The association of self-efficacy and internet-based cognitive-behavioral treatment outcome in patients with end-stage kidney disease and the potential role of illness cognitions and the therapeutic relationship therein

End-stage kidney disease (ESKD) patients suffer from an extremely lower Health-Related Quality of Life (HRQoL) than the general population. A way of supporting these patients is through internet-based cognitive-behavioral treatment (iCBT). This study aims to identify psychological variables that might impact the effectiveness of iCBT treatment within an ESKD patient group to provide suggestions for the further optimization of these interventions. This study investigated the association between self-efficacy and treatment outcome after an iCBT intervention together with the potential role of illness cognitions and the therapeutic relationship. The intervention group (N=8) followed a 3- to 4-month iCBT intervention. Secondary data analysis was performed on the prospective data of a two-arm multicenter randomized controlled superiority trial (RCT). To measure treatment outcome from baseline to the 6-month follow-up we examined physical and mental HRQoL and the personalized outcome...Show moreEnd-stage kidney disease (ESKD) patients suffer from an extremely lower Health-Related Quality of Life (HRQoL) than the general population. A way of supporting these patients is through internet-based cognitive-behavioral treatment (iCBT). This study aims to identify psychological variables that might impact the effectiveness of iCBT treatment within an ESKD patient group to provide suggestions for the further optimization of these interventions. This study investigated the association between self-efficacy and treatment outcome after an iCBT intervention together with the potential role of illness cognitions and the therapeutic relationship. The intervention group (N=8) followed a 3- to 4-month iCBT intervention. Secondary data analysis was performed on the prospective data of a two-arm multicenter randomized controlled superiority trial (RCT). To measure treatment outcome from baseline to the 6-month follow-up we examined physical and mental HRQoL and the personalized outcome measure. To measure the other variables, we used the data from the questionnaires on self-efficacy and illness cognitions at baseline and the therapeutic relationship at the 6-month follow-up. To examine the associations between the different variables within this study, hierarchical regression analyses were performed. In addition, we analyzed the possible moderating effects via the Hayes PROCESS extension. This was an underpowered study, so outcomes need to be interpreted with extreme caution. We found indications that a higher level of self-efficacy was associated with better physical HRQoL (ß = .48, p = .26). We also found indications that a higher level of helplessness was related to stronger deteriorations of mental HRQoL (ß = -.43, p = .65) and the personalized outcome measure (ß = -.31, p = .39). Lastly, we found significant moderating effects for acceptance (R²-chng = .59, p = .05) and helplessness (R²-chng = .71, p = .005) between self-efficacy and physical HRQoL. The outcomes of this study suggest that self-efficacy and helplessness are important factors to consider when aiming for the further optimization of iCBT interventions within an ESKD patient group. It seems that self-efficacy creates stronger resilience. Screening on these variables and enrolling patients into pre-treatment to positively impact these variables before iCBT can possibly better treatment outcomes.Show less

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The association of self-efficacy and internet-based cognitive-behavioral treatment outcome in patients with end-stage kidney disease and the potential role of illness cognitions and the therapeutic relationship therein