators such as: the therapist support, the severity of the condition, educational level, durability of treatment effects, and lastly, the optimal electronic platform
The data type is on the rating of the interval ratings. Regression calculations have been used here. The hypothesis formulated here are:
| Ho: There is no statistically significant relationship between durability with CCT and the therapist support’. |
| Ha: There is a statistically significant difference durability with CCT and the therapist support ‘. |
The summary of calculations is as follows.
| SUMMARY OUTPUT | |||||
| Regression Statistics | |||||
| Multiple R | 0.277701428 | ||||
| R Square | 0.077118083 | ||||
| Adjusted R Square | 0.072457063 | ||||
| Standard Error | 0.933089058 | ||||
| Observations | 200 | ||||
| ANOVA | |||||
| df | SS | MS | F | Significance F | |
| Regression | 1 | 14.40527231 | 14.40527 | 16.54532 | 6.85491E-05 |
| Residual | 198 | 172.3897277 | 0.870655 | ||
| Total | 199 | 186.795 |
| Coefficients | Standard Error | t Stat | P-value | Lower 95% | Upper 95% | Lower 95.0% | Upper 95.0% | |
| Intercept | 4.52463342 | 0.3940886 | 11.48126 | 1.02E-23 | 3.74748387 | 5.301782981 | 3.747483865 | 5.301782981 |
| x13-Durab | 0.27995865 | 0.0688266 | 4.067594 | 6.85E-05 | 0.14423141 | 0.415685887 | 0.144231412 | 0.415685887 |
From the calculation above the p value which stands at 6.85E-05 is less than 0.05 (alpha) hence reject the null hypothesis and accept the otherwise. In this sense there is a significance difference in the durability with CCT and the therapist support.
Findings and Recommendations for Future Research
- The research design used should be maintained and enhanced in the most appropriate way possible
- Apart from the data used to bring out the performance standards of the CCT, the research should have inculcated the scrutiny of how to make this mode of treatment very affordable and that which requires less skills to utilize.
- The construction of the question for the questionnaire should be maintained.
- Attendance levels should be enhanced in through profound awareness of the affected patients. Further analysis should be carried out to find out what makes the children not feature in this form of therapy.
- Therapist support should be heightened to make sure that the performance of this mode of treatment is enhanced. A further research is required in order that more ways to be developed to boost the online therapeutic support.
- Much analysis needs to be done to discern what creates the difference in the response level between the male and female patients to CCT. This will create some sense of parity after the scrutiny of the tastes and preferences of these genders
- We should not rely that much on the physical cognitive therapy mode of treatment to determine the level of efficiency of the CCT mode of treatment and among patients.
- A further research is required for looking into other ways in which outcome on patients who undergo CCT apart from the durability of treatment effects beyond the end of treatment of the patients.
- We should boost the therapeutic support in order to measure up with the kind of durability outcome level required.
Reference List
Freeman, A. (2013). Encyclopedia of cognitive behavior therapy. New York: Springer.
Joyce-Beaulieu, D., & Sulkowski, M. L. (2015). Cognitive behavioral therapy in K-12 school settings: A practitioner’s toolkit.
Wiederhold, B. K., & Riva, G. (2012). Annual review of cybertherapy and telemedicine 2012: Advanced technologies in behavioral, social, and neurosciences. Amsterdam [etc.: IOS Press.
Wright, J. H. (2012). High-yield cognitive-behavior therapy for brief sessions: An illustrated guide. Washington, DC: American Psychiatric Pub.
Wright, J. H. (2014). Cognitive-behavior therapy. Washington: D.C.
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