Costs and effects of Internet cognitive behavioral treatment blended with face-to-face treatment: results from a naturalistic study
Open accessAbstract
Research has convincingly demonstrated that Internet interventions are effective for anxiety and depression and it is suggested that these interventions can reduce therapist time and thus save costs. Therefore, many Dutch mental health organizations have started to implement these treatments into their services. They usually apply the Internet interventions in combination with the face-to-face treatments, i.e. blended treatments. To date, no empirical work has examined if implementing blended treatments actually contributes to treatment effects and cost savings. The objective of this naturalistic study was to examine this issue, using routine mental health care data for patients with depression or anxiety. All 4448 records of patients with depression or anxiety seeking help at a large mental health service between October 2009 and December 2012 were obtained. Data on GAF-index, therapist time, and therapist costs of patients who received face-to-face treatments were compared with those who received blended care, using propensity score matching. Blended care was applied in 3.6% of all patients and was given more frequently to younger patients and patients with an anxiety disorder. There were no significant differences in symptom severity at baseline between the two treatment groups, nor were there significant differences between the two groups in symptom improvement. Patients who received blended care had more treatment sessions (face-to-face plus online sessions) than patients who received standard treatment, which resulted in significantly more treatment time and higher costs. Findings suggest that in this sample blended care is more expensive compared to established face-to-face treatments and doesn't lead to additional benefits in terms of general functioning. This might be caused by suboptimal implementation strateges.
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Online treatments may reduce therapist time per patient.
“Studies suggest that online treatments may reduce therapist time per patient, because patients are encouraged to work through the treatment protocol more autonomously, and therapists can provide feedback online instead of during face-to-face sessions at the clinic (Hedman et al., 2014, Kenter et al., 2015).”
From Development and initial evaluation of blended cognitive behavioural treatment for major depression in routine specialized mental health care (2016) · cites this paper as Kenter et al., 2015
Only a small number of patients are reached with online therapies in routine practise, particularly in specialized mental health care.
“Despite the potential benefits of online treatment, only a small number of patients are reached with online therapies in routine practise, particularly in specialized mental health care (Bremmer and van Es, 2013, Kenter et al., 2015).”
From Development and initial evaluation of blended cognitive behavioural treatment for major depression in routine specialized mental health care (2016) · cites this paper as Kenter et al., 2015
Combining the two treatment formats rather than blending them into one treatment protocol can lead to increased treatment dosage and higher costs.
“However, combining the two treatment formats rather than blending them into one treatment protocol can also lead to increased treatment dosage and higher costs (Kenter et al., 2015).”
From Development and initial evaluation of blended cognitive behavioural treatment for major depression in routine specialized mental health care (2016) · cites this paper as Kenter et al., 2015
It is unclear whether adding digital mental health tools to face-to-face psychotherapy results in greater improvement or reduced psychotherapy time.
“Although these studies have found that patients improve in treatments that blend DMHT with face-to-face psychotherapy, it is unclear whether the addition of DMHT tools results in any greater improvement or reduction in the amount of time required in psychotherapy (39, 40).”
From Banbury forum consensus statement on the path forward for digital mental health treatment (2021) · cites this paper as [39]
Patients improve in treatments that blend digital mental health tools with face-to-face psychotherapy.
“Although these studies have found that patients improve in treatments that blend DMHT with face-to-face psychotherapy, it is unclear whether the addition of DMHT tools results in any greater improvement or reduction in the amount of time required in psychotherapy (39, 40).”
From Banbury forum consensus statement on the path forward for digital mental health treatment (2021) · cites this paper as [39]
In a naturalistic study by Kenter and colleagues, treatment time and costs increased for bCBT relative to ftfCBT.
“In contrast, in a naturalistic study by Kenter and colleagues treatment time and costs increased for bCBT relative to ftfCBT [68].”
In the Kenter study, no treatment protocol or clear guidelines on how to apply blended treatment were available and therapists provided online sessions on top of face-to-face sessions resulting in longer treatment durations.
“In this study, no treatment protocol or clear guidelines on how to apply blended treatment were available and therapists turned out to have provided online sessions on top of face-to-face sessions resulting in longer treatment durations.”
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- Authors
- Kenter, R. M. F., van de Ven, P. M., Cuijpers, P., Koole, G., Niamat, S., Gerrits, R. S., Willems, M., & van Straten, A.
- Affiliations
- Amsterdam Public Health (NL)
- Vrije Universiteit Amsterdam (NL)
- Dimence (NL)
- Corresponding author
- Kenter, Robin M.F.
- Venue
- Internet Interventions
- Publisher
- Elsevier BV
- Published
- 2015-03
- Volume
- 2
- Issue
- 1
- Pages
- 77-83
- ISSN
- 2214-7829 (ISSN-L)
- OpenAlex
- W2078654332
- Cited by
- 105
- References
- 43
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 6 · 2023: 4 · 2022: 11 · 2021: 15 · 2020: 9 · 2019: 15 · 2018: 11 · 2017: 11 · 2016: 10 · 2015: 2
- FWCI
- 18.34
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Internet Interventions (publishedVersion, cc-by-nc-nd)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Pure Amsterdam UMC (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- blended care, online intervention, depression, anxiety disorders, treatment costs, routine mental health care, treatment effects, general functioning
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