Why Uptake of Blended Internet-Based Interventions for Depression Is Challenging: A Qualitative Study on Therapists' Perspectives.

Mayke Mol,Digna J F Van Schaik,Heleen Riper,Claire Van Genugten,Els Dozeman,Jan H Smit,Stasja Draisma

doi:10.3390/jcm9010091

Abstract

(1) Background: Blended cognitive behavioral therapy (bCBT; online and face-to-face sessions) seems a promising alternative alongside regular face-to-face CBT depression treatment in specialized mental health care organizations. Therapists are key in the uptake of bCBT. This study focuses on therapists’ perspectives on usability, satisfaction, and factors that promote or hinder the use of bCBT in routine practice; (2) Methods: Three focus groups (n = 8, n = 7, n = 6) and semi-structured in-depth interviews (n = 15) were held throughout the Netherlands. Beforehand, the participating therapists (n = 36) completed online questionnaires on usability and satisfaction. Interviews were analyzed by thematic analysis; (3) Results: Therapists found the usability sufficient and were generally satisfied with providing bCBT. The thematic analysis showed three main themes on promoting and hindering factors: (1) therapists’ needs regarding bCBT uptake, (2) therapists’ role in motivating patients for bCBT, and (3) therapists’ experiences with bCBT; (4) Conclusions: Overall, therapists were positive; bCBT can be offered by all CBT-trained therapists and future higher uptake is expected. Especially the pre-set structure of bCBT was found beneficial for both therapists and patients. Nevertheless, therapists did not experience promised time-savings—rather, the opposite. Besides, there are still teething problems and therapeutic shortcomings that need improvement in order to motivate therapists to use bCBT.

Highlights

Face-to-face (FtF) cognitive behavioral therapy (CBT) is an evidence-based treatment for depression [1]
With respect to distribution of experience with Blended cognitive behavioral therapy (bCBT) for depression, 42% of the therapists had considerable bCBT experience, 42% had little experience, and 17% had no experience
This study showed that therapists see room for improvement with regard to platform usability, therapists’ work routines, and guideline use on bCBT

Summary

Introduction

Face-to-face (FtF) cognitive behavioral therapy (CBT) is an evidence-based treatment for depression [1]. Patient access to CBT is hindered by several barriers such as perceived personal stigma, costs, long waiting lists, and limited availability. It seems promising to offer CBT with the support of technology and without the FtF sessions, thereby potentially reducing therapists’ time and costs due to increased involvement of patients themselves. In Internet-based cognitive behavioral therapy (iCBT), treatment access can be improved to offer CBT on an online platform. This would help reduce stigma, waiting lists, and costs, since patients can work through sessions at their own pace, in their own time, and therapist time is lessened. It has been shown that iCBT, especially with online therapist guidance, has good clinical effects for patients with depression [5,6]

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Results

Discussion

Conclusion