Component analysis of a synchronous and asynchronous blended care CBT intervention for symptoms of depression and anxiety: Pragmatic retrospective study
Open accessAbstract
Depression and anxiety are leading causes of disability worldwide. Though effective treatments exist, depression and anxiety remain undertreated. Blended care psychotherapy, combining the scalability of online interventions with the personalization and engagement of a live therapist, is a promising approach for increasing access to evidence-based care. To evaluate the effectiveness and individual contribution of two components - i) digital tools and ii) video-based therapist-led sessions - in a blended care CBT-based intervention under real world conditions. A retrospective cohort design was used to analyze N = 1372 US-based individuals who enrolled in blended care psychotherapy. Of these, at baseline, 761 participants had depression symptoms in the clinical range (based on PHQ-9), and 1254 had anxiety symptoms in the clinical range (based on GAD-7). Participants had access to the program as a mental health benefit offered by their employer. The CBT-based blended care psychotherapy program consisted of regular video sessions with therapists, complemented by digital lessons and digital exercises assigned by the clinician and completed in between sessions. Depression and anxiety levels and clients' treatment engagement were tracked throughout treatment. A 3-level individual growth curve model incorporating time-varying covariates was utilized to examine symptom trajectories of PHQ-9 scores (for those with clinical range of depression at baseline) and GAD-7 scores (for those with clinical range of anxiety at baseline). On average, individuals exhibited a significant decline in depression and anxiety symptoms during the initial weeks of treatment (P < .001), and a continued decline over subsequent weeks at a slower rate (P < .001). Engaging in a therapy session in a week was associated with lower GAD-7 (b = −0.81) and PHQ-9 (b = −1.01) scores in the same week, as well as lower GAD-7 (b = −0.58) and PHQ-9 (b = −0.58) scores the following week (all P < .01). Similarly, engaging with digital lessons was independently associated with lower GAD-7 (b = −0.19) and PHQ-9 (b = −0.18) scores during the same week, and lower GAD-7 (b = −0.25) and PHQ-9 (b = −0.27) the following week (all P < .01). Therapist-led video sessions and digital lessons had separate contributions to improvements in symptoms of depression and anxiety over the course of treatment. Future research should investigate whether clients' characteristics are related to differential effects of therapist-led and digital components of care.
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The prior LCT component analysis focused exclusively on client engagement and did not assess the role of provider engagement.
“However, this prior component analysis focused exclusively on client engagement and did not assess the role of provider engagement.”
From Clinical Effects of Asynchronous Provider-Guided Practice Sessions During Blended Care Therapy for Anxiety and Depression: Pragmatic Retrospective Cohort Study (2024) · cites this paper as [22]
The Introduction and Methods > Statistical analyses explicitly say the study analyzed the contributions of both provider and digital elements to depression and anxiety outcomes. It therefore did not focus exclusively on client engagement. The analysis counted therapy sessions rather than separately measuring specific provider behaviors, but it did assess a provider-delivered component. (LLM, conf=0.85)
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Experimental — accuracy not yet measuredA prior LCT component analysis study provided preliminary support for the role of client engagement with guided practice sessions in improving symptoms.
“A prior LCT component analysis study also provided preliminary support for the role of client engagement with guided practice sessions in improving symptoms [22].”
Use of digital tools in LCT is associated with greater reductions in symptoms of anxiety and depression.
“Prior research has shown that use of these digital tools in LCT is associated with greater reductions in symptoms of anxiety and depression [22,30].”
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Self-citationDropout and completion in iCBT for university students: Insights from a thematic analysis
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Clinical outcomes from blended care therapy for anxiety and depression in the year after treatment
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“[8] Of course, all psychotherapies are not able to help people get better immediately, so CBT takes a lot of time.”
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- Authors
- Lungu, A., Wickham, R. E., Chen, S.-Y., Jun, J. J., Leykin, Y., & Chen, C. E.-J.
- Affiliations
- Northern Arizona University (US)
- Palo Alto University (US)
- Corresponding author
- Lungu, Anita
- Venue
- Internet Interventions
- Publisher
- Elsevier BV
- Published
- 2022-04
- Volume
- 28
- Pages
- 100536
- ISSN
- 2214-7829 (ISSN-L)
- PMC
- PMC9011163
- OpenAlex
- W4224250674
- Cited by
- 11
- References
- 41
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 6 · 2023: 2
- FWCI
- 2.21
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Internet Interventions (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by-nc-nd)
- 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 › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- cognitive behavioral therapy, depression, anxiety, video-based therapy, online therapy, treatment engagement, symptom trajectories, access to mental health care, PHQ-9, GAD-7
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