backgroundBlended therapy describes the use of computerised therapy combined with face-to-face therapy to extend the depth, range and nature of the face-to-face therapy. We wanted to develop a treatment manual for a randomised trial of blended therapy combining face-to-face problem solving and a smartphone app in men who present to hospital with self-harm. Objective To develop a treatment manual and to describe the experience of receiving and delivering a blended therapy. Methods After completion of the blended therapy, semistructured qualitative interviews were conducted with participants to describe their experience of the treatment. Two independent coders analysed the material using a thematic, grounded theory approach. Findings Seven men were enrolled in the study, and six completed the qualitative interviews. The two main themes identified were of trust and connection. Participants attended 85% of their appointments. conclusions In the treatment manual, we emphasised the themes of trust and connection by allowing time to discuss the app in the face-to-face to sessions, ensuring that therapists are familiar with the app and know how to respond to technical queries. Identification of trust and connection generates novel questions about the importance of the therapeutic alliance with technology rather than with people. clinical implications Clinicians and app developers need to pay attention to the therapeutic relationship with technology as trust and good communication can be easily damaged, resulting in disengagement with the app. Blended therapy may result in increased adherence to face-to-face sessions. trial registration number NCT02718248 bAckgrOund Blended therapy is the integration of internet-based treatment and psychotherapy in the treatment of psychiatric disorders. It has been described as 'any possible combination of regular face-to-face treatments and web-based interventions'.1 Several systematic reviews have examined the partial replacement of face-to-face therapy with web-based technologies.2-4 Yet there have been few descriptions of instances where internet-based therapies supplement or augment face-to-face therapy to create a new treatment rather than simply replacing face-to-face treatment with variable degrees of inperson support. This approach to blended therapy attempts to increase the depth, reach and nature of traditional face-to-face treatment.A 2016 review of mental health smartphone applications recommended the integration of cognitive behavioural therapy (CBT)-based features when developing applications.5 The smartphone's facility for establishing, rewarding and reinforcing behavioural change is also cited as a significant advantage of this technology in the context of mental health.6 Tang and Kreindler suggest that mobile applications may support homework compliance for CBT treatment when the application is congruent with therapy, fosters learning, incorporates guided therapy, inspires connection building, emphasises completion and is population specific.7 This is especial...

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