Blending internet-based and tele group treatment: acceptability, effects, and mechanisms of change of cognitive behavioral treatment for depression
Open accessAbstract
The current COV-19 pandemic increases the need for remote treatment. Among several provision strategies, tele groups have been tested as an efficient option. Still, the number of studies is comparably low, with a clear lack of studies investigating supposed treatment mechanisms. Sixty-one mildly to moderately depressed participants from Salzburg, Bavaria, and Upper Austria were randomized to the intervention or a waiting list control group (RCT). The seven-week treatment comprised preparatory online modules, followed by personalized feedback and a subsequent tele group session. Large treatment effects were observed for depression (CES-D: d = 0.99, p < .001; PHQ-9: d = 0.87, p = .002), together with large effects for cognitive behavioral skills (cognitive style, and behavioral activation, d = 0.88–0.97). Changes in skills mediated treatment outcomes for CES-D and PHQ-9, suggesting comparable mechanisms as in face-to-face therapy. Two typical moderators, therapeutic alliance, and group cohesion, however, failed to predict outcome (p = .289), or only exhibited statistical tendencies (p = .049 to .071). Client satisfaction, system usability, and treatment adherence were high. Blending Internet-based and tele group interventions offers additional options for low-threshold care that is less dependent on population density, commuting distances, or constraints due to the current COV-19 crisis. Results indicate that the blended intervention is clinically effective by fostering core CBT skills. While findings suggest the notion that working alliance and group cohesion can be established online, their relevancy for outcomes of blended treatment needs to be further investigated.
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Schuster et al. (2022) combined an Internet-based treatment for depression with weekly group sessions via videoconference and found significant reductions in depressive symptomatology at post-treatment compared to a wait-list control, high patient satisfaction, and relatively high therapeutic alliance and group cohesion.
“For example, Schuster et al. (2022) combined an Internet-based treatment for depression with weekly group sessions via videoconference, and found significant reductions in depressive symptomatology at post-treatment compared to a wait-list control. Furthermore, this study found high patient satisfaction, as well as relatively high therapeutic alliance and group cohesion”
From Feasibility, acceptability, and preliminary efficacy of a blended transdiagnostic group CBT for the treatment of emotional disorders (2025) · cites this paper as Schuster et al., 2022
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- Authors
- Schuster, R., Fischer, E., Jansen, C., Napravnik, N., Rockinger, S., Steger, N., & Laireiter, A.-R.
- Affiliations
- University of Salzburg (AT)
- University of Vienna (AT)
- Corresponding author
- Schuster, Raphael
- Venue
- Internet Interventions
- Publisher
- Elsevier BV
- Published
- 2022-09
- Volume
- 29
- Pages
- 100551
- ISSN
- 2214-7829 (ISSN-L)
- PMC
- PMC9204733
- OpenAlex
- W4281681309
- Cited by
- 15
- References
- 77
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 5 · 2023: 2 · 2022: 2 · 2021: 1
- FWCI
- 2.87
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Internet Interventions (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- GoeScholar The Publication Server of the Georg-August-Universität Göttingen (Georg-August-Universität Göttingen) (submittedVersion, cc-by)
- 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
- depression, cognitive behavioral therapy, online therapy, blended treatment, remote therapy, COVID-19 pandemic, mechanisms of change, behavioral activation, cognitive style, personalized feedback, therapeutic relationship, group cohesion, client satisfaction, system usability, medication adherence, low-threshold care
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