Patient and Therapist Expectations for a Blended Cognitive Behavioral Therapy Program for Depression: Qualitative Exploratory Study

Abstract

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.

Barriers to and Facilitators of a Blended Cognitive Behavioral Therapy Program for Depression and Anxiety Based on Experiences of University Students: Qualitative Interview Study

“…Interestingly, our study showed that the perceived benefits of this bCBT program are in line with many of the explored expectations of patients receiving standard CBT but who have not yet had an experience with blended formats [ 38 , 49 ]. This study confirms that inexperienced bCBT users’ needs for personalization, integration into daily life, psychoeducation, and self-reflection options match the experiences of participants in this bCBT program.…”

“…This study confirms that inexperienced bCBT users’ needs for personalization, integration into daily life, psychoeducation, and self-reflection options match the experiences of participants in this bCBT program. However, participants also called for more interactive therapeutic activities, which patients inexperienced in bCBT did not mention as a preference [ 38 ].…”

“…As the therapist is in charge of the therapy in bCBT, more personalized care is possible compared with iCBT, that is, by selecting modules and exercises within DTx that are most relevant to the client’s needs and goals, which might enhance motivation and compliance [ 36 ]. Tailored interventions also seem to be a prerequisite to increasing university students’ intention to use mental health services because one-size-fits-all approaches are unlikely to be effective for everyone [ 37 , 38 ]. Thus, to increase treatment uptake among students with depression or anxiety symptoms, there is a need for bCBT approaches that fit therapists’ as well as patients’ needs and preferences [ 39 ].…”

“…Thus, to increase treatment uptake among students with depression or anxiety symptoms, there is a need for bCBT approaches that fit therapists’ as well as patients’ needs and preferences [ 39 ]. A few studies have focused on therapists’ perspectives regarding their expectations for and experiences with bCBT [ 38 , 40 ], but to date, there is little qualitative research on patients in general and with students in particular. A study by Etzelmueller et al [ 41 ] reported predominantly positive experiences with a bCBT program among patients with major depressive disorder.…”