E-Coach: reducing the impact of chronic diseases on patients’ daily life

eHealth & Self management

Andrea Evers is a Professor of Health Psychology at Leiden University. Her team has developed an online behavioural therapy for people with chronic somatic diseases. “A chronic condition can severely impact your daily life,” she says. “E-coaching is ideally suited to help patients cope with the impairments they face.”

Chronic somatic conditions, such as cardiovascular disease, rheumatoid arthritis and cancer, often cause physical complaints such as pain, itching and fatigue. They may also have a substantial impact on people’s future, including their career path and family planning. Not surprisingly, says Professor Evers, about one-third of these patients have psychological complaints, such as negative mood and impairments in social contacts. “Cognitive behavioural therapy is an evidence-based method to help patients cope with these psychological problems. But it’s time-consuming and tiring for patients to have to visit a psychologist on a regular basis. So ten years ago, we set out to develop an online cognitive behavioural therapy, called ‘e-Coach’. The team has now developed tailored online treatments for several specific patient groups, and they’ve scientifically proven their effectiveness in dealing with a variety of disorders.”

Diverse goals

The e-Coach intervention is guided by a psychologist. Therapy usually starts with the patient completing several diagnostic questionnaires. Next, there is a single face-to-face kick-off meeting, during which therapist and patient jointly decide upon the treatment goals. “These goals may be varied,” says Evers. “One patient may wish to decrease her fatigue by improving the balance between rest and activity. Another patient may wish to deal with his mood problems by reducing maladaptive negative cognitions.”

Dynamic interaction

The therapy continues with online treatment modules, which deal with themes such as social adjustment, pain, fatigue, mood problems and social relationships. Each treatment module consists of multiple assignments and reading texts, which the e-coach therapist can tailor to the needs of an individual patient. The patient follows the modules at home, saving time, energy and costs for both patients and caregivers. The therapist receives a message as soon as the patient has completed an assignment. They usually agree on a certain contact schedule. For instance, the therapist may send feedback every Wednesday. “But in practice, the interaction is often very dynamic, allowing the therapist to provide intensive guidance,” says Evers.

Patient empowerment

This dynamic interaction is one of the many advantages of online therapy. Patients can easily incorporate the treatment into their daily lives, says Evers. “They may perform a short relaxation exercise or keep a diary. Of course, people also receive daily assignments in traditional face-to-face therapy; but with e-health, the therapist can monitor the patient’s progress much more intensively. And it is an approach that fits in with modern times, when many people love to use apps to keep track of their health. These patients are working on their mental health in their own environment at their own speed, which gives them a feeling of empowerment. “We’ve repeatedly shown that the e-Coach intervention is effective in reducing the impact of chronic diseases on patients’ daily lives. The therapy is suitable for anyone with an internet connection and elementary computer skills. In our experience, this applies to almost everybody, including elderly people.”

Centre of expertise

The team is now implementing the e-Coach intervention at Leiden University Medical Center, as well as at other healthcare centres in the Netherlands. “It’s already up and running in several departments, and the Board of Directors is in favour of implementing it in two additional departments,” says Evers. “Eventually, they want to use it hospital-wide, and that’s just fantastic!” The team is also looking into the possibility of implementing the intervention in peripheral hospitals, in collaboration with health insurers. “And we’re starting an academic treatment centre in the Department of Social Sciences of Leiden University in 2017. That’s going to become a centre of expertise.”

Our serious games project is a good fit with Medical Delta, combining technical expertise from Delft, clinical expertise from LUMC, and psychological expertise from my own group

New horizons

With the implementation of the e-Coach intervention now in full progress, the team is already exploring new horizons. “So far, e-coaching has been more or less an online copy of traditional cognitive behavioural therapy,” says Evers. “People are now starting to realise that much more is possible. For instance, so-called ‘serious games’ seem to be very suitable for influencing people’s unconscious behaviour. There are very promising examples in the literature. For example, a computer game in which alcoholics have to push away glasses of beer seems to protect them from relapse. Together with TU Delft, we’re looking into the possibility of developing a similar game to promote healthy behaviour. But this is all still under investigation.”

Ten years

Evers looks back over: “Like Medical Delta, which has just celebrated its tenth anniversary, we’ve been working on this research project for about ten years now – so it’s the result of a long collaboration. Our serious games project is a good fit with Medical Delta, combining technical expertise from Delft, clinical expertise from LUMC, and psychological expertise from my own group. I’m delighted that our therapy is now actually being implemented!”

Interview by: Linda van den Berg