Abstract
BackgroundBlended treatments, combining digital components with face-to-face (FTF) therapy, are starting to find their way into mental health care. Knowledge on how blended treatments should be set up is, however, still limited. To further explore and optimize blended treatment protocols, it is important to obtain a full picture of what actually happens during treatments when applied in routine mental health care.ObjectiveThe aims of this study were to gain insight into the usage of the different components of a blended cognitive behavioral therapy (bCBT) for depression and reflect on actual engagement as compared with intended application, compare bCBT usage between primary and specialized care, and explore different usage patterns.MethodsData used were collected from participants of the European Comparative Effectiveness Research on Internet-Based Depression Treatment project, a European multisite randomized controlled trial comparing bCBT with regular care for depression. Patients were recruited in primary and specialized routine mental health care settings between February 2015 and December 2017. Analyses were performed on the group of participants allocated to the bCBT condition who made use of the Moodbuster platform and for whom data from all blended components were available (n=200). Included patients were from Germany, Poland, the Netherlands, and France; 64.5% (129/200) were female and the average age was 42 years (range 18-74 years).ResultsOverall, there was a large variability in the usage of the blended treatment. A clear distinction between care settings was observed, with longer treatment duration and more FTF sessions in specialized care and a more active and intensive usage of the Web-based component by the patients in primary care. Of the patients who started the bCBT, 89.5% (179/200) also continued with this treatment format. Treatment preference, educational level, and the number of comorbid disorders were associated with bCBT engagement.ConclusionsBlended treatments can be applied to a group of patients being treated for depression in routine mental health care. Rather than striving for an optimal blend, a more personalized blended care approach seems to be the most suitable. The next step is to gain more insight into the clinical and cost-effectiveness of blended treatments and to further facilitate uptake in routine mental health care.
Highlights
Web-based interventions for depressive disorders have been studied and applied in different ways [1]
Educational level, and the number of comorbid disorders were associated with blended cognitive behavioral therapy (bCBT) engagement
Blended treatments can be applied to a group of patients being treated for depression in routine mental health care
Summary
Web-based interventions for depressive disorders have been studied and applied in different ways [1]. Direct comparisons of Web-based and face-to-face (FTF) treatment formats indicated equivalence [8], and it has been shown that guided Web-based interventions lead to better treatment outcomes compared with unguided treatments [9,10,11] These effects tend to be replicated in clinical practice [12,13,14,15], effectiveness studies of Web-based interventions for depression among routine care populations are scarce and upscaling is still limited. For the treatment of patients in routine mental health care settings, so called blended formats combining digital components with FTF therapy in one integrated treatment protocol are being developed, investigated, and implemented [16] This way of working may better suit the regular practice and skills of psychotherapists and help meet the ethical and current professional guidelines [17]. To further explore and optimize blended treatment protocols, it is important to obtain a full picture of what happens during treatments when applied in routine mental health care
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