Internet-delivered Cognitive Behavioural Therapy (iCBT) is an effective treatment for depression and anxiety disorders. However longitudinal qualitative research into the client's subjective experience of this form of treatment 'in the wild' is relatively scarce. We present an analysis of secondary outcomes in a naturalistic RCT conducted within the UK's Improving Access to Psychological Therapies programme. We evaluated clients' expectations, experience, and context of usage of iCBT, across three timepoints. Results are discussed in terms of the creation of a therapeutic space online, the impact of hope, expectations and personal factors on the therapeutic experience, iCBT as "therapy on the go" and developing skills for life. While iCBT on the whole provides a positive, supportive and therapeutic experience for clients, the study identified managing expectations, polarized preferences, momentary help-seeking and longterm support as important aspects of the experience to consider in future design.

Background Psychological therapy is an effective treatment method for mental illness; however, many people with mental illness do not seek treatment or drop out of treatment early. Increasing client uptake and engagement in therapy is key to addressing the escalating global problem of mental illness. Attitudinal barriers, such as a lack of motivation, are a leading cause of low engagement in therapy. Digital interventions to increase motivation and readiness for change hold promise as accessible and scalable solutions; however, little is known about the range of interventions being used and their feasibility as a means to increase engagement with therapy. Objective This review aimed to define the emerging field of digital interventions to enhance readiness for psychological therapy and detect gaps in the literature. Methods A literature search was conducted in PubMed, PsycINFO, PsycARTICLES, Scopus, Embase, ACM Guide to Computing Literature, and IEEE Xplore Digital Library from January 1, 2006, to November 30, 2021. The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) methodology was applied. Publications were included when they concerned a digitally delivered intervention, a specific target of which was enhancing engagement with further psychological treatment, and when this intervention occurred before the target psychological treatment. Results A total of 45 publications met the inclusion criteria. The conditions included depression, unspecified general mental health, comorbid anxiety and depression, smoking, eating disorders, suicide, social anxiety, substance use, gambling, and psychosis. Almost half of the interventions (22/48, 46%) were web-based programs; the other formats included screening tools, videos, apps, and websites. The components of the interventions included psychoeducation, symptom assessment and feedback, information on treatment options and referrals, client testimonials, expectation management, and pro-con lists. Regarding feasibility, of the 16 controlled studies, 7 (44%) measuring actual behavior or action showed evidence of intervention effectiveness compared with controls, 7 (44%) found no differences, and 2 (12%) indicated worse behavioral outcomes. In general, the outcomes were mixed and inconclusive owing to variations in trial designs, control types, and outcome measures. Conclusions Digital interventions to enhance readiness for psychological therapy are broad and varied. Although these easily accessible digital approaches show potential as a means of preparing people for therapy, they are not without risks. The complex nature of stigma, motivation, and individual emotional responses toward engaging in treatment for mental health difficulties suggests that a careful approach is needed when developing and evaluating digital readiness interventions. Further qualitative, naturalistic, and longitudinal research is needed to deepen our knowledge in this area.

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BACKGROUND Psychological therapy is an effective treatment method for mental illness, yet many people who are suffering do not seek treatment, or dropout of treatment early. Increasing client uptake and engagement in therapy is key to addressing the escalating, global issue of mental illness. Attitudinal barriers, such as a lack of motivation, have shown to be a leading cause of low engagement in therapy. Digital interventions to increase motivation and readiness for change hold promise as accessible, scalable solutions, yet little is known about the range of interventions being used and their feasibility as a means to increase uptake and engagement with therapy. OBJECTIVE This review aimed to define the emerging field of digital interventions to enhance readiness for psychological therapy and detect gaps in the literature. METHODS A literature search was conducted in PubMed, PsycINFO, PsycARTICLES, Scopus, EMBASE, ACM Guide to Computing Literature and IEEE Xplore Digital Library, from January 1, 2006 to November 30, 2021. PRISMA-ScR methodology was applied. Publications were included when they concerned a digitally delivered intervention, a specific target of which was enhancing engagement with further psychological treatment, and when this intervention occurred before the target psychological treatment. RESULTS A total of 45 publications met the inclusion criteria. Conditions covered included depression, unspecified general mental health, comorbid anxiety and depression, smoking, eating disorders, suicide, social anxiety, substance use, gambling and psychosis. Almost half of the interventions were online programs; other formats included screening tools, videos, apps and websites. Most interventions took less than 90 minutes to complete, and were delivered either to people who had not already sought help, via outreach methods such as social media, marketing or email, or to those interested in treatment or actively seeking treatment. The components of the interventions included psychoeducation, symptom assessments and feedback, information on treatment options and referral, client testimonials, expectation management and pro-con lists. Outcomes of controlled studies were mixed and inconclusive due to variations in trial designs, control types and outcome measures. CONCLUSIONS The field of digital interventions to enhance readiness for psychological therapy is broad and varied. While these easily accessible, digital approaches show potential as a means of preparing people for therapy, they are not without risks. The complex nature of stigma, motivation, and individual emotional responses towards engaging in treatment for mental health difficulties, suggests that a careful approach is needed when developing and evaluating digital readiness interventions. Further qualitative, naturalistic, and longitudinal research is needed to deepen our knowledge in this area.