Added value or added burden? A qualitative investigation of blending internet self-help with face-to-face cognitive behaviour therapy for depression
Abstract
Objectives: Numerous studies and reviews have explored the value of adding therapist support to internet self-help for improving client adherence and outcomes. This study is different as it explores the value of adding internet self-help to face-to-face therapy, from the perspective of practitioners who used both. This study explores practitioners’ experiences of whether—and how—internet self-help blended with face-to-face therapy may confer an added value or become an added burden to their routine practice. Methods: Using a structured topic guide, we collected narrative data via 3 focus groups and 1 telephone interview from 11 practitioners across two sites in England. We carried out a thematic analysis within two domains, “value vs. burden”. Results: Practitioners reported that internet self-help can confer added value to face-to-face therapy by: fostering client engagement with face-to-face sessions; making therapy ubiquitous beyond sessions; and preventing therapeutic drift between sessions. Conversely, internet self-help can add burden to face-to-face therapy when it is experienced as disruptive, overwhelming and time-consuming. Conclusions: Recognizing and mitigating factors that can turn internet self-help from an added value to an added burden will help practitioners adopt and make the most out of blended therapy.
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European research shows that local mental health professionals value blended DMHIs that are flexible to use, can be customized to suit client needs, and help clients with symptom tracking and homework completion between therapy sessions.
“European research also shows that local mental health professionals value blended DMHIs that are flexible to use [3839], can be customized to suit client needs [283140], and help clients with symptom tracking and homework completion between therapy sessions [2838].”
Adequate training and minimizing the time burden of DMHI use with clients is important to European mental health professionals.
“Adequate training and minimizing the time burden of DMHI use with clients is also important to European mental health professionals [283138-40undefinedundefined].”
Cerga-Pashoja and colleagues reported that mental health care workers who deliver low-intensity psychological interventions wanted blended care to help facilitate continuity between therapy sessions.
“Further, Cerga-Pashoja and colleagues [38] reported that mental health care workers who deliver low-intensity psychological interventions (ie, UK psychological well-being practitioners) wanted blended care to help facilitate continuity between therapy sessions.”
EA and MS created the interview guide with the help and synthesis of interview guidelines from a number of studies that qualitatively examined user experiences in applications developed in the field of digital health.
“EA and MS created the interview guide with the help and synthesis of interview guidelines from a number of studies that qualitatively examined user experiences in applications developed in the field of digital health [45-49].”
Allowing the therapist to keep track of the student's process could have helped reinforce the connection to face-to-face sessions even more.
“Similarly, allowing the therapist to keep track of the student’s process could have helped reinforce the connection to face-to-face sessions even more [45].”
Many participants evaluated the app as a supportive tool and caring companion.
“Many participants evaluated the app as a supportive tool and caring companion, which has been echoed by prior research on the ability of DTx to potentially prevent a therapeutic drift between face-to-face therapy sessions [42,45] but not yet for the specific target group of students.”
Reminders can also be perceived as possible stressors for users.
“However, this suggestion needs to be regarded with caution, as reminders can also be perceived as possible stressors for users [45,60].”
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- Authors
- Cerga-Pashoja, A., Doukani, A., Gega, L., Walke, J., & Araya, R.
- Affiliations
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
- London School of Hygiene & Tropical Medicine (GB)
- University of York (GB)
- Corresponding author
- Araya, Ricardo
- Venue
- Psychotherapy Research
- Publisher
- Informa UK Limited
- Published
- 2020-02-05
- Volume
- 30
- Issue
- 8
- Pages
- 998-1010
- ISSN
- 1050-3307 (ISSN-L)
- 1468-4381
- OpenAlex
- W3004752901
- Cited by
- 30
- References
- 35
- Citations by year
- 2026: 1 · 2025: 8 · 2024: 7 · 2023: 3 · 2022: 7 · 2021: 3 · 2020: 1
- FWCI
- 3.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychotherapy Research (publishedVersion)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- European Commission (603098)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- blended therapy, cognitive behavioral therapy, depression, practitioner experiences, therapist workload, customer engagement, digital mental health interventions
- MeSH terms
- Internet-Based Intervention, Adolescent, Adult, Aged, Depression, Female, Humans, Male, Middle Aged, Self Care, Health Behavior, Cognitive Behavioral Therapy, Qualitative Research, Young Adult
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