An Investigation Into E-therapies for Older Adults

This thesis concerns the use of e-therapies, that is, the delivery via a digital platform of a psychotherapeutic intervention. More specifically, it concerns the use of e-therapies for mild to moderate stress, anxiety and depression by older adults, a sector of the population hitherto neglected both in the design of e-therapies and in research of this nature. The primary aim of the work was to explore ways in which the user interface of an e-therapy could be enhanced to improve usability for and promote acceptability by older adults, and hence improve access to this mode of therapy for this particular service user group. Secondary aims were to examine whether perceived usability is associated with other factors that influence the delivery of therapy such as credibility, pre-expectancy and the therapeutic relationship. Phase one, comprising two surveys and a meta-analysis, mapped the landscape of contemporary e-therapy use within NHS England in order to determine: what e-therapies are used; what evidence exists for them; and whether they are suitable for older adults. Findings indicated that e-therapies used in the NHS are broadly effective, but they are less effective with age, and there is a dearth of research on their use in older adults. Following on from this, phase two, comprising three empirical studies, investigated: the relationship between usability and expectancies and acceptability of e-therapies, in older adults. Findings indicated that the perceived therapeutic relationship older adults formed with the e-therapy was related to the e-therapy’s usability, suggesting that usability is an important factor in e-therapy design that requires further research attention.