Online-CBT for endometriosis: Exploring the acceptability and impact of the Ed.iTh program

Theoretical background: Psychological distress significantly contributes to impairment in endometriosis. However, patients face systemic barriers to psychological support, including long waiting times, stigma, and a lack of endometriosis-specific expertise. Internet-based CBT (iCBT) offers a promising alternative, yet its acceptability and perceived helpfulness in addressing the psychological needs of endometriosis patients remains unexplored. Aim: This study aimed to evaluate users' experiences with Ed.iTh, the first therapist-guided iCBT program developed for individuals with endometriosis. The program includes psychoeducation, cognitive restructuring, pacing, emotion regulation, and asynchronous therapist support. Methods: = 163 individuals with endometriosis were invited to complete the eight-week Ed.iTh program. Each week, users engaged with a new module and provided written feedback on (1) the content and (2) suggestions for improvement. Free-text responses (1678 statements from 137 users) were analyzed using directed content analysis, based on the DeLone and McLean model (2003), which evaluates the success of information systems (e.g., internet-based interventions) across six dimensions. Results: Participants expressed overall satisfaction with the program. They appreciated the relevance and clarity of the provided information (information quality) and emotional support, which helped reduce feelings of isolation (individual impact). Some participants noted difficulties applying techniques independently and requested more concrete guidance (service quality). Others highlighted a need for more interactivity and flexible pacing (system quality). Discussion: The findings demonstrate the acceptability of Ed.iTh and highlight the potential of iCBT as a low-threshold treatment option for endometriosis. Suggested improvements include greater personalization, more flexible scheduling, and enhanced interactivity to increase engagement.