Implementing internet-delivered cognitive behavior therapy for common mental health disorders: A comparative case study of implementation challenges perceived by therapists and managers in five European internet services
Open accessAbstract
OBJECTIVE: Internet-delivered cognitive behavior therapy programs have been developed and evaluated in randomized controlled trials during the past two decades to alleviate the rising demand for effective treatment of common mental health disorders such as anxiety and depression. While most of the research on internet-based cognitive behavior therapy (iCBT) has focused on efficacy and effectiveness only little attention has been devoted to the implementation of iCBT. The aim of this study was to identify the main implementation challenges perceived by therapists and managers involved in the practical operation of iCBT services in routine care settings in five European countries. METHOD: The study was designed as a multiple comparative case study to explore differences and similarities between five different iCBT services in Sweden, Norway, Denmark, The Netherlands and Scotland. Field visits were carried out to each of the five services including interviews with the management of the service (n = 9), focus group interviews with key staff (n = 15) and demonstration of online programs. The data material was processed through thematic, comparative analysis. RESULTS: The analysis generated four transversal themes: 1) integration in the mental health care system; 2) recruitment of patients; 3) working practice of therapists; and 4) long-term sustainability of service. The main results concerned the need to address the informal integration in the health care systems related to the perceived skepticism towards iCBT from GPs and face-to-face therapists, the role of referral models and communication strategies for the stable recruitment of patients, the need for knowledge, standards and material for the training of therapists in the provision of online feedback, the need to improve the possibilities to tailor programs to individual patients, and the need for considerate long-term sustainability planning of the transitions from local projects to permanent regional or national services. CONCLUSION: The present study gives an overview of the main implementation challenges regarding the practical operation of iCBT services perceived by the therapists and managers of the iCBT services. Future studies into specific details of each challenge will be important to strengthen the evidence base of iCBT and to improve uptake and implementation of iCBT in routine care.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
BTB has been rolled out to NHS primary care across Scotland as one of its low intensity treatments and in self-guided format for patients with mild to moderate anxiety and depression.
“It has also been rolled out to NHS primary care across Scotland as one of its low intensity treatments and in self-guided format for patients with mild to moderate anxiety and depression (Du et al ., 2013; Folker et al ., 2018; NHS Lothian, 2019; The Scottish Government, 2017).”
From A qualitative study of patients’ experiences and acceptance of computerised cognitive behavioural therapy in primary care, Scotland (2021) · cites this paper as Folker et al., 2018
Methods > Case study selection (page unavailable) says Beating the Blues was offered at six NHS Health Boards in Scotland and used as an automated, therapist-free service in primary care. Table 1 lists it as unguided iCBT for depression and anxiety. The copy does not specify that it was classified as a low-intensity treatment or limited to patients with mild to moderate symptoms. (LLM, conf=0.88)
Experimental — accuracy not yet measuredComputerised cognitive behavioural therapy (CCBT) has been made available within the National Health Service (NHS) across Scotland as an alternative treatment for mild to moderate anxiety and depression.
“Computerised cognitive behavioural therapy (CCBT) has been made available within the National Health Service (NHS) across Scotland as an alternative treatment for mild to moderate anxiety and depression.”
From A qualitative study of patients’ experiences and acceptance of computerised cognitive behavioural therapy in primary care, Scotland (2021) · cites this paper as Folker et al., 2018
The Methods (Case study selection; page not provided) say that the computerised CBT service Beating the Blues was offered at six NHS Health Boards in Scotland and treated depression and anxiety. The paper does not specify that it was for mild to moderate cases, and six boards does not establish availability throughout Scotland. (LLM, conf=0.86)
Experimental — accuracy not yet measuredInsufficient information for patients can lead to inappropriate referrals or an incorrect match between patients and programmes.
“Moreover, insufficient information for patients can lead to inappropriate referrals (Bennett et al ., 2008) or an incorrect match between patients and programmes (Folker et al ., 2018).”
From A qualitative study of patients’ experiences and acceptance of computerised cognitive behavioural therapy in primary care, Scotland (2021) · cites this paper as Folker et al., 2018
The Results section (“Recruitment of patients”; page not provided) reports that patients were referred to services that did not match their needs. It discusses communication separately but does not say that insufficient information for patients caused those mismatches. The inappropriate-referrals clause is attributed to Bennett et al., not Folker et al. (LLM, conf=0.85)
Experimental — accuracy not yet measuredResearchers noted that a GP's referral of a patient for CCBT could take a month and suggested that self-referral would be a much faster option, which would also help improve accessibility of CCBT services.
“Researchers also noted that a GP ' s referral of a patient for CCBT could take a month and suggested that selfreferral would be a much faster option. It would also help to improve accessibility of CCBT services (Folker et al ., 2018; Titov et al ., 2018).”
From A qualitative study of patients’ experiences and acceptance of computerised cognitive behavioural therapy in primary care, Scotland (2021) · cites this paper as Folker et al., 2018
This study complements research concerning the constraints on implementation of CCBT services and might shed light on potential reasons for poor engagement of patients and high drop-out rates.
“In addition, this study complements research concerning the constraints on implementation of CCBT services (Folker et al ., 2018), and might shed light on potential reasons for poor engagement of patients (Apolinario-Hagen et al ., 2017) and high drop-out rates.”
From A qualitative study of patients’ experiences and acceptance of computerised cognitive behavioural therapy in primary care, Scotland (2021) · cites this paper as Folker et al., 2018
Low usability of internet-based interventions is one of the barriers for implementation.
“As research showed that one of the barriers for implementation is the low usability of internet-based interventions, it is important to assess the usability of iCBT [5, 6].”
From Dimensionality of the system usability scale among professionals using internet-based interventions for depression: a confirmatory factor analysis (2020) · cites this paper as [5]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
(1984) · Cited by 81,983 · see citing works
Three Approaches to Qualitative Content Analysis
Hsieh, H.-F., & Shannon, S. E. (2005) · Qualitative Health Research · doi:10.1177/1049732305276687 · Cited by 44,601 · cited 1× · see citing works
“We used qualitative content analysis to analyse the data in which coding categories are derived directly from the text data (Hsieh and Shannon, 2005).”
MethodCase Study Research: Design and Methods
Chaiklin, H. (1991) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-199102000-00025 · Cited by 39,631 · see citing works
Rogers, E. M., Singhal, A., & Quinlan, M. M. (2019) · Routledge eBooks · doi:10.4324/9780203710753-35 · Cited by 37,557 · see citing works
Valente, T. W. (2003) · Genetics in Medicine · doi:10.1097/01.gim.0000061743.67794.c4 · Cited by 20,555 · see citing works
Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009) · Implementation Science · doi:10.1186/1748-5908-4-50 · Cited by 14,496 · cited 3× · see citing works
“Various frameworks and conceptual models of implementation exist within the field of implementation science e.g. the Consolidated Framework for Implementation Science (Damschroder et al., 2009; Hadjistavropoulos et al., 2017), Theory of Diffusion (Rogers, 2003), the RE-AIM model (Bennett and Glasgow, 2009), and Normal…”
BackgroundMethodQualitative research practice: a guide for social science students and researchers
Ruhl, K. (2003) · Choice Reviews Online · doi:10.5860/choice.41-1319 · Cited by 10,514 · see citing works
Qualitative Case Study Methodology: Study Design and Implementation for Novice Researchers
Baxter, P., & Jack, S. (2015) · The Qualitative Report · doi:10.46743/2160-3715/2008.1573 · Cited by 7,594 · see citing works
Diffusion of Innovations in Service Organizations: Systematic Review and Recommendations
GREENHALGH, T., ROBERT, G., MACFARLANE, F., BATE, P., & KYRIAKIDOU, O. (2004) · The Milbank Quarterly · doi:10.1111/j.0887-378x.2004.00325.x · Cited by 7,448 · cited 1× · see citing works
“However, as pointed out by Greenhalgh et al. (2004), Fixsen et al. (2005) and Ross et al. (2016) sustainability or maintenance is rarely singled out as a separate implementation challenge and there have been little empirical work examining factors that either facilitate or limit sustainability of…”
BackgroundStake, R. E. (2005) · Cited by 4,706 · see citing works
McLeod, J. (1999) · SAGE Publications Ltd eBooks · doi:10.4135/9781849209588.n8 · Cited by 3,964 · see citing works
The size and burden of mental disorders and other disorders of the brain in Europe 2010
Wittchen, H. U., Jacobi, F., Rehm, J., Gustavsson, A., Svensson, M., Jönsson, B., Olesen, J., Allgulander, C., Alonso, J., Faravelli, C., et al. (2011) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2011.07.018 · Cited by 3,754 · see citing works
(2005) · Cited by 3,748 · see citing works
Crowe, S., Cresswell, K., Robertson, A., Huby, G., Avery, A., & Sheikh, A. (2011) · BMC Medical Research Methodology · doi:10.1186/1471-2288-11-100 · Cited by 2,697 · cited 2× · see citing works
“The study was designed as a multiple comparative case study to explore differences and similarities between cases (Yin, 2014; Crowe et al., 2011; Stake, 2006).”
BackgroundMethodQualitative Research Practice : A Guide for Social Science Students and Researchers
อรุณภาคย์, ก. (2012) · Journal of Social Sciences and Humanities Kasetsart University · Cited by 1,779 · see citing works
Murray, E., Treweek, S., Pope, C., MacFarlane, A., Ballini, L., Dowrick, C., Finch, T., Kennedy, A., Mair, F., O'Donnell, C., et al. (2010) · BMC Medicine · doi:10.1186/1741-7015-8-63 · Cited by 1,478 · see citing works
Barriers to mental health treatment: results from the WHO World Mental Health surveys
Andrade, L. H., Alonso, J., Mneimneh, Z., Wells, J. E., Al-Hamzawi, A., Borges, G., Bromet, E., Bruffaerts, R., de Girolamo, G., de Graaf, R., et al. (2014) · Psychological Medicine · doi:10.1017/s0033291713001943 · Cited by 1,289 · see citing works
Whiteford, H. A., Ferrari, A. J., Degenhardt, L., Feigin, V., & Vos, T. (2015) · PLOS ONE · doi:10.1371/journal.pone.0116820 · Cited by 1,175 · see citing works
Undertreatment of people with major depressive disorder in 21 countries
Thornicroft, G., Chatterji, S., Evans-Lacko, S., Gruber, M., Sampson, N., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Andrade, L., Borges, G., et al. (2017) · British Journal of Psychiatry · doi:10.1192/bjp.bp.116.188078 · Cited by 1,121 · see citing works
Core Implementation Components
Fixsen, D. L., Blase, K. A., Naoom, S. F., & Wallace, F. (2009) · Research on Social Work Practice · doi:10.1177/1049731509335549 · Cited by 1,103 · see citing works
Andersson, G., Cuijpers, P., Carlbring, P., Riper, H., & Hedman, E. (2014) · World Psychiatry · doi:10.1002/wps.20151 · Cited by 1,077 · cited 1× · see citing works
“…mental and somatic disorders with outcomes that are comparable to face-to-face interventions when delivered with some form of professional guidance (Andersson et al., 2014; Andersson and Hedman, 2013; Arnberg et al., 2014; El Alaoui et al., 2015; Hedman et al., 2013; Hedman et al., 2014; Karyotaki…”
BackgroundRoss, J., Stevenson, F., Lau, R., & Murray, E. (2016) · Implementation Science · doi:10.1186/s13012-016-0510-7 · Cited by 1,011 · cited 2× · see citing works
“Future research could aim to answer these questions through systematic experiments with service models and implementation strategies (Powell et al., 2014; Ross et al., 2016).”
BackgroundCrabtree, B. F., Miller, W. L., & Swenson, M. M. (1995) · Nursing Research · doi:10.1097/00006199-199507000-00011 · Cited by 956 · see citing works
The Delivery of Public Health Interventions via the Internet: Actualizing Their Potential
Bennett, G. G., & Glasgow, R. E. (2009) · Annual Review of Public Health · doi:10.1146/annurev.publhealth.031308.100235 · Cited by 800 · see citing works
Karyotaki, E., Riper, H., Twisk, J., Hoogendoorn, A., Kleiboer, A., Mira, A., Mackinnon, A., Meyer, B., Botella, C., Littlewood, E., et al. (2017) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2017.0044 · Cited by 691 · cited 2× · see citing works
“Several randomized controlled trials and meta-analyses have demonstrated that iCBT can be effective for various mental and somatic disorders with outcomes that are comparable to face-to-face interventions when delivered with some form of professional guidance (Andersson et al., 2014; Andersson and Hedman, 2013; Arnber…”
BackgroundInternet-Delivered Psychological Treatments
Andersson, G. (2016) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-021815-093006 · Cited by 595 · cited 4× · see citing works
“Internet-based psychological treatment for common mental health disorders may be one way to minimise barriers to treatment delivery and increase access to evidence-based treatment (Andersson, 2016).”
BackgroundInfluentialWaller, R., & Gilbody, S. (2009) · Psychological Medicine · doi:10.1017/s0033291708004224 · Cited by 393 · cited 2× · see citing works
“In our study, the perceived skepticism of CBT colleagues was mainly linked to worries about the quality of the therapeutic relationship and the overall quality of iCBT aligning with previous studies of CBT therapists and referring-providers' perceptions and attitudes towards iCBT (Topooco et al., 2017; Waller and Gilb…”
ResultTherapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults
Olthuis, J. V., Watt, M. C., Bailey, K., Hayden, J. A., & Stewart, S. H. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011565.pub2 · Cited by 390 · see citing works
Arnberg, F. K., Linton, S. J., Hultcrantz, M., Heintz, E., & Jonsson, U. (2014) · PLoS ONE · doi:10.1371/journal.pone.0098118 · Cited by 330 · cited 2× · see citing works
“Several randomized controlled trials and meta-analyses have demonstrated that iCBT can be effective for various mental and somatic disorders with outcomes that are comparable to face-to-face interventions when delivered with some form of professional guidance (Andersson et al., 2014; Andersson and Hedman, 2013; Arnber…”
BackgroundPopulation level of unmet need for mental healthcare in Europe
Alonso, J., Codony, M., Kovess, V., Angermeyer, M. C., Katz, S. J., Haro, J. M., De Girolamo, G., De Graaf, R., Demyttenaere, K., Vilagut, G., et al. (2007) · British Journal of Psychiatry · doi:10.1192/bjp.bp.106.022004 · Cited by 299 · cited 2× · see citing works
“cognitive behavior therapy (CBT) or Interpersonal Psychotherapy (IPT)), and psychopharmacology, a substantial proportion of people suffering from mental disorders go untreated (Demyttenaere et al., 2004; Thornicroft et al., 2017; Alonso et al., 2007).”
BackgroundMusiat, P., Goldstone, P., & Tarrier, N. (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-109 · Cited by 273 · cited 3× · see citing works
“In a British study of attitudes towards iCBT in the general population it was found that web-based treatments were expected to be convenient but to have lower appeal and credibility than face-to-face therapy (Musiat et al., 2014).”
BackgroundResultJohansson, R., Sjöberg, E., Sjögren, M., Johnsson, E., Carlbring, P., Andersson, T., Rousseau, A., & Andersson, G. (2012) · PLoS ONE · doi:10.1371/journal.pone.0036905 · Cited by 268 · cited 2× · see citing works
“Few studies have specifically targeted tailored treatment in iCBT, but it has been indicated that programs which can be adapted to individual patients' conditions may be superior to standardized iCBT programs for higher severity levels of mental health disorders (Carlbring et al., 2011; Andersson et al., 2011; Johanss…”
BackgroundA Systematic Review of Strategies for Implementing Empirically Supported Mental Health Interventions
Powell, B. J., Proctor, E. K., & Glass, J. E. (2014) · Research on Social Work Practice · doi:10.1177/1049731513505778 · Cited by 268 · cited 1× · see citing works
“Future research could aim to answer these questions through systematic experiments with service models and implementation strategies (Powell et al., 2014; Ross et al., 2016).”
BackgroundAttitudes towards digital treatment for depression: A European stakeholder survey
Topooco, N., Riper, H., Araya, R., Berking, M., Brunn, M., Chevreul, K., Cieslak, R., Ebert, D. D., Etchmendy, E., Herrero, R., et al. (2017) · Internet Interventions · doi:10.1016/j.invent.2017.01.001 · Cited by 262 · cited 4× · see citing works
“Regarding patients' attitudes it has been found that patients worry about the clinical effectiveness of iCBT (Topooco et al., 2017) which has been shown to correlate with poorer treatment outcome (El Alaoui et al.”
BackgroundResultInfluentialIndividually-tailored, internet-based treatment for anxiety disorders: a randomized controlled trial
Carlbring, P., Maurin, L., Törngren, C., Linna, E., Eriksson, T., Sparthan, E., Strååt, M., Marquez von Hage, C., Bergman-Nordgren, L., & Andersson, G. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2010.10.002 · Cited by 227 · cited 1× · see citing works
“…in iCBT, but it has been indicated that programs which can be adapted to individual patients' conditions may be superior to standardized iCBT programs for higher severity levels of mental health disorders (Carlbring et al., 2011; Andersson et al., 2011; Johansson et al., 2012; Andersson, 2016).”
BackgroundMARKS, I. M., KENWRIGHT, M., McDONOUGH, M., WHITTAKER, M., & MATAIX-COLS, D. (2004) · Psychological Medicine · doi:10.1017/s003329170300878x · Cited by 226 · cited 2× · see citing works
“In a study of the use of the iCBT program FearFighter for anxiety on waiting list patients in a Danish secondary routine care clinic no treatment effect was found (Mathiasen et al., 2016) even though the program had been shown to be effective in earlier studies (Marks et al., 2004).”
BackgroundResultHedman, E., Ljótsson, B., Kaldo, V., Hesser, H., El Alaoui, S., Kraepelien, M., Andersson, E., Rück, C., Svanborg, C., Andersson, G., et al. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.10.023 · Cited by 224 · see citing works
Newby, J. M., Twomey, C., Yuan Li, S. S., & Andrews, G. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.03.018 · Cited by 189 · cited 6× · see citing works
“E.g. results from the MindSpot Clinic in Australia suggest that only 25% of self-referring patients take up free iCBT (Titov et al., 2017).”
BackgroundInfluentialTitov, N., Dear, B. F., Staples, L. G., Bennett-Levy, J., Klein, B., Rapee, R. M., Andersson, G., Purtell, C., Bezuidenhout, G., & Nielssen, O. B. (2017) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867416671598 · Cited by 183 · cited 6× · see citing works
“…and how to disseminate iCBT is an open question, since few implementation studies of internet-delivered treatments have been performed in routine care settings (Hadjistavropoulos et al., 2014; Ebert and Baumeister, 2017; Hadjistavropoulos et al., 2017; Titov et al., 2017; Nordgreen et al., 2018).”
BackgroundResultInfluentialTitov, N., Dear, B. F., Staples, L. G., Bennett-Levy, J., Klein, B., Rapee, R. M., Shann, C., Richards, D., Andersson, G., Ritterband, L., et al. (2015) · Psychiatric Services · doi:10.1176/appi.ps.201400477 · Cited by 181 · cited 3× · see citing works
“…there are other examples of iCBT services operating in routine care such as THIS WAY UP Clinic (Newby et al., 2016) and the MindSpot Clinic (Titov et al., 2017, 2015) in Australia sponsored by the Australian Government and the Online Therapy Unit (Hadjistavropoulos et al., 2016, 2017) in…”
BackgroundEffectiveness of Guided Internet-Based Cognitive Behavior Therapy in Regular Clinical Settings
Andersson, G., & Hedman, E. (2013) · Verhaltenstherapie · doi:10.1159/000354779 · Cited by 165 · cited 3× · see citing works
“Although some authors have identified key components to consider for successful implementation (Andersson and Hedman, 2013; Andersson et al., 2008) very little research has been done on implementation challenges and facilitators relating to the practical operation of iCBT services…”
BackgroundHedman, E., Ljótsson, B., Rück, C., Bergström, J., Andersson, G., Kaldo, V., Jansson, L., Andersson, E., Andersson, E., Blom, K., et al. (2013) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12079 · Cited by 144 · see citing works
Development of a new approach to guided self-help via the internet: the Swedish experience
Andersson, G., Bergström, J., Buhrman, M., Carlbring, P., Holländare, F., Kaldo, V., Nilsson-Ihrfelt, E., Paxling, B., Ström, L., & Waara, J. (2008) · Journal of Technology in Human Services · doi:10.1080/15228830802094627 · Cited by 114 · cited 6× · see citing works
“Although some authors have identified key components to consider for successful implementation (Andersson and Hedman, 2013; Andersson et al., 2008) very little research has been done on implementation challenges and facilitators relating to the practical operation of iCBT services (Hadjistavropoulos et al.”
BackgroundResultInfluentialHadjistavropoulos, H. D., Nugent, M. M., Alberts, N. M., Staples, L., Dear, B. F., & Titov, N. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.05.006 · Cited by 103 · cited 2× · see citing works
“…there are other examples of iCBT services operating in routine care such as THIS WAY UP Clinic (Newby et al., 2016) and the MindSpot Clinic (Titov et al., 2017, 2015) in Australia sponsored by the Australian Government and the Online Therapy Unit (Hadjistavropoulos et al., 2016, 2017) in Canada.”
BackgroundAndersson, G., Estling, F., Jakobsson, E., Cuijpers, P., & Carlbring, P. (2011) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2010.529457 · Cited by 102 · cited 2× · see citing works
“Few studies have specifically targeted tailored treatment in iCBT, but it has been indicated that programs which can be adapted to individual patients' conditions may be superior to standardized iCBT programs for higher severity levels of mental health disorders (Carlbring et al., 2011; Andersson et al., 2011; Johanss…”
BackgroundEl Alaoui, S., Hedman, E., Kaldo, V., Hesser, H., Kraepelien, M., Andersson, E., Rück, C., Andersson, G., Ljótsson, B., & Lindefors, N. (2015) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0039198 · Cited by 99 · see citing works
Hadjistavropoulos, H. D., Nugent, M. M., Dirkse, D., & Pugh, N. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1496-7 · Cited by 94 · cited 13× · see citing works
“…about the quality of the therapeutic relationship and the overall quality of iCBT aligning with previous studies of CBT therapists and referring-providers' perceptions and attitudes towards iCBT (Topooco et al., 2017; Waller and Gilbody, 2009; Musiat et al., 2014; Hadjistavropoulos et al., 2017).”
BackgroundMethodResultInfluentialDeveloping a roadmap for the translation of e-mental health services for depression
Batterham, P. J., Sunderland, M., Calear, A. L., Davey, C. G., Christensen, H., Teesson, M., Kay-Lambkin, F., Andrews, G., Mitchell, P. B., Herrman, H., et al. (2015) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867415582054 · Cited by 77 · cited 2× · see citing works
“…treatment among providers and patients, lack of awareness of internetbased treatment options among patients and providers, high drop-out numbers from treatment, limited availability of adequately trained professionals and limited evidence for cost-effectiveness (Batterham et al., 2015).”
BackgroundVis, C., Kleiboer, A., Prior, R., Bønes, E., Cavallo, M., Clark, S. A., Dozeman, E., Ebert, D., Etzelmueller, A., Favaretto, G., et al. (2015) · Internet Interventions · doi:10.1016/j.invent.2015.10.002 · Cited by 71 · cited 1× · see citing works
“Research concerning iCBT has so far primarily focused on efficacy and effectiveness trials, with little attention to the process of implementation (Drozd et al., 2016; Vis et al., 2015).”
BackgroundSelf-citationPesaro, A. E. P., Katz, M., Katz, J. N., Barbas, C. S. V., Makdisse, M. R. P., Correa, A. G., Franken, M., Pereira, C., Junior, C. V. S., & Lópes, R. D. (2016) · PLoS ONE · doi:10.1371/journal.pone.0151302 · Cited by 66 · see citing works
Hadjistavropoulos, H. D., Pugh, N. E., Nugent, M., Hesser, H., Andersson, G., Ivanov, M., Butz, C. G., Marchildon, G. P., Asmundson, G. J. G., Klein, B., et al. (2014) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2014.09.018 · Cited by 60 · cited 1× · see citing works
“…and how to disseminate iCBT is an open question, since few implementation studies of internet-delivered treatments have been performed in routine care settings (Hadjistavropoulos et al., 2014; Ebert and Baumeister, 2017; Hadjistavropoulos et al., 2017; Titov et al., 2017; Nordgreen et al., 2018).”
BackgroundThe Implementation of Internet Interventions for Depression: A Scoping Review
Drozd, F., Vaskinn, L., Bergsund, H. B., Haga, S. M., Slinning, K., & Bjørkli, C. A. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.5670 · Cited by 60 · cited 4× · see citing works
“Research concerning iCBT has so far primarily focused on efficacy and effectiveness trials, with little attention to the process of implementation (Drozd et al., 2016; Vis et al., 2015).”
InfluentialWilhelmsen, M., Høifødt, R. S., Kolstrup, N., Waterloo, K. K., Eisemann, M. R., Chenhall, R. D., & Risør, M. B. (2014) · Journal of Medical Internet Research · doi:10.2196/jmir.3556 · Cited by 55 · cited 2× · see citing works
“Emphasis on the working practices of iCBT therapists as important factors in the implementation of iCBT is also stressed in the literature (Wilhelmsen et al., 2014; Bengtsson et al., 2015; Mol et al., 2016).”
BackgroundEl Alaoui, S., Ljótsson, B., Hedman, E., Svanborg, C., Kaldo, V., & Lindefors, N. (2016) · PLOS ONE · doi:10.1371/journal.pone.0161191 · Cited by 51 · cited 1× · see citing works
“Regarding patients' attitudes it has been found that patients worry about the clinical effectiveness of iCBT (Topooco et al., 2017) which has been shown to correlate with poorer treatment outcome (El Alaoui et al., 2016).”
BackgroundTherapists' Experiences of Conducting Cognitive Behavioural Therapy Online vis-à-vis Face-to-Face
Bengtsson, J., Nordin, S., & Carlbring, P. (2015) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2015.1053408 · Cited by 48 · cited 1× · see citing works
“Emphasis on the working practices of iCBT therapists as important factors in the implementation of iCBT is also stressed in the literature (Wilhelmsen et al., 2014; Bengtsson et al., 2015; Mol et al., 2016).”
BackgroundNordgreen, T., Gjestad, R., Andersson, G., Carlbring, P., & Havik, O. E. (2017) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2017.1348389 · Cited by 46 · cited 4× · see citing works
“, 2008) very little research has been done on implementation challenges and facilitators relating to the practical operation of iCBT services (Hadjistavropoulos et al., 2017; Nordgreen et al., 2018).”
BackgroundInfluentialTherapist-supported internet cognitive—behavioural therapy for anxiety disorders in adults
Olthuis, J. V., Watt, M. C., Bailey, K., Hayden, J. A., & Stewart, S. H. (2015) · BJPsych Advances · doi:10.1192/apt.21.5.290 · Cited by 46 · cited 2× · see citing works
“Several randomized controlled trials and meta-analyses have demonstrated that iCBT can be effective for various mental and somatic disorders with outcomes that are comparable to face-to-face interventions when delivered with some form of professional guidance (Andersson et al., 2014; Andersson and Hedman, 2013; Arnber…”
BackgroundEffect of referral source on outcome with cognitive-behavior therapy self-help
Mataix‐Cols, D., Cameron, R., Gega, L., Kenwright, M., & Marks, I. M. (2006) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2005.11.007 · Cited by 37 · see citing works
Internet-Based Self-help Interventions for Depression in Routine Care
Ebert, D. D., & Baumeister, H. (2017) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2017.1394 · Cited by 29 · cited 2× · see citing works
“According to Andersson and Hedman (2013), it is possible to transfer iCBT into routine clinical practice with moderate to large effect sizes; however, which service model should be used for iCBT and how to disseminate iCBT is an open question, since few implementation studies of internet-delivered treatments have been…”
BackgroundMathiasen, K., Riper, H. M., Ehlers, L. H., Valentin, J. B., & Rosenberg, N. (2016) · Internet Interventions · doi:10.1016/j.invent.2016.03.001 · Cited by 28 · cited 3× · see citing works
“In a study of the use of the iCBT program FearFighter for anxiety on waiting list patients in a Danish secondary routine care clinic no treatment effect was found (Mathiasen et al., 2016) even though the program had been shown to be effective in earlier studies (Marks et al., 2004).”
BackgroundSelf-citationFleuren, M., van Dommelen, P., & Dunnink, T. (2015) · Social Science & Medicine (1967) · doi:10.1016/j.socscimed.2015.05.001 · Cited by 26 · cited 2× · see citing works
“(2015) described how determinants of implementation of clinical guidelines in health care should be described on three levels: i) the developers, ii) the professionals/coordinators in the organizations, and iii) the end users (Fleuren et al., 2015).”
BackgroundMethodMol, M., Dozeman, E., van Schaik, A., Vis, C., Riper, H. M., & Smit, J. H. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-1045-9 · Cited by 11 · cited 1× · see citing works
“Emphasis on the working practices of iCBT therapists as important factors in the implementation of iCBT is also stressed in the literature (Wilhelmsen et al., 2014; Bengtsson et al., 2015; Mol et al., 2016).”
BackgroundSelf-citationFolker, M. P., Lauridsen, S., Mathiasen, K., Stenderup, E., & Folker, A. P. (2017) · University of Southern Denmark Research Portal (University of Southern Denmark) · Cited by 1 · see citing works
Self-citation
Flagged first, then by citations
1 of the 65 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
An overview of and recommendations for more accessible digital mental health services
Lattie, E. G., Stiles-Shields, C., & Graham, A. K. (2022) · Nature Reviews Psychology · doi:10.1038/s44159-021-00003-1 · Cited by 446 · see citing works
ICBT in routine care: A descriptive analysis of successful clinics in five countries
Titov, N., Dear, B., Nielssen, O., Staples, L., Hadjistavropoulos, H., Nugent, M., Adlam, K., Nordgreen, T., Bruvik, K. H., Hovland, A., et al. (2018) · Internet Interventions · doi:10.1016/j.invent.2018.07.006 · Cited by 353 · see citing works
“, costs, web application, retaining personnel) or future directions (Folker et al., 2018).”
BackgroundMethodInfluentialSelf-citationInternet interventions: Past, present and future
Andersson, G. (2018) · Internet Interventions · doi:10.1016/j.invent.2018.03.008 · Cited by 315 · see citing works
“Moreover, our trials on psychodynamic internet treatment are now included in systematic reviews on the effects of psychodynamic treatment (Fonagy, 2015).”
BackgroundTorous, J., Linardon, J., Goldberg, S. B., Sun, S., Bell, I., Nicholas, J., Hassan, L., Hua, Y., Milton, A., & Firth, J. (2025) · World Psychiatry · doi:10.1002/wps.21299 · Cited by 323 · see citing works
Berardi, C., Antonini, M., Jordan, Z., Wechtler, H., Paolucci, F., & Hinwood, M. (2024) · BMC Health Services Research · doi:10.1186/s12913-023-10536-1 · Cited by 175 · see citing works
“…sectors such as health, justice, social support with public engagement in policy development [40, 94] may allow better coordination to facilitate implementation, while public awareness through marketing will drive engagement and create acceptance and facilitate demand [40, 55, 69, 72, 81, 94, 115].”
BackgroundInfluentialFrom Research to Practice: Ten Lessons in Delivering Digital Mental Health Services
Titov, N., Hadjistavropoulos, H. D., Nielssen, O. B., Mohr, D. C., Andersson, G., & Dear, B. F. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8081239 · Cited by 117 · see citing works
“In addition to reports of outcomes from individual clinics, and reflecting the maturing state of the field, there is now an increasing number of studies describing barriers [20,23,31,32], guidelines for implementation [33,34], and comparisons of clinics across different countries [35].”
BackgroundDavies, F., Shepherd, H. L., Beatty, L., Clark, B., Butow, P., & Shaw, J. (2020) · Journal of Medical Internet Research · doi:10.2196/17362 · Cited by 110 · see citing works
“Several studies noted the need to supplement patient self-referral and management with health professional monitoring and follow-up, to ensure the program matched the patient’s needs [14,28] and to encourage adherence.”
BackgroundInfluentialMol, M., van Schaik, A., Dozeman, E., Ruwaard, J., Vis, C., Ebert, D. D., Etzelmueller, A., Mathiasen, K., Moles, B., Mora, T., et al. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02627-8 · Cited by 92 · see citing works
Self-citationVis, C., Ruwaard, J., Finch, T. L., Rapley, T., Beurs, D. P. D., van Stel, H. F., van Lettow, B., Mol, M., Kleiboer, A. M., Riper, H. M., et al. (2019) · Journal of Medical Internet Research · doi:10.2196/12376 · Cited by 86 · see citing works
“Several examples of clinics routinely offering innovative and new eMH services exist, such as the Australian MindSpot clinic [2], GGZ InGeest Mindway [3] and Interapy in the Netherlands [4], Internetpsykiatr in Sweden [5], and Internetpsykatrien in Denmark [6,7].”
Schuster, R., Topooco, N., Keller, A., Radvogin, E., & Laireiter, A.-R. (2020) · Internet Interventions · doi:10.1016/j.invent.2020.100326 · Cited by 77 · see citing works
“Among other initiatives is a national web-based treatment platform and quality register for internet-based cognitive behavior therapy (Folker et al., 2018; Titov et al., 2018).”
BackgroundBeukes, E. W., Manchaiah, V., Allen, P. M., Baguley, D. M., & Andersson, G. (2019) · Trends in Hearing · doi:10.1177/2331216519851749 · Cited by 75 · see citing works
Weise, C., Kaiser, G., Janda, C., Kues, J. N., Andersson, G., Strahler, J., & Kleinstäuber, M. (2019) · Psychotherapy and Psychosomatics · doi:10.1159/000496237 · Cited by 63 · see citing works
Mol, M., van Genugten, C., Dozeman, E., van Schaik, D. J. F., Draisma, S., Riper, H., & Smit, J. H. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm9010091 · Cited by 61 · see citing works
“[37] who identified implementation challenges perceived by therapists and managers of iCBT in routine care settings in five European countries.”
BackgroundSelf-citationvan der Vaart, R., van Driel, D., Pronk, K., Paulussen, S., te Boekhorst, S., Rosmalen, J. G. M., & Evers, A. W. M. (2019) · JMIR Formative Research · doi:10.2196/12883 · Cited by 55 · see citing works
“Over the past few years it has become clear that implementing internet interventions into regular health care is challenging [4-6], but the focus on the needs and skills of patients in this matter has been minimal.”
Chen, T., Ou, J., Li, G., & Luo, H. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1356554 · Cited by 55 · see citing works
Mendes-Santos, C., Nunes, F., Weiderpass, E., Santana, R., & Andersson, G. (2021) · doi:10.2196/preprints.32558 · Cited by 52 · see citing works
“Moreover, qualitative studies on the topic often focus on cognitive behavioral therapy–oriented interventions [38,39], specific treatment modalities [39,40], and particular mental health conditions [22,29,39] or include participants of specific research programs [22,29,39,41], failing to characterize in depth the pers…”
BackgroundMoeini, B., Bashirian, S., Soltanian, A. R., Ghaleiha, A., & Taheri, M. (2019) · PubMed Central · Cited by 52 · see citing works
Bührmann, L., Schuurmans, J., Ruwaard, J., Fleuren, M. A. H., Etzelmueller, A., Piera-Jiménez, J., Finch, T. L., Rapley, T., Potthoff, S., Aouizerate, B., et al. (2020) · Trials · doi:10.1186/s13063-020-04686-4 · Cited by 51 · see citing works
Self-citationMathiasen, K., Riper, H., Andersen, T. E., & Roessler, K. K. (2018) · Journal of Medical Internet Research · doi:10.2196/10927 · Cited by 45 · see citing works
Self-citationVis, C., Schuurmans, J., Aouizerate, B., Craggs, M. A., Batterham, P. J., Bührmann, L., Calear, A. L., Pashoja, A. C., Christensen, H. M., Dozeman, E., et al. (2022) · Journal of Medical Internet Research · doi:10.2196/41532 · Cited by 42 · see citing works
“…barriers is relatively rich and identifies factors such as available resources; attitudes and capabilities of service referrers [14,15] and mental health service providers [11,16,17]; and other barriers that exist at the system, organizational, service provider, and patient levels [18].”
Self-citationLiu, M., & Schueller, S. M. (2023) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-023-00298-2 · Cited by 47 · see citing works
Kadesjö Banck, J., & Bernhardsson, S. (2020) · BMC Health Services Research · doi:10.1186/s12913-020-05596-6 · Cited by 35 · see citing works
“Training regarding the evidence base for internet-delivered treatment has been shown to facilitate ICBT implementation [11, 26–28], as well as practical training in the programme itself [26], supervision of therapists during the intervention [11, 28], and technical support [25].”
BackgroundResultInfluentialWeineland, S., Ribbegårdh, R., Kivi, M., Bygdell, A., Larsson, A., Vernmark, K., & Lilja, J. L. (2020) · Internet Interventions · doi:10.1016/j.invent.2020.100356 · Cited by 34 · see citing works
Gordon, E. J., Romo, E., Amórtegui, D., Rodas, A., Anderson, N., Uriarte, J. J., McNatt, G. E., Caicedo, J. C., Ladner, D. P., & Shumate, M. (2020) · Health Expectations · doi:10.1111/hex.13124 · Cited by 37 · see citing works
Mathiasen, K., Andersen, T. E., Lichtenstein, M. B., Ehlers, L. H., Riper, H., Kleiboer, A., & Roessler, K. K. (2022) · Journal of Medical Internet Research · doi:10.2196/36577 · Cited by 34 · see citing works
“Participants were recruited from March 1, 2016, to April 1, 2018, from the iCBT clinic “Internetpsykiatrien,” which is situated within secondary mental health care (Centre for Telepsychiatry) at the Mental Health Services of the Region of Southern Denmark [41,42].”
Self-citationGanapathy, A., Clough, B. A., & Casey, L. M. (2021) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2020.0455 · Cited by 38 · see citing works
“30 A lack of access to such training, especially for older and rural MHPs 39 and poorly designed DMH training, further exacerbate the challenges to adoption.”
InfluentialImplementation of e‐mental health for depression and anxiety: A critical scoping review
Ellis, L. A., Augustsson, H., Grødahl, A. I., Pomare, C., Churruca, K., Long, J. C., Ludlow, K., Zurynski, Y. A., & Braithwaite, J. (2020) · Journal of Community Psychology · doi:10.1002/jcop.22309 · Cited by 33 · see citing works
Duffy, D. J., Richards, D., Hisler, G. C., & Timulák, L. (2024) · Journal of Medical Internet Research · doi:10.2196/47927 · Cited by 34 · see citing works
“The practice of iCBT in the workplace [2,4,9,12,14,18,20-23,27,30-33,35,”
InfluentialAlkish, I., Iyiola, K., Alzubi, A. B., & Aljuhmani, H. Y. (2025) · Sustainability · doi:10.3390/su17104365 · Cited by 35 · see citing works
Reupert, A., Bartholomew, C., Cuff, R., Foster, K., Matar, J., Maybery, D. J., & Pettenuzzo, L. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00059 · Cited by 28 · see citing works
Brantnell, A., Woodford, J., Baraldi, E., van Achterberg, T., & von Essén, L. (2020) · Journal of Medical Internet Research · doi:10.2196/18033 · Cited by 27 · see citing works
“For example, evidence supporting ICBT programs is reported to be a key facilitator to implementation [34,35], whereas lack of resources [34] and lack of integration with the mental health care system [36] are reported to be important barriers to ICBT implementation.”
BackgroundInternet-delivered mental health treatment systems in Scandinavia – A usability evaluation
Yogarajah, A., Kenter, R. M. F., Lamo, Y., Kaldo, V., & Nordgreen, T. (2020) · Internet Interventions · doi:10.1016/j.invent.2020.100314 · Cited by 27 · see citing works
“In Scandinavia, Sweden, Denmark, and Norway all have clinics which provide guided Internetdelivered treatment for depression as part of routine care (Folker et al., 2018).”
BackgroundTitzler, I., Berking, M., Schlicker, S., Riper, H., & Ebert, D. D. (2020) · JMIR Mental Health · doi:10.2196/18642 · Cited by 25 · see citing works
“The finding that GPs feel no conflict with their role was in contrast with psychotherapists’ perceptions [36] but could potentially be explained through their gatekeeper function [40].”
BackgroundResultHadjistavropoulos, H. D., Peynenburg, V., Thiessen, D. L., Nugent, M., Adlam, K., Owens, K. M. B., Karin, E., Dear, B. F., & Titov, N. (2020) · Internet Interventions · doi:10.1016/j.invent.2020.100357 · Cited by 25 · see citing works
“Understanding therapist H.D. Hadjistavropoulos et al. Internet Interventions 22 (2020) 100357 experiences is critical in routine care as implementation challenges have significant potential to impact uptake and outcomes of iCBT (Hadjistavropoulos et al., 2017a; Folker et al., 2018).”
BackgroundZelihić, D., van Dalen, M., Kling, J., Pripp, A. H., Nordgreen, T., Kvalem, I. L., Pasmans, S. G. M. A., Mathijssen, I. M. J., Koudstaal, M. J., Hillegers, M. H. J., et al. (2022) · Body Image · doi:10.1016/j.bodyim.2022.01.008 · Cited by 24 · see citing works
Bai, P. (2023) · Journal of Cancer · doi:10.7150/jca.82632 · Cited by 23 · see citing works
Metz, M. J., Elfeddali, I., Veerbeek, M., de Beurs, E., Beekman, A. T. F., & Feltz-Cornelis, C. M. V. D. (2018) · PLoS ONE · doi:10.1371/journal.pone.0199795 · Cited by 22 · see citing works
“regular supervision sessions) targeting to integrate the application of eHealth tools in their daily working practice [40].”
Backgroundvan der Vaart, R., Worm-Smeitink, M., Bos, Y., Wensing, M., Evers, A. W. M., & Knoop, H. (2019) · Internet Interventions · doi:10.1016/j.invent.2019.100290 · Cited by 20 · see citing works
Coumoundouros, C., Mårtensson, E., Ferraris, G., Zuidberg, J. M., von Essén, L., Sanderman, R., & Woodford, J. (2022) · JMIR Mental Health · doi:10.2196/41891 · Cited by 20 · see citing works
“Implementation challenges span many levels, including factors related to policy (eg, difficulty in navigating regulations), organizations (eg, lack of infrastructure or lack of training), and individual characteristics (eg, negative attitudes and beliefs about e–mental health) [29,31,32].”
BackgroundVernmark, K., Buhrman, M., Carlbring, P., Hedman‐Lagerlöf, E., Kaldo, V., & Andersson, G. (2024) · Digital Health · doi:10.1177/20552076241287059 · Cited by 19 · see citing works
“77,96 Decentralized implementation formats can be more widely disseminated and includes involving and changing the mindset of the whole organization but can be more dif fi cult to control in terms of fi delity and conducting research over prolonged periods of time.”
Lukka, L., Karhulahti, V., & Palva, J. M. (2023) · JMIR Human Factors · doi:10.2196/44681 · Cited by 19 · see citing works
IJzerman, R. V. H., van der Vaart, R., & Evers, A. W. M. (2019) · Journal of Medical Internet Research · doi:10.2196/13432 · Cited by 17 · see citing works
“These outcomes are in line with recent research on iCBT use in primary and routine care [26,27].”
BackgroundResultInfluentialEvaluation of the implementation of an internet intervention in well-baby clinics: A pilot study
Drozd, F., Haga, S. M., Lisøy, C., & Slinning, K. (2018) · Internet Interventions · doi:10.1016/j.invent.2018.04.003 · Cited by 17 · see citing works
“In fact, concerns about the integration of iCBT in the mental health care systems and their long-term sustainability were also shared and expressed by managers and clinical staff in a recent multi-national, comparative study on iCBT (Folker et al., 2018).”
BackgroundResultKuso, S., Nitsch, M., Zeiler, M., Simek, M., Adamcik, T., Dey, M., Berger, T., Krieger, T., Weisel, K. K., Zarski, A.-C., et al. (2021) · European Journal of Public Health · doi:10.1093/eurpub/ckab043 · Cited by 16 · see citing works
Békés, V., Bőthe, B., & Doorn, K. A. (2025) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70085 · Cited by 16 · see citing works
Topooco, N. (2018) · doi:10.3384/diss.diva-148016 · Cited by 15 · see citing works
“Moreover, therapist-patient contact seems essential for clinicians to perceive their work as meaningful (Folker et al., 2018).”
BackgroundJohnsen, H., & Haddeland, K. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100389 · Cited by 11 · see citing works
Gervind, E., Salem, M. B., Svanborg, C., Nyström, M. E., Lilja, J. L., Kaldo, V., & Weineland, S. (2023) · Internet Interventions · doi:10.1016/j.invent.2023.100698 · Cited by 14 · see citing works
“However, there is limited research focusing on designing successful iCBT implementations in various contexts and with different organizational models (Folker et al., 2018; Titov et al., 2018).”
BackgroundMethodInfluentialGuillén, V., Fonseca-Baeza, S., Fernández‐Felipe, I., Botella, C., Baños, R., García‐Palacios, A., & Marco, J. H. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100532 · Cited by 12 · see citing works
Eilert, N., Timulak, L., Duffy, D., Earley, C., Enrique, A., Kennedy, P., McCormack, C., Palacios, J., Wogan, R., & Richards, D. (2022) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2619 · Cited by 11 · see citing works
“during treatment and practice them after their mostly short-term, minimally supported active treatments have ended (Folker et al., 2018; Titov et al., 2018).”
BackgroundSchure, M. B., Howard, M., Bailey, S. J., Bryan, B., & Greist, J. (2018) · Journal of Rural Mental Health · doi:10.1037/rmh0000102 · Cited by 10 · see citing works
“For example, studies have demonstrated mental health professionals’ criticism toward cCBT programs on their ability to be a truly effective in improving patients’ symptoms (Folker et al., 2018; Vigerland et al., 2014).”
Internet-delivered self-help for adults with ADHD (MyADHD): usability study
Kenter, R. M. F., Schønning, A., & Inal, Y. (2022) · JMIR Formative Research · doi:10.2196/37137 · Cited by 10 · see citing works
“For common mental health disorders like depression and anxiety, internet-delivered interventions are part of official treatment guidelines [2].”
BackgroundGupta, N., Leuba, S., Seifritz, E., Berger, T., & Kawohl, W. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1417784 · Cited by 10 · see citing works
Lo, B., Durocher, K., Charow, R., Kimball, S., Phạm, Q., Sockalingam, S., Wiljer, D., & Strudwick, G. (2025) · Journal of Medical Internet Research · doi:10.2196/67820 · Cited by 10 · see citing works
“Folker et al [102] discussed the need to push system-level policies that support the uptake and adoption of digital mental health tools such that there is overall encouragement and support for the use of these emerging approaches in care.”
Coumoundouros, C., von Essén, L., Sanderman, R., & Woodford, J. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-035406 · Cited by 10 · see citing works
Titov, N., Rock, D. J., Bezuidenhout, G., Webb, N., Kayrouz, R., Nielssen, O. B., Williams, L., Purtell, C., Dear, B. F., & Staples, L. (2019) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2019.1666162 · Cited by 9 · see citing works
“, 2010, 2014, 2013; Johansson, Bjärehed, Andersson, Carlbring, & Lundh, 2019; Kaldo-Sandstrom, Larsen, & Andersson, 2004), Norway (Nordgreen, Gjestad, Andersson, Carlbring, & Havik, 2018a, 2018b), Denmark (Folker et al., 2018; Mathiasen, Riper, Ehlers, Valentin, & Rosenberg, 2016), and Australia (Newby et al.”
BackgroundInfluentialContreras, M., Van Hout, E., Farquhar, M., Gould, R. L., McCracken, L. M., Hornberger, M., Richmond, E., & Kishita, N. (2021) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x21000337 · Cited by 9 · see citing works
Qiu, Y., Zhang, Y., & Liu, M. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.979979 · Cited by 8 · see citing works
Varshini, R. J., Mathias, E. G., Bhavana, R., Patil, S. G., & Kamath, R. (2025) · Scientifica · doi:10.1155/sci5/2693791 · Cited by 8 · see citing works
“However, skepticism from healthcare professionals and a lack of standardized training for therapists remain signifcant obstacles [57].”
User journey method: a case study for improving digital intervention use measurement
Lukka, L., Vesterinen, M., Salonen, A., Bergman, V.-R., Torkki, P. M., Palva, S., & Palva, J. M. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-12641-9 · Cited by 8 · see citing works
“This provided us with several insights: [1] The nature of the intervention influences its modelling and measurement.”
Børtveit, L., Nordgreen, T., & Nordahl-Hansen, A. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1236895 · Cited by 9 · see citing works
“This might indicate that the mail function was viewed as a possibility for the therapist to have some influence on, and tailor the intervention for the patients, which is a frequently described challenge and potential barrier for internetdelivered treatment (Folker et al., 2018; Meisel et al., 2018; Titzler et al., 20…”
BackgroundResultInfluentialDuffy, D. J., Richards, D., Earley, C., & Timulák, L. (2023) · Frontiers in Digital Health · doi:10.3389/fdgth.2023.1139125 · Cited by 9 · see citing works
Nævdal, R., Vis, C., & Kenter, R. M. F. (2025) · Internet Interventions · doi:10.1016/j.invent.2025.100881 · Cited by 6 · see citing works
“Group B consisted of three clinics established through a dissemination project conducted from 2019 to 2021 within the Western Health Region of Norway.”
InfluentialBjarke, J., Gjestad, R., & Nordgreen, T. (2025) · JMIR Mental Health · doi:10.2196/68165 · Cited by 6 · see citing works
“However, the implementation of guided ICBT in specialist mental health care has been slow, partly due to lack of knowledge, prejudice, and negative attitudes among health care professionals and general practitioners (GPs) [26].”
Freund, J., Ebert, D. D., Thielecke, J., Braun, L., Baumeister, H., Berking, M., & Titzler, I. (2023) · Frontiers in Digital Health · doi:10.3389/fdgth.2022.1083143 · Cited by 6 · see citing works
Measuring and Fostering Engagement with Mental Health e-Coaches
Callejas, Z., Griol, D., Benghazi, K., Noguera, M., Chollet, G., Torres, M. I., & Esposito, A. A. (2020) · Companion Publication of the International Conference on Multimodal Interaction (ICMI Companion) · doi:10.1145/3395035.3425316 · Cited by 5 · see citing works
“Meeting the demands for prevention and treatment of common mental health disorders constitutes a major health challenge [12].”
BackgroundDu, E., Quayle, E., & Macleod, H. (2021) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x21000210 · Cited by 5 · see citing works
Bringing a Systems Approach to Living Donor Kidney Transplantation
Horton, A., Loban, K., Nugus, P., Fortin, M., Gunaratnam, L., Knoll, G. A., Mucsi, I., Chaudhury, P. K., Landsberg, D. N., Pâquet, M. R., et al. (2024) · Kidney International Reports · doi:10.1016/j.ekir.2024.07.014 · Cited by 5 · see citing works
Research status of internet-delivered cognitive behavioral therapy in cancer patients
Li, B., & Wang, J. (2023) · World Journal of Psychiatry · doi:10.5498/wjp.v13.i11.831 · Cited by 5 · see citing works
Shiner, C. T., Li, I., Millard, M., & Mahoney, A. (2024) · Disability and Rehabilitation Assistive Technology · doi:10.1080/17483107.2024.2389208 · Cited by 4 · see citing works
Bendelin, N., Gerdle, B. U. C., & Andersson, G. (2023) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2022-0139 · Cited by 4 · see citing works
“These process evaluations have resulted in guidelines emphasizing appropriate governance to ensure maintenance of safe and high-quality interventions [20] and built-in routines for referrals and alignments with other health services [19].”
BackgroundShirotsuki, K., Uehara, S., Adachi, S., & Nakao, M. (2019) · Psych · doi:10.3390/psych1010025 · Cited by 4 · see citing works
“A previous study suggested that good writing skills are considered necessary to provide effective ICBT [33].”
BackgroundLorente-Català, R., Gili, M., del Hoyo, Y. L., Mayoral, F., Pérez‐Aranda, A., Castro, A., Moreno, E. V., Baños, R., Roca, M., Monreal‐Bartolomé, A., et al. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100581 · Cited by 4 · see citing works
“Although these characteristics act as facilitators, the lack of time, the negative beliefs about the intervention and ICT, and the lack of knowledge are some of the observed barriers (Folker et al., 2018; Vis et al., 2018; Wilhelmsen et al., 2014).”
BackgroundDopp, A. R., North, M. N., Gilbert, M., Ringel, J. S., Silovsky, J. F., Blythe, M., Edwards, D., Schmidt, S. R., & Funderburk, B. W. (2024) · Implementation Research and Practice · doi:10.1177/26334895241249394 · Cited by 3 · see citing works
“…across diverse sources of evidence despite the small sample available for this pilot study, similar to the rich fi ndings of prior comparative case studies from implementation research (Bullock & Lavis, 2019; Dickson et al., 2022; Folker et al., 2018; Thompson et al., 2022; Zeitlin et al., 2016).”
MethodResultSemonella, M., Marchesi, G., Castelnuovo, G., Andersson, G., & Pietrabissa, G. (2024) · Digital Health · doi:10.1177/20552076241258419 · Cited by 4 · see citing works
Petersen, E. M., Öfverström, H. A., Johansson, M., Sundström, C., & Berman, A. H. (2025) · Addiction Science & Clinical Practice · doi:10.1186/s13722-025-00570-1 · Cited by 4 · see citing works
“However, developing effective communication strategies and structured patient referrals is also vital for successful digital intervention adoption, as shown in previous studies [43, 44].”
Bäckström, M. K., Girdler, S. J., Jonsson, U., Håkansson, C., & Lexén, A. (2025) · PLoS ONE · doi:10.1371/journal.pone.0327617 · Cited by 3 · see citing works
“Conducting a case study is well-suited to study complex interplays concerning mental health and well-being needs and outcomes [93–95], this due to its methodological emphasis on building a case with multiple chains of evidence and situating the research within the phenomena studied [96].”
Mendes-Santos, C. (2021) · Linköping studies in arts and science · doi:10.3384/9789179291143 · Cited by 3 · see citing works
Ganapathy, A., Casey, L. M., Rowland, D. P., Grady, A. B., Sotheren, K. V., & Clough, B. A. (2023) · Advances in Mental Health · doi:10.1080/18387357.2023.2254864 · Cited by 4 · see citing works
Celleri, M., Klajner, F., Cremades, F. C., Garay, C. J., Etchevers, M. J., & Osma, J. (2025) · Journal of Clinical Psychology · doi:10.1002/jclp.70037 · Cited by 2 · see citing works
“…interventions are superficial, as a barrier to implementation, consistent with previous research about negative attitudes from therapists as a barrier (Folker et al. 2018), and therapists' willingness to use tele-therapy tools depends on their perceived usefulness (Monthuy ‐ Blanc et al. 2013).”
Vernmark, K., Geranmayeh, A., Topooco, N., Andersson, G., & Shahnavaz, S. (2026) · JMIR Human Factors · doi:10.2196/75263 · Cited by 3 · see citing works
“If digital interventions are to help close this gap, it is essential to understand how they should be provided in routine care settings [78], including through broad dissemination that extends beyond trauma-focused treatment in specialized settings [64].”
Brunner, I. C., Støme, L. N., & Kenter, R. M. F. (2026) · Internet Interventions · doi:10.1016/j.invent.2026.100983 · Cited by 2 · see citing works
“A study on the implementation of guided DMHIs in five countries by Folker et al. identified the referral process as a source of time waste because the programs were not suitable for a substantial fraction of the patients (Folker et al., 2018).”
Sampson, E. (2023) · Journal of Psychosocial Nursing and Mental Health Services · doi:10.3928/02793695-20230424-01 · Cited by 2 · see citing works
Beahm, J. D., McCall, H. C., Carleton, R. N., Jones, N. A., & Hadjistavropoulos, H. D. (2024) · Internet Interventions · doi:10.1016/j.invent.2024.100718 · Cited by 2 · see citing works
“Previous research has examined the perceptions of ICBT service providers, managers, and ICBT users (e.g., Duffy et al., 2023; Folker et al., 2018).”
BackgroundMathiasen, K., Andersen, T. E., Lichtenstein, M. B., Riper, H., Kleiboer, A., & Roessler, K. K. (2022) · doi:10.2196/preprints.36577 · Cited by 2 · see citing works
Self-citationMathiasen, K., Holmberg, T. T., Skaarnes, H., Jensen, E. S., Vis, C., & Tarp, K. (2023) · Frontiers in Digital Health · doi:10.3389/fdgth.2023.1128893 · Cited by 1 · see citing works
“One of the barriers which can obstruct the dissemination of iCBT is the implementation process itself (17, 18).”
BackgroundSelf-citationThuen, C., Hinderaker, H. K., Steinsvik, E. K., Vikøren, L. A. S., Lied, G. A., Berentsen, B., & Kenter, R. M. F. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-13171-0 · Cited by 1 · see citing works
“Our findings align with previous research in which leadership engagement and organisational location within larger specialised organisations were identified as facilitators [14, 20].”
Lee, M., Hunter, S. B., Tumendemberel, B., Shiferaw, M., Godley, M. D., Purtle, J., Aarons, G. A., & Dopp, A. R. (2025) · Implementation Science · doi:10.1186/s13012-025-01470-3 · Cited by 1 · see citing works
“Other applications of these methods have evaluated EBP implementation and sustainment [17, 34, 35], as well as policy-and systems-level efforts to implement and sustain change [36–39].”
Bjarke, J., Gjestad, R., & Nordgreen, T. (2026) · Internet Interventions · doi:10.1016/j.invent.2026.100907 · Cited by 1 · see citing works
“Self-referral is an established pathway to ICBT-clinics in several countries (Titov et al., 2018; Folker et al., 2018), yet to our knowledge, no previous study has examined referral pathway as a potential moderating factor on treatment outcomes in routine clinical care.”
Family digital mental health interventions: aligning design and systemic practice principles
Welsh, E. T., Boyd, J., Cloud, Z. C. G., Cordukes, K., Charles, N., & McIntosh, J. (2026) · Mental Health and Digital Technologies · doi:10.1108/mhdt-03-2026-0021 · Cited by 1 · see citing works
Improve Job Satisfaction With Cognitive Behavioral Therapy
Jones, K. (2020) · Advances in higher education and professional development book series · doi:10.4018/978-1-7998-3519-6.ch002 · Cited by 1 · see citing works
Bertuzzi, V., Semonella, M., Castelnuovo, G., Andersson, G., & Pietrabissa, G. (2023) · doi:10.2196/preprints.46692 · Cited by 1 · see citing works
Comorbid mental and substance use disorders: A common and complex treatment consideration
Prior, K. (2021) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2021.85.2.89
Lundorff, M., Damholdt, M. F., Nissen, E. R., & Zachariae, B. (2021) · Psyke & Logos · doi:10.7146/pl.v42i1.128774
Bendelin, N. (2023) · Linköping University medical dissertations · doi:10.3384/9789180750288
Implementing internet-delivered cognitive behavioural therapy in integrated care systems
Duffy, D. J., & Rota, J. (2024) · British Journal of Healthcare Management · doi:10.12968/bjhc.2024.0037
Bjarke, J., Gjestad, R., & Nordgreen, T. (2024) · doi:10.2196/preprints.68165
Frumer, M., Rask, M. T., Frostholm, L., & Rosendal, M. (2024) · Research Square · doi:10.21203/rs.3.rs-5366931/v1
Internet-Based Cognitive Rehabilitation for Working Cancer Survivors
Klaver, K. M., Duijts, S. F. A., Geusgens, C. A. V., Aarts, M. J. B., Ponds, R., van der Beek, A. J., & Schagen, S. B. (2025) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000003312
“66,67 Therefore, in order to maintain the implementation scores as found within the current RCTalso in future clinical practice, additional implementation efforts (eg, generating awareness of the online cognitive rehabilitation program among the target population and professionals, advocating for…”
- Authors
- Folker, A. P., Mathiasen, K., Lauridsen, S. M., Stenderup, E., Dozeman, E., & Folker, M. P.
- Affiliations
- University of Southern Denmark (DK)
- GGZ inGeest (NL)
- Corresponding author
- Folker, Anna Paldam
- Venue
- Internet Interventions
- Publisher
- Elsevier BV
- Published
- 2018-03
- Volume
- 11
- Pages
- 60-70
- ISSN
- 2214-7829 (ISSN-L)
- PMC
- PMC6084870
- OpenAlex
- W2789586768
- Cited by
- 116
- References
- 65
- Citations by year
- 2026: 10 · 2025: 20 · 2024: 13 · 2023: 15 · 2022: 12 · 2021: 9 · 2020: 17 · 2019: 13 · 2018: 7
- FWCI
- 14.50
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- 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)
- Pure Amsterdam UMC (publishedVersion, cc-by)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, cc-by-nc-nd)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- TrygFonden (113360)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- internet-based cognitive behavioral therapy, implementation barriers, common mental disorders, anxiety, depression, usual care, therapist training, online feedback, referral model, patient recruitment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
