Heidi Frølund Pedersen

Background: Internet-based cognitive behavioral therapy (iCBT) is an effective and scalable alternative to face-to-face psychotherapy, but its reach is constrained by the time therapists spend reviewing patient input and manually drafting written responses. Studies suggest that large language models (LLMs) may be capable of generating high-quality therapeutic text, with the potential to support therapists in delivering treatment. Their suitability as therapist-support tools in structured iCBT, however, remains insufficiently studied. Objective: This study aims to assess the quality of LLM-generated iCBT responses to patient messages by comparing them to the quality of responses produced by humans. Methods: In a preregistered blinded clinician rating experiment, experienced clinicians assessed the quality of human-produced vs LLM-generated therapist responses within a simulated iCBT treatment for functional somatic disorder. Raters were exposed to a stimulus material consisting of 5 fictitious patient messages, each paired with 1 human and 1 LLM-generated response. Raters assessed message/response pairs on 5 quality dimensions (overall quality, helpfulness, empathy, professionalism, and protocol adherence) and were asked to indicate the source of the response (human/LLM). Analyses were primarily descriptive, supplemented by exploratory statistical tests and descriptive thematic content analysis of open-ended text fields. The full preregistered study protocol is available at Open Science Framework. Results: A total of 61 raters provided data, while 54 were eligible and included for analysis. Human- and LLM-generated responses were rated similarly across quality dimensions on a 1-5 scale: overall quality (LLM: mean 4.00, SD 0.54 vs human: mean 3.96, SD 0.53; d=0.06), helpfulness (LLM: mean 3.85, SD 0.57 vs human: mean 3.93, SD 0.49; d=0.13), professionalism (LLM: mean 4.25, SD 0.53 vs human: mean 4.11, SD 0.53; d=0.24), protocol adherence (LLM: mean 4.13, SD 0.52 vs human: mean 4.13, SD 0.54; d=0.03) and empathy (LLM: mean 4.31, SD 0.47 vs human: mean 4.08, SD 0.50; d=0.42). Raters correctly identified the source of human-generated responses (mean 79%, SD 19.65%) more accurately than LLM-generated responses (mean 63%, SD 21.30%). In all, 30/54 (55%) raters responded to one or more open text fields. Qualitative analysis indicated that LLM-generated responses were perceived as polished but also generic and at times excessively empathetic. Conclusions: LLM-generated responses were judged to be of comparable quality to those written by human therapists, though qualitative feedback indicated they were at times generic and insufficiently challenging. These findings provide initial support for the feasibility of using LLMs as therapist-support tools in iCBT, but further research is needed to determine whether their integration yields tangible clinical and organizational benefits.

BACKGROUND Internet-based cognitive behavioral therapy (iCBT) is an effective and scalable alternative to face-to-face psychotherapy, but its reach is constrained by the time therapists spend reviewing patient input and manually drafting written responses. Studies suggest that large language models (LLMs) may be capable of generating high-quality therapeutic text, and may potentially be able to support therapists to deliver high quality care and increasing the number of patients each therapist can serve. The suitability of LLMs in an iCBT setting, however, remains insufficiently studied. OBJECTIVE This study aims to evaluate the quality of LLM-generated iCBT responses to patient messages by comparing them to the quality of responses produced by humans. METHODS In a pre-registered blinded clinician rating experiment, experienced clinicians assessed the quality of human-produced versus LLM-generated therapist responses within a simulated iCBT treatment for functional somatic disorder. Raters were exposed to a stimulus material consisting of five fictitious patient messages, each paired with one human and one LLM-generated response. Raters assessed message/response pairs on five quality dimensions (overall quality, helpfulness, empathy, professionalism, and protocol adherence) and were asked to indicate the source of the response (human/LLM). Analyses were primarily descriptive, supplemented by exploratory statistical tests and descriptive thematic content analysis of open-ended text fields. The full pre-registered study protocol is available at https://osf.io/yxncv/. RESULTS A total of 61 raters provided data while 54 were eligible and included for analysis. Human- and LLM-generated responses were rated similarly across quality dimensions on a 1-5 scale: overall quality (LLM: M = 4.00 vs human: M = 3.96, d = 0.06), helpfulness (LLM: M = 3.85 vs human: M = 3.93, d = 0.13), professionalism (LLM: M = 4.25 vs human: M = 4.11, d = 0.24), and protocol adherence (LLM: M = 4.13 vs human: M = 4.13, d = 0.03). LLM-generated responses, however, received higher scores on empathy (LLM: M = 4.31 vs human: M = 4.08, d=0.42). Raters correctly identified the source of human-generated responses (79%) more accurately than LLM-generated responses (63%). In all, 55% of raters responded to one or more open text fields. Qualitative analysis indicated that LLM-generated responses were perceived as polished but also generic and at times excessively empathetic. CONCLUSIONS LLM-generated responses were judged to be of comparable quality to those written by human therapists, though qualitative feedback indicated they were at times generic and insufficiently challenging. These findings provide initial support for the feasibility of using LLMs as therapist-support tools in iCBT, but further research is needed to determine whether their integration yields tangible clinical and organizational benefits.

BACKGROUND Cognitive behavioral therapy (CBT) is an effective treatment for functional somatic disorder (FSD), but access to treatment remains limited in many countries. Studies indicate that internet-based CBT (iCBT) for FSD might improve accessibility and scalability without compromising effectiveness. However, most research on iCBT for FSD has relied on quantitative designs, providing limited insight into participants' subjective experiences with this digital approach. OBJECTIVE This study aimed to explore the experience of receiving iCBT for FSD, with a focus on how participants experienced the therapeutic process, the online format, the role of the therapist, and the outcome of the treatment. METHODS In total, 15 semi-structured qualitative interviews were conducted three months post- treatment in the context of a larger randomized controlled trial testing the efficacy of therapist-assisted iCBT for multi-system FSD. The interviews were transcribed and analyzed by two researchers using reflexive thematic analysis. RESULTS The reflexive thematic analysis identified three themes. The first theme labelled “Helpful - but not Enough” explored the participants' descriptions of the changes they observed following treatment. The second theme labelled “Reversing a History of Overexertion” described how participants had engaged with the treatment content, and what they had found helpful in their therapeutic process. The third theme labelled “Psychotherapy is Hard” addressed the factors that facilitated or hindered engagement with the digital treatment. CONCLUSIONS Findings from this study highlight that participants with FSD found iCBT relevant, acceptable, and helpful. The internet format did not compromise treatment delivery and may be a way to improve treatment access and make treatment participation more feasible for individuals with FSD. Several factors served as both facilitators and impediments to treatment engagement, which may account for the heterogeneity of the reported treatment outcome. The study suggests that future iCBT development should adopt a more iterative user-centered design approach to continually identify and mitigate barriers to engagement while strengthening key facilitators CLINICALTRIAL ClinicalTrial.gov NCT05525598; https://clinicaltrials.gov/study/NCT05525598

Cancer survivors may be struggling to re‐create meaning in life. Addressing their personal sources of meaning can support them in this process. The sources of meaning card method (SoMeCaM) aims to map and explore personal sources of meaning in a 1‐h session. It includes 26 cards, each with a statement on a source of meaning. The purpose of this study was to validate the statements on the sources of meaning cards for use among participants in cancer rehabilitation by examining whether participants attribute the same meaning to the statements as intended. The three step test interview method was used to assess response processes to the sources of meaning cards among 12 participants in a 5‐day cancer rehabilitation program in Denmark. The interviews were transcribed verbatim and analyzed using framework analysis. Nineteen of the 26 statements were interpreted congruently, that is, in line with the underlying theory, by all participants. Issues of incongruency, ambiguity and confusion were observed in participants' interpretations of the statements on religiosity (n = 6), spirituality (n = 10), and reason (n = 6). Minor issues were observed for the statements on practicality, achievement, knowledge, and attentiveness. In most statements, cancer survivors' interpretation aligned with the underlying theory. Problems were apparent regarding the sources of meaning religiosity, spirituality and reason, and a reconsideration of the wording of the statements is recommended. These problems may be due to cultural and linguistic interpretations rather than to being a cancer survivor. Future studies could focus on these issues in other target populations. Despite these minor issues, the SoMeCaM has proven useful in addressing the important topic of meaning in life in the cancer rehabilitation setting. Clinicians should pay attention to nuances in participants' understanding of the cards.

Background: The COVID‐19 pandemic was a global health and economic crisis. In the early phase of the pandemic, studies found that populations were reporting lower levels of mental well‐being and high levels of distress and worry. This study investigated potential protective and risk factors such as sociodemographics and psychological factors such as adaptation/coping.Methods: Two convenience samples from Norway and Denmark were recruited during the early phase of the first lockdown in May 2020 using snowball sampling primarily by social media. Measures included the Patient Health Questionnaire‐4 (PHQ‐4) for screening anxiety and depression, COVID‐19 distress, and coping strategies applied during the lockdown. Descriptive analyses were applied as well as bivariate correlations for associations between coping and mental health measures.Results: Levels of anxiety and depression were not alarmingly high, but being young, single, and female constituted a higher risk for poorer mental health. Applying positive reframing strategies was negatively associated with poor mental health and high COVID‐19 stress, whereas distraction coping strategies were positively correlated with poor mental health and high COVID‐19 stress.Conclusion: Applying positive reframing as a coping strategy may constitute a protective factor for mental health in the early phase of a crisis such as a pandemic. This knowledge may inform public health agencies on how to promote mental health in similar situations in the future. However, longitudinal and qualitative studies are needed to investigate the long‐term effects of the different coping strategies applied.

Aim: The aim of this study was to investigate the possible impact of the Covid-19 pandemic on general health, mental well-being, and experiences of control compared to pre-pandemic populations. Our hypotheses were that we would observe a significantly lower level of psychological well-being and general health in the 2020 sample compared to the pre-pandemic samples, and that we would observe younger age groups to be the most affected.Method: Two representative Danish populations (2016, n = 1656) and (2017, n = 3366) were compared to a representative Danish population (2020, n = 1538) sampled during the first lockdown in May 2020. Two-tailed tests of proportions were used to investigate possible differences between samples in proportions reporting poorer mental well-being measured by 5-item World Health Organization Well-Being Index, general health, and internal locus of control.Results: Younger men (aged 18–24) and younger women (aged 18–44) as well as elderly women (aged 65–74) reported lower mental well-being during the early phase of the pandemic compared to the population from 2016. Both women and men in 2020 reported significantly lower levels of internal locus of control compared to the 2017 sample. This was especially true for younger men and women. There were no statistically significant differences in general health between populations.Discussion: This study partly supports the hypothesis that the Covid-19 pandemic affected mental well-being negatively among younger persons. However, longitudinal studies are needed to investigate possible long-term effects of the pandemic on mental health and well-being. Further, qualitative studies are needed to investigate the in-depth consequences of Covid-19.

Dette er en oversigt over Coronasygdommens første måneder i Danmark.