Therapist characteristics and acceptance of internet-delivered cognitive behavioral therapy: A national cross-sectional survey using the technology acceptance model after ten years of iCBT in Norway

“All scales measuring TAM-constructs were scored on the same 7-point likert-scale used in the original scales, ranging from 1: completely agree to 7: completely disagree (Davis, 1989; Davis et al., 1989; Venkatesh and Bala, 2008).”

“Summarizing much of this research, the Technology Acceptance Model (TAM) describes factors influencing the adoption and use of a technology system (Davis, 1989; Davis et al., 1989; Venkatesh and Bala, 2008; Venkatesh and Davis, 2000).”

“This supports findings from broader technology adoption literature suggesting that voluntariness alone does not drive sustained use if not accompanied by adequate training and support (Davis et al., 2024; Garavand et al., 2016; Venkatesh and Bala, 2008).”

“…and improving technology adoption across sectors such as education, business, and information systems (Davis et al., 2024; King and He, 2006; Venkatesh, 2000; Venkatesh and Bala, 2008; Venkatesh and Davis, 2000), its application in healthcare, particularly in understanding mental health…”

“…value in understanding and improving technology adoption across sectors such as education, business, and information systems (Davis et al., 2024; King and He, 2006; Venkatesh, 2000; Venkatesh and Bala, 2008; Venkatesh and Davis, 2000), its application in healthcare, particularly in…”

“…indicates that iCBT, particularly when guided by a therapist, can achieve comparable outcomes to face-to-face therapy while requiring fewer clinical resources (Carlbring et al., 2018; Etzel-mueller et al., 2020; Hedman-Lagerl ¨ of et al., 2023; Karyotaki et al., 2018; K ¨ all et al., 2024).”

“Similarly, the IKEA Effect shows that people value products requiring personal effort, like self-assembled furniture (Norton et al., 2012).”

“This finding echoes research suggesting digital therapies may lack cultural prestige within traditional mental health services where in-person work remains the gold standard (Andersson et al., 2019; Chong et al., 2022).”

“A second reason may be that iCBT conflict with important professional identities (Cresswell and Sheikh, 2013; Lee et al., 2006).”

“For example, the Effort Heuristic demonstrates that people judge quality based on perceived effort invested (Kruger et al., 2004).”

“Although unguided iCBT needs less resources, several countries have opted to implement guided iCBT where a trained therapist supports patients through asynchronous messaging systems or telephone calls (Titov et al., 2018).”

“Previous studies looking at therapists who do not use iCBT tend to show that therapists are skeptical to it replacing face-to-face therapy and report low likelihood of use (Hildebrand et al., 2024; Musiat et al., 2014).”

“This aligns with literature showing that centralized implementation support, supervision, and resource allocation improve therapist buy-in for digital interventions (Molloy et al., 2021; Tremain et al., 2020; Vis et al., 2023).”

“…indicates that iCBT, particularly when guided by a therapist, can achieve comparable outcomes to face-to-face therapy while requiring fewer clinical resources (Carlbring et al., 2018; Etzel-mueller et al., 2020; Hedman-Lagerl ¨ of et al., 2023; Karyotaki et al., 2018; K ¨ all et al., 2024).”

“A second reason may be that iCBT conflict with important professional identities (Cresswell and Sheikh, 2013; Lee et al., 2006).”

“This organizational model appears uncommon compared to centralized clinics delivering treatments to larger catchment areas or even nationally (Andersson and Hedman, 2013; Hadjistavropoulos et al., 2016).”

“Furthermore, although the TAM posits that forced adoption of an innovation can lead to reduced motivation (Venkatesh and Bala, 2008), it has also been found that mass exposure and hands on experience, even when forced, often can lead to more positive perceptions over time (B ´ ek ´ es et al., 2021).”

“Successful implementation of guided iCBT therefore requires clinicians to adopt not just a different treatment approach, but also a digital product (Chong et al., 2022; Cresswell and Sheikh, 2013; Garavand et al., 2016).”

“Group B consisted of three clinics established through a dissemination project conducted from 2019 to 2021 within the Western Health Region of Norway.”

“This organizational model appears uncommon compared to centralized clinics delivering treatments to larger catchment areas or even nationally (Andersson and Hedman, 2013; Hadjistavropoulos et al., 2016).”

“This finding echoes research suggesting digital therapies may lack cultural prestige within traditional mental health services where in-person work remains the gold standard (Andersson et al., 2019; Chong et al., 2022).”

“Both perceived usefulness and ease of use were rated highly for patients and therapists, reinforcing previous findings that iCBT can be seen as both clinically effective and operationally feasible (Hadjistavropoulos et al., 2020; Hedman-Lagerl ¨ of et al., 2023).”

“This aligns with literature showing that centralized implementation support, supervision, and resource allocation improve therapist buy-in for digital interventions (Molloy et al., 2021; Tremain et al., 2020; Vis et al., 2023).”

“In line with this, Terpstra et al. (2018) found that therapists with no former iCBT training scored perceived usefulness and ease of use highly after a structured training session.”

“…indicates that iCBT, particularly when guided by a therapist, can achieve comparable outcomes to face-to-face therapy while requiring fewer clinical resources (Carlbring et al., 2018; Etzel-mueller et al., 2020; Hedman-Lagerl ¨ of et al., 2023; Karyotaki et al., 2018; K ¨ all et al., 2024).”

“Previous studies looking at therapists who do not use iCBT tend to show that therapists are skeptical to it replacing face-to-face therapy and report low likelihood of use (Hildebrand et al., 2024; Musiat et al., 2014).”

“In addition, the TAM has been extensively used and extended in CBT to forecast people’s acceptance and use, such as in digital therapeutics [54] and internet-delivered interventions [40].”

“A detailed description of therapist characteristics is available in Nævdal et al [27].”

“…iCBT therapists showed that the highest levels of acceptance were achieved through a structured top-down implementation process in which therapists with diverse professional backgrounds and characteristics were mandated to use iCBT while receiving supervision and support (Nævdal et al., 2025).”