Abstract
BackgroundBlending online modules into face-to-face therapy offers perspectives to enhance patient self-management and to increase the (cost-)effectiveness of therapy, while still providing the support patients need. The aim of this study was to outline optimal usage of blended care for depression, according to patients and therapists.MethodsA Delphi method was used to find consensus on suitable blended protocols (content, sequence and ratio). Phase 1 was an explorative phase, conducted in two rounds of online questionnaires, in which patients’ and therapists’ preferences and opinions about online psychotherapy were surveyed. In phase 2, data from phase 1 was used in face-to-face interviews with therapists to investigate how blended therapy protocols could be set up and what essential preconditions would be.ResultsTwelve therapists and nine patients completed the surveys. Blended therapy was positively perceived among all respondents, especially to enhance the self-management of patients. According to most respondents, practical therapy components (assignments, diaries and psycho-education) may be provided via online modules, while process-related components (introduction, evaluation and discussing thoughts and feelings), should be supported face-to-face. The preferred blend of online and face-to-face sessions differs between therapists and patients; most therapists prefer 75% face-to-face sessions, most patients 50 to 60%. The interviews showed that tailoring treatment to individual patients is essential in secondary mental health care, due to the complexity of their problems. The amount and ratio of online modules needs to be adjusted according to the patient’s problems, skills and characteristics. Therapists themselves should also develop skills to integrate online and face-to-face sessions.ConclusionsBlending online and face-to-face sessions in an integrated depression therapy is viewed as a positive innovation by patients and therapists. Following a standard blended protocol, however, would be difficult in secondary mental health care. A database of online modules could provide flexibility to tailor treatment to individual patients, which asks motivation and skills of both patients and therapists. Further research is necessary to determine the (cost-)effectiveness of blended care, but this study provides starting points and preconditions to blend online and face-to-face sessions and create a treatment combining the best of both worlds.
Highlights
Blending online modules into face-to-face therapy offers perspectives to enhance patient self-management and to increase theeffectiveness of therapy, while still providing the support patients need
In phase 2, data from phase 1 was translated to clinical practice, using interviews with therapists to investigate more in depth how actual blended therapy protocols could be set up and what essential preconditions would be to make this form of therapy feasible in secondary mental health care practice
In the first items all the benefits and drawbacks from round 1 were used as statement items to gain consensus on the attitudes of respondents concerning online and blended therapy
Summary
Blending online modules into face-to-face therapy offers perspectives to enhance patient self-management and to increase the (cost-)effectiveness of therapy, while still providing the support patients need. Innovations in web technology offer promising perspectives to decrease these issues, by providing adequate care in a low key and efficient manner, often through online self-help or guided self-help programs. In these programs patients mostly follow a standardized psychological treatment (cognitive behavioral therapy) via the internet, with minimal feedback or support [4,5]. Studies on the experiences of patients with online therapy show that personal feedback and support are perceived as positive among patients, to optimally use the program and to keep them motivated [12,13,14]
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