BACKGROUND Blended cognitive behavioral therapy (bCBT)—the combination of CBT and digital mental health applications—has been increasingly used to treat depression and anxiety disorders. As a resource-efficient treatment approach, bCBT appears promising for addressing the growing need for mental healthcare services, for example, as early interventions before chronification of symptoms. Yet, further research into the efficacy and feasibility of integrated bCBT interventions is needed. OBJECTIVE This study aimed to evaluate the effectiveness of a novel bCBT program comprising short (25-minutes) weekly face-to-face therapy sessions combined with a smartphone-based digital health application for treating mild to moderate symptoms of depression or anxiety. METHODS This prospective uncontrolled trial comprised two measurement points (pre- and post-treatment) and two intervention groups. We recruited university students with mild to moderate symptoms of depression or anxiety. Based on primary symptoms, subjects were assigned either to a depression intervention group (N = 67 completers) or an anxiety intervention group (N = 33 completers). Participants in each group received six weekly individual psychotherapy sessions via videoconference and completed modules tailored to their respective symptoms in the smartphone-based digital health application. RESULTS The depression group displayed medium to large improvements in symptoms of depression (d = -.70 to -.90, ps < .001). The anxiety group experienced large improvements in symptoms of generalized anxiety assessed with the Generalized Anxiety Disorder Scale-7 (d = -.80, p < .001), but not in symptoms of anxiety assessed with the Beck Anxiety Inventory (d = -.35, p = .058). Additionally, both groups experienced significant improvements in their perceived self-efficacy (d = .50 in the depression group, d = .71 in the anxiety group, ps < .001) and quality of life related to psychological health (d = .87, p < .001 in the depression group; d = .40, p = .035 in the anxiety group). Work and social adjustment of patients improved significantly in the depression (d = -.49, p < .001) but not in the anxiety sample (d = -.06, p = .719). Patients' mental health literacy improved in the anxiety sample (d = .45, p = .017) but not in the depression sample (d = .21, p = .103). Patient satisfaction with the bCBT program and ratings of the usability of the digital application were high in both treatment groups. CONCLUSIONS This study provides preliminary evidence for the feasibility and effectiveness of a novel brief bCBT intervention. The intervention effects generalized across a broad spectrum of patient-reported outcomes. Hence, the newly developed bCBT intervention appears promising for treating mild to moderate depression and anxiety in young adults.

Background Blended cognitive behavioral therapy (bCBT)—the combination of digital elements and face-to-face psychotherapy—has been proposed to alleviate challenges that patients and therapists face in conventional cognitive behavioral therapy. There is growing evidence that adding digital elements to face-to-face psychotherapy can contribute to better treatment outcomes. However, bCBT programs still show considerable shortcomings, and knowledge on how to improve digital apps using a bCBT protocol is limited. Objective This study aimed to inductively identify functions and qualities that are expected from a bCBT treatment for depression in the eyes of patients and psychotherapists who were not currently receiving or practicing bCBT treatment. Methods We used a qualitative exploratory study design and conducted 3 focus group interviews (n=6 in each) and 5 semistructured in-depth interviews with therapists as well as 11 individual interviews with patients with a primary diagnosis of depression and currently undergoing cognitive behavioral therapy treatment in Germany. Themes and categories were established inductively from transcribed interview records based on a rigorous coding method. Results Both therapists and patients expected a digital app to provide patients with the opportunity to track their mood, work on therapeutic homework activities, easily access an intervention set for harder moments, and efficiently facilitate administrative tasks. The desire to be able to customize bCBT protocols to individual patient circumstances was evident in both patient and therapist interviews. Patients differed with respect to what content and the amount of material the app should focus on as well as the method of recording experiences. Therapists viewed digital apps as potentially aiding in their documentation work outside of sessions. Different attitudes surfaced on the topic of data security, with patients not as concerned as therapists. Conclusions Both patients and therapists had substantially positive attitudes toward the option of an integrated bCBT treatment. Our study presents novel findings on the expectations and attitudes of patients and therapists.

Background Blended cognitive behavioral therapy (bCBT) programs have been proposed to increase the acceptance and adoption of digital therapeutics (DTx) such as digital health apps. These programs allow for more personalized care by combining regular face-to-face therapy sessions with DTx. However, facilitators of and barriers to the use of DTx in bCBT programs have rarely been examined among students, who are particularly at risk for developing symptoms of depression and anxiety disorders. Objective This study aimed to evaluate the facilitators of and barriers to the use of a bCBT program with the elona therapy app among university students with mild to moderate depression or anxiety symptoms. Methods Semistructured interviews were conducted via videoconference between January 2022 and April 2022 with 102 students (mean age 23.93, SD 3.63 years; 89/102, 87.2% female) from universities in North Rhine-Westphalia, Germany, after they had completed weekly individual cognitive behavioral therapy sessions (25 minutes each) via videoconference for 6 weeks and regularly used the depression (n=67, 65.7%) or anxiety (n=35, 34.3%) module of the app. The interviews were coded based on grounded theory. Results Many participants highlighted the intuitive handling of the app and indicated that they perceived it as a supportive tool between face-to-face sessions. Participants listed other benefits, such as increased self-reflection and disorder-specific knowledge as well as the transfer of the content of therapy sessions into their daily lives. Some stated that they would have benefited from more personalized and interactive tasks. In general, participants mentioned the time requirement, increased use of the smartphone, and the feeling of being left alone with potentially arising emotions while working on tasks for the next therapy session as possible barriers to the use of the app. Data security was not considered a major concern. Conclusions Students mostly had positive attitudes toward elona therapy as part of the bCBT program. Our study shows that DTx complementing face-to-face therapy sessions can be perceived as a helpful tool for university students with mild to moderate anxiety or depression symptoms in their daily lives. Future research could elaborate on whether bCBT programs might also be suitable for students with more severe symptoms of mental disorders. In addition, the methods by which such bCBT programs could be incorporated into the university context to reach students in need of psychological support should be explored.

Blended cognitive behavioral therapy (bCBT) combines face-to-face therapy with digital elements such as digital health apps. Many researchers and practitioners expect bCBT to be advantageous for treating mental disorders such as depression. Yet, studies comparing bCBT to non-blended face-to-face cognitive behavioral therapy (CBT) are limited and have yielded heterogeneous results. Thus, this pilot study aimed to explore the efficacy and safety of a novel bCBT digital therapeutic for treating unipolar depression in adults combined with face-to-face CBT compared to face-to-face CBT alone (treatment as usual; TAU) in routine care. Patients (N = 80) were randomly assigned to bCBT (n = 41) or standard CBT (n = 39) over 12 weeks. bCBT consisted of weekly face-to-face CBT sessions accompanied by the digital therapeutic elona therapy for use between sessions. Standard CBT consisted of weekly face-to-face CBT sessions, mirroring routine care. A broad set of outcomes were measured at baseline, at six weeks, and at 12 weeks. These outcomes were analyzed with linear mixed models. Improvements in depressive symptoms were descriptively larger for the bCBT group than for the CBT group (BDI-II: d = -.22, PHQ-9: d = -.27). Yet, this difference did not reach statistical significance. bCBT was superior to standard CBT in secondary outcome measures of psychological health (d = .54) and generalized anxiety symptoms (d = -.50). In other secondary outcomes, improvements were also descriptively larger for bCBT than for CBT, but these differences did not reach statistical significance (BAI: d = -.28, PSWQ: d = .28, GSE: d = .31, WHOQOL-BREF physical health scale: d = .28). In sum, this pilot study indicated that bCBT is superior to standard CBT and safe to use in clinical samples. Future research using larger samples is needed to solidify our findings.

BACKGROUND Blended cognitive behavioral therapy (bCBT)—the combination of digital elements and face-to-face psychotherapy—has been proposed to alleviate challenges patients and therapists face in conventional CBT. There is growing evidence that adding digital elements to face-to-face psychotherapy can contribute to better treatment outcomes. However, bCBT programs still show considerable shortcomings and knowledge on how to improve digital applications using a bCBT protocol is limited. OBJECTIVE This study aims to inductively identify functions and qualities that are expected from a bCBT treatment for depression in the eyes of patients and psychotherapists who were not currently receiving or practicing bCBT treatment. METHODS We employed a qualitative exploratory study design and conducted semi-structured interviews with 23 psychotherapists as well as 11 patients with a primary diagnosis of depression and currently undergoing CBT treatment. Themes and categories were established inductively from transcribed interview records based on a rigorous coding method. RESULTS Both therapists and patients expected a digital application to provide patients the opportunity to track their mood, work on therapeutic homework activities, easily access an intervention set for harder moments and efficiently facilitate administrative tasks. The desire to be able to customize bCBT protocols to individual patient circumstances was evident in both patient and therapist interviews. Patients differed with respect to what content and the amount of material the app should focus on as well as the method of recording experiences. Therapists viewed digital applications as potentially aiding in their documentation work outside of sessions. Different attitudes surfaced on the topic of data security, with patients not as concerned as therapists. CONCLUSIONS Both patients and therapists had substantially positive attitudes towards the option of an integrated bCBT treatment. Our study presents novel findings on the expectations and attitudes of patients and therapists.