Client perspectives of internet-based treatment for depression in Arabic-speaking countries

Mental health care faces significant challenges, particularly in Arabic-speaking countries, where only a fraction of individuals with depression receive treatment. While internet-based interventions (IBIs) have shown promising results, how clients experience IBIs is not well known, highlighting the need for a deeper understanding of client experiences. To better understand the impact of IBIs, qualitative interviews were conducted with participants from Arabic-speaking countries regarding perceived changes, causes of changes, and hindering and helpful aspects of IBIs. In total, 93 participants (68% female; Mₐge = 27. 45) from various Arabic-speaking countries who completed either an internet-based cognitive (n = 49) or an internet-based interpersonal (n = 44) treatment for depression were interviewed via structured change interviews to understand perceived positive and negative changes after treatment as well as perceived causes of changes, as well as helpful and hindering aspects. The interviews were analyzed using qualitative content analysis. Most of the participants reported positive changes after treatment, which were categorized into the five following domains: Coping strategies, Personal Growth, Interpersonal Changes, Symptomatic Changes and Increase in Activity and Energy. Causes of changes were attributed mainly to the Program Structure, Personal Factors, Working Alliance, and External Reasons. However, negative changes were also reported and categorized into Short-term and Persistent Negative Changes. Hindering aspects were related to the Program Structure and Technical Difficulties, Standardization and External Reasons. Helpful aspects were related to the Program Structure. Despite some hindering aspects and negative changes, the IBIs predominantly induced positive changes across multiple life domains, with the Program Structure being identified as both the main cause of positive effects and an obstacle, which indicates individual-dependent differences.