Stefan Elbers

164 Chapter 6 Adaptability The theme adaptability was added in response to multiple comments relating to individual personal characteristics that were believed to either facilitate or hinder optimal use of the workbook. In particular, participants reported that the current version of the prototype intervention required a high level of commitment and an active mindset to autonomously explore the features of the workbook. Because of my work, I am used to discover things on my own, but I expect that this method will not work for everyone if it is not clearly instructed. [P8] Patients with low health literacy were expected to encounter problems with the current amount of instruction texts, reading level, writing down their own input, and analyzing which values would underlie their most important treatment goals. Characteristics that were reported to facilitate the use of the workbook included being organized, being able to reflect on experiences, and possessing adequate reading and writing skills. DISCUSSION Principal Findings This study was conducted to assess the feasibility of two relapse prevention strategies specifically designed to enhance IMPT programs. Overall, the workbook was perceived by participants as useful, easy to use, and in line with the treatment program. However, there was a difference in how the individual relapse prevention strategies were perceived. Insight Cards were expected to benefit all patients and were relatively easy to learn and apply. VBG helped patients to plan meaningful goals, but these were more difficult to understand and did not always fit into the treatment program. However, it is important to note that the focus group consisted solely of HCPs who provided exposure in vivo treatment and were not experienced with VBG. Participants indicated a preference for a digital app over a paper-and-pencil workbook as a future delivery mode. Other suggestions for improvement included more specific implementation guidelines for the treatment staff, group sessions among patients to discuss their input, and more attention to the workbook during the final phase of the treatment. Overall, these findings indicate that the workbook is feasible within the context of IMPT and acceptable to both patients and HCPs. Importantly, these initial results contain detailed feedback on how the strategies can be refined. First, the study protocol allowed for substantial variation in when and how the workbook was applied. This flexible approach maximized HCP autonomy with respect to dose and content but at times resulted in limited or even no interaction at all once the