Dropout and completion in iCBT for university students Insights from a thematic analysis

Online cognitive behavioral therapy (iCBT) is a promising treatment for depression and anxiety among university students but faces high dropout rates. Understanding the reasons behind dropout or completion can help improve the implementation of iCBT in educational settings. Semi-structured phone interviews were conducted with 32 students who dropped out early (n = 9), midway (n = 12), or completed (n = 11) guided or unguided iCBT in the context of a randomized controlled trial. Data were analyzed using Braun and Clarke's (2012) thematic analysis. Common themes among dropouts included personal factors (like competing priorities), perceived difficulty or redundancy of the intervention, and lack of human interaction. Early dropouts uniquely cited disbelief in the intervention's efficacy and preference for other mental health support. Midway dropouts mentioned issues with the interactivity, feedback, content, perceived effectiveness, and lack of personalization. Completers had positive initial impressions, valued the online format, found the exercises and guidance helpful, and felt cared for. The themes identified among participants who dropped out from or completed the iCBT intervention provide valuable insights into factors which may be of importance for retention. Implications regarding setting expectations, participant selection, interactive functionalities, personalized feedback, and the role of therapist guidance are discussed.