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Cited by 76Digital Mental Health InterventionsTelemedicine and Telehealth ImplementationPsychotherapy Techniques and Applications

Patient’s experience with blended video- and internet based cognitive behavioural therapy service in routine care

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Etzelmueller, Anne, Radkovsky, Anna, Hannig, Wiebke, Berking, Matthias, Ebert, David Daniel·2018·Internet Interventions
DOI 10.1016/j.invent.2018.01.003PMC PMC6096318
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Abstract

INTRODUCTION: Internet-based guided self-help and face-to-face CBT have shown to be effective in the treatment of depression, but both approaches might not be an available treatment option for all patients. A treatment which blends internet-based guided self-help with video-based psychotherapy might reduce potential disadvantages of both approaches, while maintaining major advantages such as being location-independent. Additionally, it could provide a stronger focus on patient empowerment and lower resource use compared to traditional face-to-face treatment. AIM: The aim of this study is to evaluate patient's experiences with blended internet- and video-based CBT (blended iCBT) treatment and to derive suggestions for the improvement of such services. METHODS: Semi-structured interviews were conducted with 15 participants of the blended iCBT treatment as part of the European MasterMind trial. Participants included adults suffering from Major Depressive Disorder. The interview guide assessed patient's experiences regarding the four treatment components program, 1. face-to-face diagnostic interviews, 2. video-based synchronous therapy sessions (VTS), 3. online self-help treatment modules (OTM) as well as 4. behaviour diaries and symptom monitoring. Interviews were analyzed using the framework method and outcomes regarding connections within and between participants and categories were generated by counting the statements within relevant themes. RESULTS: Overall, patients indicated to have been satisfied with all components of the treatment, highlighting the option to independently work from home in their own pace. While the OTMs allowed for a deeper reflection of the content, the VTS with the therapist were mentioned to provide the personal character of the service. The working alliance with the therapist was experienced as fostering the individual fit of the treatment. Patients reported a high self-perceived treatment effectiveness. Negative effects included that some patients felt overwhelmed by the service, e.g. by working with the content of the OTM as they forced them to address their problems. Within the combination of OTM and VTS, both components were rated as equally important and patients felt that the combination depicted a treatment at least equal to regular face-to-face treatment regarding the perceived effectiveness. Other identified themes included patient's individual factors, reactions in their social environment and suggestions for improvement of the service. DISCUSSION: Predominantly, patients reported positive experiences with the blended iCBT service and rate the treatment as adequate and effective to treat their condition. The importance of the VTS is highlighted. Following this approach might be an option to make affordable and effective evidence-based CBT available independent from regional barriers.

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  • Therapy adherence in this study seems substantially higher than in study designs using either only face-to-face therapy sessions or DTx alone.

    “Furthermore, almost all participants completed the bCBT program; hence, the therapy adherence seems to be substantially higher than that in study designs using either only face-to-face therapy sessions or DTx alone [41,65].”

    From Barriers to and Facilitators of a Blended Cognitive Behavioral Therapy Program for Depression and Anxiety Based on Experiences of University Students: Qualitative Interview Study (2023) · cites this paper as [41]

    The Methods (Participants and Procedure; page unavailable) report substantial participation in the blended service, including a mean of 21.96 sessions completed among the 25 patients considered for interviews. The Introduction says adherence can be challenging with purely self-guided interventions. The paper does not establish that blended therapy has substantially higher adherence than either face-to-face therapy or digital treatment alone, and its interview sample cannot establish that almost all program participants completed treatment. (LLM, conf=0.84)

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  • To date, there have been very few large-scale studies examining the effectiveness of BC-CBT interventions delivered via telehealth on a large scale in real-world settings.

    “To date, there have been very few large-scale studies examining the effectiveness of BC-CBT interventions delivered via telehealth on a large scale in real-world settings [20,29].”

    From Blended care-cognitive behavioral therapy for depression and anxiety in real-world settings: Pragmatic retrospective study (2020) · cites this paper as [20]

    The Introduction says conclusive evidence on the effectiveness of blended CBT was still pending, and the Discussion describes a large-scale evaluation as ongoing. These passages support a scarcity of effectiveness evidence, but neither specifically establishes how many large-scale studies had examined telehealth-delivered blended CBT in real-world settings. No page numbers are available in our copy. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • In comparison to stand-alone internet interventions, patient acceptance can be higher.

    “In comparison to stand-alone internet interventions, the patient acceptance can be higher [15].”

    From Blended care in in-patient acute psychiatric care. The example of a group training for social competences in adults—A pretest–posttest feasibility study (2021) · cites this paper as [15]

    The Introduction says stand-alone, self-help-focused internet interventions may not appeal to all patients, and the Discussion reports that interviewed patients were generally satisfied with the blended service. The paper does not establish that patient acceptance is higher for blended treatment than for stand-alone internet interventions; it provides no direct acceptance comparison. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • The results are in line with other studies which conclude that blended interventions are positively valued and well accepted, and that the combination with technology is seen as a facilitator.

    “These results are in line with other studies (Etzelmueller et al., 2018; Schuster et al., 2018) which generally conclude that blended interventions are positively valued and well accepted, and that the combination with technology is seen as a facilitator.”

    From Feasibility, acceptability, and preliminary efficacy of a blended transdiagnostic group CBT for the treatment of emotional disorders (2025) · cites this paper as Etzelmueller et al., 2018

  • Etzelmueller et al reported predominantly positive experiences with a bCBT program among patients with major depressive disorder.

    “A study by Etzelmueller et al [41] reported predominantly positive experiences with a bCBT program among patients with major depressive disorder.”

    From Barriers to and Facilitators of a Blended Cognitive Behavioral Therapy Program for Depression and Anxiety Based on Experiences of University Students: Qualitative Interview Study (2023) · cites this paper as [41]

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1 of the 90 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. First M.B. Spitzer R.L. Gibbon M. Wiliams J.B.W. Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition. (SCID-I/P), Biometrics Research 2002 New York State Psychiatric Institute

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Authors
Etzelmueller, A., Radkovsky, A., Hannig, W., Berking, M., & Ebert, D. D.
Affiliations
  • Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
  • Philipps University of Marburg (DE)
Corresponding author
Etzelmueller, Anne
ORCID
Venue
Internet Interventions
Publisher
Elsevier BV
Published
2018-06
Volume
12
Pages
165-175
ISSN
2214-7829 (ISSN-L)
DOI
10.1016/j.invent.2018.01.003
PMC
PMC6096318
OpenAlex
W2791736226
Cited by
75
References
90
Citations by year
2026: 7 · 2025: 6 · 2024: 7 · 2023: 6 · 2022: 20 · 2021: 18 · 2020: 7 · 2019: 4
FWCI
9.14
Type
journal article
Language
en
Open access
Licence
Locations
  • Internet Interventions (publishedVersion, cc-by-nc-nd)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • VU Research Portal (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Funders
European Commission (621000)
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
major depressive disorder, patient experience, guided self-help, therapeutic relationship, treatment effectiveness, symptom monitoring, telemedicine, usual care

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