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Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study
Open accessAbstract
BACKGROUND: Blending online modules into face-to-face therapy offers perspectives to enhance patient self-management and to increase the (cost-)effectiveness of therapy, while still providing the support patients need. The aim of this study was to outline optimal usage of blended care for depression, according to patients and therapists. METHODS: A Delphi method was used to find consensus on suitable blended protocols (content, sequence and ratio). Phase 1 was an explorative phase, conducted in two rounds of online questionnaires, in which patients' and therapists' preferences and opinions about online psychotherapy were surveyed. In phase 2, data from phase 1 was used in face-to-face interviews with therapists to investigate how blended therapy protocols could be set up and what essential preconditions would be. RESULTS: Twelve therapists and nine patients completed the surveys. Blended therapy was positively perceived among all respondents, especially to enhance the self-management of patients. According to most respondents, practical therapy components (assignments, diaries and psycho-education) may be provided via online modules, while process-related components (introduction, evaluation and discussing thoughts and feelings), should be supported face-to-face. The preferred blend of online and face-to-face sessions differs between therapists and patients; most therapists prefer 75% face-to-face sessions, most patients 50 to 60%. The interviews showed that tailoring treatment to individual patients is essential in secondary mental health care, due to the complexity of their problems. The amount and ratio of online modules needs to be adjusted according to the patient's problems, skills and characteristics. Therapists themselves should also develop skills to integrate online and face-to-face sessions. CONCLUSIONS: Blending online and face-to-face sessions in an integrated depression therapy is viewed as a positive innovation by patients and therapists. Following a standard blended protocol, however, would be difficult in secondary mental health care. A database of online modules could provide flexibility to tailor treatment to individual patients, which asks motivation and skills of both patients and therapists. Further research is necessary to determine the (cost-)effectiveness of blended care, but this study provides starting points and preconditions to blend online and face-to-face sessions and create a treatment combining the best of both worlds.
Overview
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Written from the paper’s full text.
TL;DR
This Delphi study found that patients and therapists viewed blending online modules into face-to-face depression therapy positively, especially for self-management, but preferred different online/face-to-face ratios and emphasized tailoring rather than standard protocols. It provides preconditions for secondary mental health care but calls for further research on effectiveness.
Key findings
- Blended therapy was positively perceived. Self-management benefits included always having access to therapy content (92% therapists, 100% patients), encouraging patient responsibility (83%, 100%), blending therapy into home/private situation (92%, 88%), completing sessions in own time (92%, 80%) and pace (83%, 80%), and less travel (67%, 80%). Main drawbacks were that it is not suitable for every patient (92% therapists, 88% patients) and interpretation problems due to lack of non-verbal communication (75%, 80%).
- Content preferences: treatment introduction was 100% face-to-face for both groups; treatment evaluation was face-to-face for 67% of therapists and 88% of patients; assignments online for 75% of therapists and 63% of patients; psycho-education online for 100% and 75%; diaries online for 100% and 88%; asking questions about assignments face-to-face for 83% and 75%; expressing thoughts/feelings on assignments face-to-face for 67% and 88%; diary content face-to-face for 83% and 75%; reminders online for 75% and 88%.
- Preferred ratio differed: most therapists chose 75% face-to-face/25% online (33%, 4/12), while patients most commonly chose 50% face-to-face/50% online (38%, 3/8) or 40% face-to-face/60% online (38%, 3/8), i.e., 50–60% online.
- Phase 2 therapists (n=9) said there is no “typical patient” in secondary mental health care and standard blended protocols were not feasible; they emphasized flexible online modules, tailoring to patient characteristics, meta-communication, online intake, technology innovations, therapist training, and management support.
Methods
- A Delphi method was used: Phase 1 consisted of two rounds of online questionnaires with patients and therapists; Phase 2 consisted of individual interviews with therapists. Participants were recruited from three mental health care institutions in different regions of the Netherlands.
- Twelve therapists (8 female, 4 male; mean age 45, range 28–60) completed both survey rounds; nine patients (3 female, 6 male; mean age 37, range 23–56) completed round 1, and eight patients completed round 2. Nine therapists were interviewed in Phase 2.
- Phase 1 data were analyzed by quantifying item scores and calculating percentages; Phase 2 interviews were transcribed verbatim and coded by two independent researchers into themes and subthemes until consensus was reached.
Limitations
- Stated: possible self-selection bias toward more positive attitudes; small participant numbers; the sample may not represent the diverse secondary mental health care depression population; no patients participated in Phase 2; findings are specific to secondary care and cannot simply be translated to primary care.
- Stated/evident: many participants had no prior experience with online therapy, so benefits, drawbacks, and preferences were mostly perceived; the focus was largely on text-based online therapy, possibly limiting awareness of other technological possibilities.
- Evident: therapists could not describe a typical patient or a standard blended protocol, limiting consensus on protocolized blended care; the small qualitative sample limits generalizability.
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39 Own result · 28 Not checked yet · 17 Own interpretation · 9 No basis given · 5 Own method · 1 Supported
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Therefore, developing standard blended protocols with a pre-set plan for routing and content of every session was not feasible in the interviews”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 2
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“most patients 50 to 60%”
- Also stated in: § Phase 1 · hedged
“Patients are, overall, a little less conservative and would like to perform half or slightly more of the therapy sessions in an online environment (50 to 60%).”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Abstract > Results
plainn = 12- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Phase 1 · hedged
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Preferences of patients and therapists were highly similar on these matters.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 1
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“According to most respondents, practical therapy components (assignments, diaries and psycho-education) may be provided via online modules”
- Also stated in: § Phase 1 · hedged
“Practical components of treatment, such as assignments, psycho-education and diaries could be performed online according to most respondents.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Abstract > Results
hedgedn = 12- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Phase 1 · hedged
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The interviews showed that tailoring treatment to individual patients is essential in secondary mental health care, due to the complexity of their problems.”
- Also stated in: § Phase 2 · boosted
“Based on these reactions, it became clear that there is a need for flexible, non-standardized, scenarios for blended therapies, aimed at individual patients.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Abstract > Results
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Phase 2 · boosted
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, a large part of our sample had no previous experience with providing or receiving online therapy.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Discussion
plain- Asserted: passes — The authors put it forward as true.
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- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“concerning the process of the treatment face-to-face contact is much preferred to ask questions, and to share thoughts, feelings and difficulties with assignments.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 1
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Because of this difference among patient groups, clear scenarios of how blended care could be protocolized in clinical practice could not be gained from our interviews.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most respondents did not agree with the statement that online therapy would be too impersonal”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 1
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“most therapists prefer 75% face-to-face sessions”
- Also stated in: § Phase 1 · plain
“a large part of therapists wants to see their patients in person for the main part of the therapy (75% face-to-face sessions)”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Abstract > Results
plainn = 12- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Phase 1 · plain
- Probably not a substantial claim. 45
- It may state two separate claims as one. 23
- The quote only partly states this claim. 1
Every source the paper cites for this claim was checked and supports it.
In the paper
“Nevertheless, concurrent with the roadmap [23], thorough development from the start of an online intervention is inevitable for proper use and effects of eHealth in general, and also of blended care.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Discussion
What the sources say
- Supportedcites [23] Van Gemert-Pijnen JEWC, Nijland N, van Limburg M, Ossebaard HC, Kelders SM, Eysenbach G, Seydel ER: A holistic framework to improve the uptake and impact of eHealth technologies. J Med Internet Res. 2011, 13: e111-10.2196/jmir.1672. source
The ‘Strategies and Principles for a Holistic Development Approach’ section says implementation conditions must be considered ‘right from the start.’ The ‘Holistic Framework: CeHRes roadmap’ section says the framework applies broadly to eHealth technologies, including online interventions, supporting the cited development principle. (LLM, conf=0.86)
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“All therapists emphasized that patients in secondary mental health care, suffering from major depression, have severe and complicated problems.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 2
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Twelve therapists and nine patients completed the surveys.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Abstract > Results
plainn = 12- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In order to encourage patients to use the program, to support usability, and to increase the discipline to keep using the program, innovations in technology should be used.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 2
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“This way, the online components would not be fixed and protocolled, but therapists could shape and fill in the online sessions themselves, according to the patients’ needs and abilities.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 2
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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Probably not a substantial claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Patients often suffer from personality disorders as well, and they often experience problems in several areas of life (personal relationships, work, or financially).”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 2
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“all interviewees answered that a typical patient does not exist in secondary mental health care”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 2
plainn = 6- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Online feedback, reminders and stimuli (such as games, collecting points) might encourage the motivation and discipline of patients to stay in therapy and to fulfill the assignments.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 2
hedgedconditional- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“According to the therapists, animations, videos and expressive examples could help patients understand the theory and assignments, without reading large amounts of texts.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 2
hedgedconditional- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“opinions varied with respect to the statement that the use of online sessions could weaken the patient-therapist bonding.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 1
hedged- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our results show that many practical parts of the therapy could be performed in an online environment, while discussing thoughts, feelings and difficulties regarding these practical parts should still be done face-to-face.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Discussion
hedged- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our results show that both patients and therapists are positive about online and blended therapy and expect more benefits than drawbacks.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
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It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“A perceived drawback of online sessions is that certain problems or matters could become more difficult to discuss, due to a lack in non-verbal communication or because patients need intensive support in dealing with their problems.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Lastly, it is not just the patients and the technology that must be suited for online therapy; the intentions and motivations from therapists and management weigh very heavy in the succeeding of blended care.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 2
plaindirectSingle case- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Meta-communication about the form of therapy, how the content will be presented, and for what reason, will help to explain the rationale of the therapy.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 2
plainconditional- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and that protocols cannot be followed exactly as they are provided.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 2
plainn = 6- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“According to many respondents, it could make the therapy more transparent because patients can exactly follow the structure of the therapy and the sequence of the sessions.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 1
hedgedconditional- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“According to the therapists, taking patients’ characteristics into account is essential in order to match the online therapy with the individual patient.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 2
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“To show how useful online tools can be, patients can start filling in intake forms right away and start their treatment.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 2
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Therapists stress that patients’ characteristics should be carefully taken into account in the choice for blended care, and the online program should be flexible enough to fit a patient’s specific needs.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Discussion
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In every part of the treatment, patients need extensive guidance in translating the theory and assignments of the therapy into their own life and to become activated in a way that matches their abilities.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 2
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Predominantly, the use of face-to-face sessions is crucial; to create commitment, to activate and motivate patients, to monitor patients and to keep up the pace of the treatment.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 2
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Therapists stress that patients’ characteristics should be carefully taken into account in the choice for blended care, and the online program should be flexible enough to fit a patient’s specific needs.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
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Probably not a substantial claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Also, the therapists would highly appreciate a large database of available online assignments.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 2
hedged- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and that problems with interpretation could occur due to a lack of non-verbal communication.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 1
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Blended therapy was positively perceived among all respondents, especially to enhance the self-management of patients.”
- Also stated in: § Phase 1 · plain
“It can be seen that online sessions are positively perceived, especially to enhance the self-management of patients.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Abstract > Results
plainn = 12- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Also stated in: § Phase 1 · plain
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Lastly, it should be noted that this study particularly focused on secondary care.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“It proved to be difficult to recruit participants for such an explorative study, since not many therapists have experience with online treatment, and therapists do not receive extra time to take part in research from their management.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“While recent studies have shown that adding online sessions or modules to regular face-to-face psychotherapy can increase the adherence and effectiveness of a patients’ treatment, it also increases costs and workload among professionals [17-19].”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Background
What the sources say
- Not checked yetcites [17] Meglic M, Furlan M, Kuzmanic M, Kozel D, Baraga D, Kuhar I, Kosir B, Iljaz R, Novak Sarotar B, Dernovsek MZ, Marusic A, Eysenbach G, Brodnik A: Feasibility of an eHealth service to support collaborative depression care: results of a pilot study. J Med Internet Res. 2010, 12: e63-10.2196/jmir.1510. source
- Not checked yetcites [18] Meyer B, Berger T, Caspar F, Beevers CG, Andersson G, Weiss M: Effectiveness of a novel integrative online treatment for depression (Deprexis): randomized controlled trial. J Med Internet Res. 2009, 11: e15-10.2196/jmir.1151. source
- Not checked yetcites [19] Robertson L, Smith M, Castle D, Tannenbaum D: Using the Internet to enhance the treatment of depression. Australas Psychiatry. 2006, 14: 413-417. 10.1111/j.1440-1665.2006.02315.x. source
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“While effective psychotherapy for depression is available, many patients do not receive appropriate treatment since it is time-consuming and costly, and mental health care institutions often do not have the capacity to provide everyone with the care they need [2,3].”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Background
What the sources say
- Not checked yetcites [2] Donohue JM, Pincus HA: Reducing the societal burden of depression: a review of economic costs, quality of care and effects of treatment. Pharmacoeconomics. 2007, 25: 7-24. 10.2165/00019053-200725010-00003. source
- Not checked yetcites [3] Richards D, Richardson T: Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev. 2012, 32: 329-342. 10.1016/j.cpr.2012.02.004. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“To overcome these drawbacks, adopting a combination of online and face-to-face therapy, in which online sessions replace or substitute some (parts) of the sessions with a health professional, could offer patients the best of both worlds [13,20].”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Background
What the sources say
- Not checked yetcites [13] Gega L, Marks I, Mataix-Cols D: Computer-aided CBT self-help for anxiety and depressive disorders: experience of a London clinic and future directions. J Clin Psychol. 2004, 60: 147-157. 10.1002/jclp.10241. source
- Not checked yetcites [20] Postel M, Witting M, Van Gemert-Pijnen L: Blended care in mental health care [Blended behandeling in de geestelijke gezondheidszorg]. Dir Ther. 2013, 33: 210-221.
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“Nevertheless, problems with adherence to the online program and translation of therapy content into daily life can be difficult for patients [8-10].”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Background
What the sources say
- Not checked yetcites [8] Gerhards SA, Abma TA, Arntz A, de Graaf LE, Evers SM, Huibers MJH, Widdershoven GA: Improving adherence and effectiveness of computerised cognitive behavioural therapy without support for depression: a qualitative study on patient experiences. J Affect Disord. 2011, 129: 117-125. 10.1016/j.jad.2010.09.012. source
- Not checked yetcites [9] Marks IM, Kenwright M, McDONOUGH M, Whittaker M, Mataix-Cols D: Saving clinicians’ time by delegating routine aspects of therapy to a computer: a randomized controlled trial in phobia/panic disorder. Psychol Med. 2004, 34: 9-18. 10.1017/S003329170300878X. source
- Not checked yetcites [10] Sharry J, Davidson R, McLoughlin O, Doherty G: A service-based evaluation of a therapist-supported online cognitive behavioral therapy program for depression. J Med Internet Res. 2013, 15: e121-10.2196/jmir.2248. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Most systematic reviews found that offering some form of support or guidance during the online treatment increases its effectiveness and is associated with higher levels of completion [3,6,11].”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Background
What the sources say
- Not checked yetcites [3] Richards D, Richardson T: Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev. 2012, 32: 329-342. 10.1016/j.cpr.2012.02.004. source
- Not checked yetcites [6] Andersson G, Cuijpers P: Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cogn Behav Ther. 2009, 38: 196-205. 10.1080/16506070903318960. source
- Not checked yetcites [11] Newman MG, Szkodny LE, Llera SJ, Przeworski A: A review of technology-assisted self-help and minimal contact therapies for anxiety and depression: is human contact necessary for therapeutic efficacy?. Clin Psychol Rev. 2011, 31: 89-103. 10.1016/j.cpr.2010.09.008. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Studies on the experiences of patients with online therapy also show that personal feedback and support are perceived as positive among patients, to optimally use the program and to keep them motivated [12-14].”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Background
What the sources say
- Not checked yetcites [12] Beattie A, Shaw A, Kaur S, Kessler D: Primary-care patients’ expectations and experiences of online cognitive behavioural therapy for depression: a qualitative study. Health Expect. 2009, 12: 45-59. 10.1111/j.1369-7625.2008.00531.x. source
- Not checked yetcites [13] Gega L, Marks I, Mataix-Cols D: Computer-aided CBT self-help for anxiety and depressive disorders: experience of a London clinic and future directions. J Clin Psychol. 2004, 60: 147-157. 10.1002/jclp.10241. source
- Not checked yetcites [14] Bendelin N, Hesser H, Dahl J, Carlbring P, Nelson KZ, Andersson G: Experiences of guided Internet-based cognitive-behavioural treatment for depression: a qualitative study. BMC Psychiatry. 2011, 11: 107-10.1186/1471-244X-11-107. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“The optimal level of support, the nature of the support, and essential preconditions to make blended care acceptable and cost-effective have not been studied as well [11,10,22].”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Background
What the sources say
- Not checked yetcites [11] Newman MG, Szkodny LE, Llera SJ, Przeworski A: A review of technology-assisted self-help and minimal contact therapies for anxiety and depression: is human contact necessary for therapeutic efficacy?. Clin Psychol Rev. 2011, 31: 89-103. 10.1016/j.cpr.2010.09.008. source
- Not checked yetcites [10] Sharry J, Davidson R, McLoughlin O, Doherty G: A service-based evaluation of a therapist-supported online cognitive behavioral therapy program for depression. J Med Internet Res. 2013, 15: e121-10.2196/jmir.2248. source
- Not checked yetcites [22] Kooistra LC, Wiersma JE, Ruwaard JJ, Van Oppen PC, Smit F, Lokkerbol J, Cuijpers P, Riper H: Blended vs. face-to-face cognitive behavioral treatment for major depression in specialized mental health care: study protocol of a randomized controlled cost-effectiveness trial. BMC Psychiatry. 2014, 14: 290-10.1186/s12888-014-0290-z. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Based on these reactions, it became clear that there is a need for flexible, non-standardized, scenarios for blended therapies, aimed at individual patients.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 2
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Blended therapy has the potential to bring about an increased intensity and continuity of therapy, by combining a face-to-face session with online modules within one week, which could possibly decrease the length of the therapy in weeks.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The amount and ratio of online modules needs to be adjusted according to the patient’s problems, skills and characteristics.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Abstract > Results
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“This roadmap uses a bottom-up process to incorporate the context of a particular health care setting and the values of all stakeholders and end-users of an intervention, to improve the implementation and impact of eHealth technologies.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Background
What the sources say
- Not checked yetcites [23] Van Gemert-Pijnen JEWC, Nijland N, van Limburg M, Ossebaard HC, Kelders SM, Eysenbach G, Seydel ER: A holistic framework to improve the uptake and impact of eHealth technologies. J Med Internet Res. 2011, 13: e111-10.2196/jmir.1672. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Using other forms of media such as video, or gamification elements could broaden the potential of online and blended therapy for many people.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Subsequently, these categories were discussed between the two researchers, until consensus about the final categories was reached.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Methods > Data-analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Of the twelve therapists in round 1, nine agreed to participate in an interview.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 2
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“the audiotapes of the interviews were transcribed verbatim and coded by two independent researchers.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Methods > Data-analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
In the paper
“Using the first steps of an eHealth intervention development roadmap [23], this study offers a helpful starting point for the implementation of blended care for depression in secondary mental health care.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Discussion
What the sources say
- Not checked yetcites [23] Van Gemert-Pijnen JEWC, Nijland N, van Limburg M, Ossebaard HC, Kelders SM, Eysenbach G, Seydel ER: A holistic framework to improve the uptake and impact of eHealth technologies. J Med Internet Res. 2011, 13: e111-10.2196/jmir.1672. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
None of the sources cited for this claim have been checked yet.
In the paper
“This agrees with what has been previously shown in qualitative studies on the essentials for adherence and effect of online therapy [13,8].”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Discussion
What the sources say
- Not checked yetcites [13] Gega L, Marks I, Mataix-Cols D: Computer-aided CBT self-help for anxiety and depressive disorders: experience of a London clinic and future directions. J Clin Psychol. 2004, 60: 147-157. 10.1002/jclp.10241. source
- Not checked yetcites [8] Gerhards SA, Abma TA, Arntz A, de Graaf LE, Evers SM, Huibers MJH, Widdershoven GA: Improving adherence and effectiveness of computerised cognitive behavioural therapy without support for depression: a qualitative study on patient experiences. J Affect Disord. 2011, 129: 117-125. 10.1016/j.jad.2010.09.012. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The involvement of end-users in the early stages of development is crucial to create commitment and to determine the requirements for design.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Background
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
In the paper
“Next, the first researcher (RV) examined the raw data again to ensure the robustness of the analytical process and to confirm that all the data was indeed reflected in the coding [26].”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Methods > Data-analysis
What the sources say
- Not checked yetcites [26] Patton M: Qualitative Research & Evaluation Methods. 1990, Sage, Newbury Park, CA, 2
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A database of online modules could provide flexibility to tailor treatment to individual patients”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Abstract > Conclusions
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
In the paper
“An online intervention is not just a simple translation of a regular face-to-face therapy to an online environment [27].”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Discussion
What the sources say
- Not checked yetcites [27] Kelders SM, Pots WTM, Oskam MJ, Bohlmeijer ET, van Gemert-Pijnen JEWC: Development of a web-based intervention for the indicated prevention of depression. BMC Med Inform Decis Mak. 2013, 13: 26-10.1186/1472-6947-13-26. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In round 2, eight out of nine patients completed the survey”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 1
plainn = 8- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In the intake period and for practical assignments online tools could be used in a low key manner, from which the database of online modules can be built up.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Conclusions
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“This could increase our knowledge on how to tailor blended care to individual patients, related to the severity of their symptoms and their characteristics [41,42].”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Discussion
What the sources say
- Not checked yetcites [41] Carlbring P, Maurin L, Törngren C, Linna E, Eriksson T, Sparthan E, Strååt M, Marquez von Hage C, Bergman-Nordgren L, Andersson G: Individually-tailored, Internet-based treatment for anxiety disorders: a randomized controlled trial. Behav Res Ther. 2011, 49: 18-24. 10.1016/j.brat.2010.10.002. source
- Not checked yetcites [42] Johansson R, Sjöberg E, Sjögren M, Johnsson E, Carlbring P, Andersson T, Rousseau A, Andersson G: Tailored vs. standardized internet-based cognitive behavior therapy for depression and comorbid symptoms: a randomized controlled trial. PLoS One. 2012, 7: e36905-10.1371/journal.pone.0036905. source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It is possible that the patients and therapists that participated in our study have a more positive attitude to online therapy than non-responders (self-selection bias).”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although this study adds new insights to the body of literature, our results should be interpreted with care.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“When both patients and therapists become more adepted to online therapy and experience the possibilities of technology, blending online sessions into face-to-face therapy could create a treatment using the best of both worlds.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Conclusions
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
In the paper
“In a study by Wright et al. [21], patients were seen every week by a therapist, but half of the sessions were done independently by the patient behind a computer, at the mental health care institution.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Discussion
What the sources say
- Not checked yetcites [21] Wright JH, Wright AS, Albano AM, Basco MR, Goldsmith LJ, Raffield T, Otto MW: Computer-assisted cognitive therapy for depression: maintaining efficacy while reducing therapist time. Am J Psychiatry. 2005, 162: 1158-1164. 10.1176/appi.ajp.162.6.1158. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“This will provide further insight into the suitability among groups and in the effectiveness of blended therapy from a different perspective, namely from what actually happens during the therapy [40].”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Discussion
What the sources say
- Not checked yetcites [40] Kelders SM, Bohlmeijer ET, Van Gemert-Pijnen JE: Participants, usage, and use patterns of a web-based intervention for the prevention of depression within a randomized controlled trial. J Med Internet Res. 2013, 15: e172-10.2196/jmir.2258. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our study provides a first exploration of how the two modes of delivery could be blended optimally, integrated as equal parts of treatment.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“A recent study by Høifødt et al. [35] investigated the effect of a guided web-based intervention with face-to-face support, with positive results on depression and anxiety symptoms.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Discussion
What the sources say
- Not checked yetcites [35] Høifødt RS, Lillevoll KR, Griffiths KM, Wilsgaard T, Eisemann M, Waterloo K, Kolstrup N: The clinical effectiveness of web-based cognitive behavioral therapy with face-to-face therapist support for depressed primary care patients: randomized controlled trial. J Med Internet Res. 2013, 15: e153-10.2196/jmir.2714. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper relies on this without support.
Patients receiving blended therapy would have actual duration of therapy stay equal or become shorter.
“while the actual duration of therapy stays equal or could become shorter.”
The paper relies on this without support.
The preferences and opinions of the included patients and therapists are representative of patients and therapists in secondary mental health care.
“The aim of this study was to outline optimal usage of blended care for depression, according to patients and therapists.”
The paper relies on this without support.
A Delphi consensus among a small sample of patients and therapists can identify optimal usage of blended care.
“A Delphi method was used [24], which aimed to find consensus on suited protocols, concerning content, sequence and ratio to blend online and face-to-face therapy for depression.”
The paper relies on this without support.
Online therapy is still scarce in clinical practice.
“Because online therapy is still scarce in clinical practice many therapists and patients are probably not aware of the large amount of other possibilities that technology can offer.”
The paper relies on this without support.
Therapists have experience with regular protocols for depression therapy among a broad range of patients.
“This choice was made because therapists have experience with regular protocols for depression therapy among a broad range of patients.”
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?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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].”
From Barriers to and Facilitators of a Blended Cognitive Behavioral Therapy Program for Depression and Anxiety Based on Experiences of University Students: Qualitative Interview Study (2023) · cites this paper as [49]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Interestingly, our study showed that the perceived benefits of this bCBT program are in line with many of the explored expectations of patients receiving standard CBT but who have not yet had an experience with blended formats [38,49].”
From Barriers to and Facilitators of a Blended Cognitive Behavioral Therapy Program for Depression and Anxiety Based on Experiences of University Students: Qualitative Interview Study (2023) · cites this paper as [49]
Experimental — accuracy not yet measuredIn the citing paper
“Third, reaching consensus can take time and can be complex. This means that Delphi studies can require a lot of time from researchers and participants, which is not always available in eHealth development processes”
From Methods for Human-Centered eHealth Development: Narrative Scoping Review (2022) · cites this paper as [101]
In the citing paper
“Second, it can be challenging to recruit participants for a Delphi study because, for example, there are not many experts in a specific or new field, which can be especially relevant when studying novel applications of an eHealth technology”
From Methods for Human-Centered eHealth Development: Narrative Scoping Review (2022) · cites this paper as [101]
In the citing paper
“Further, a recent Delphi study suggested that blended treatment is positively perceived by patients and therapists (Van der Vaart et al., 2014).”
From Development and initial evaluation of blended cognitive behavioural treatment for major depression in routine specialized mental health care (2016) · cites this paper as Van der Vaart et al., 2014
In the citing paper
“A further possible advantage is that online components can be integrated into routine practice more gradually [22], making the blended format easier than iCBT to adopt for application in routine care.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Abstract > Results
“most therapists prefer 75% face-to-face sessions, most patients 50 to 60%.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 1
“| Ratio in percentages | Therapists; % (n) | Patients; % (n) | | --- | --- | --- | | 75% face-to-face/25% online | 33 (4) | 0 (0) |”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“| Sessions can be completed in own time | 92 (11) | 0 (0) | 80 (6) | 13 (1) |”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 1
Reported 80 · recomputed 75
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 1
“all patients and therapists in our sample felt that they had the need to see their patient or therapist face-to-face.”
§ Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study > Results > Phase 1
“| Ability to see a patient/therapist face-to-face | 83 (10) | 0 (0) | 100 (8) | 0 (0) |”
Citations
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“Methods A Delphi method was used [24], which aimed to find consensus on suited protocols, concerning content, sequence and ratio to blend online and face-to-face therapy for depression.”
MethodComputer-based psychological treatments for depression: A systematic review and meta-analysis
Richards, D., & Richardson, T. (2012) · Clinical Psychology Review · doi:10.1016/j.cpr.2012.02.004 · Cited by 1,442 · cited 4×
“Up until now, the largest supply of eHealth interventions for common mental disorders focuses on the general community and to a lesser extent on primary care, reaching people who suffer from mild to moderate depressive symptoms [3,6,15].”
BackgroundInfluentialInternet-Based and Other Computerized Psychological Treatments for Adult Depression: A Meta-Analysis
Andersson, G., & Cuijpers, P. (2009) · Cognitive Behaviour Therapy · doi:10.1080/16506070903318960 · Cited by 1,368
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“[29], previously showed that the satisfaction and experienced benefits and barriers of online therapy versus face-to-face therapy can differ between individuals and between target groups, depending on the severity of the depression and characteristics of the patient (internet skills, personality, self-management skill…”
BackgroundA Holistic Framework to Improve the Uptake and Impact of eHealth Technologies
van Gemert-Pijnen, J. E., Nijland, N., van Limburg, M., Ossebaard, H. C., Kelders, S. M., Eysenbach, G., & Seydel, E. R. (2011) · Journal of Medical Internet Research · doi:10.2196/jmir.1672 · Cited by 1,126
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“Models on essential factors of human support in online treatment could provide more insight into how support can be optimally delivered to enhance adherence and satisfaction within individual blended treatments [30].”
BackgroundPrevalence and clinical course of depression: a review
Richards, D. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2011.07.004 · Cited by 623 · cited 1×
“Background Depression is one of the most commonly diagnosed mental disorders among adults, which causes a major public health problem [1].”
Background
Research works printed but not linked: 2
- Van der Vaart R, Van Gemert-Pijnen L, Bohlmeijer E: Eindverslag Ontwikkeling en Evaluatie van Gepaste Blended Behandeling bij Depressie [Final Report Development and Evaluation of Suitable Blended Care for Depression]. 2013, University of Twente, Enschede
- Semlianoi B, Wentzel J: Co-creatie met zorgverleners: Blended Care instrument [co-creation with health care professionals: Blended Care instrument] Presentation 4th NSRII (Netherlands’ Society for Research on Internet Interventions) symposium ‘Designing Persuasive Technology to Improve eHealth Interventions’. June 20th 2014, Enschede: University of Twente.
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Metadata
- Authors
- van der Vaart, R., Witting, M., Riper, H., Kooistra, L., Bohlmeijer, E. T., & van Gemert-Pijnen, L. J.
- Affiliations
- Saxion (NL)
- Vrije Universiteit Amsterdam (NL)
- University of Twente (NL)
- Venue
- BMC Psychiatry
- Published
- 2014-12
- Volume
- 14
- Issue
- 1
- Pages
- 355-355
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC4271498
- OpenAlex
- W2117200319
- Cited by
- 273
- References
- 43
- Citations by year
- 2026: 13 · 2025: 16 · 2024: 13 · 2023: 24 · 2022: 28 · 2021: 44 · 2020: 46 · 2019: 14 · 2018: 26 · 2017: 24 · 2016: 19 · 2015: 6
- FWCI
- 25.32
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- University of Twente Research Information (publishedVersion, cc-by)
- Leiden Repository (Leiden University) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- VU Research Portal (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- University of Twente Research Information (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Innovatiefonds Zorgverzekeraars
- 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 › Education › Online and Blended Learning
- Keywords
- blended care, depression, online therapy, face-to-face therapy, online modules, therapist preferences, patient preferences, self-management, psychoeducation, secondary mental health care, treatment tailoring, therapist skills
- MeSH terms
- Adult, Attitude of Health Personnel, Attitude to Health, Clinical Protocols, Cost-Benefit Analysis, Delphi Technique, Depressive Disorder, Female, Health Personnel, Humans, Male, Middle Aged, Motivation, Personal Satisfaction, Psychotherapy, Surveys and Questionnaires, Self Care, Patient Satisfaction, Remote Consultation, Internet, Consensus, Young Adult, Patient Preference
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.
A language model drew the claims from the paper on 2026-10-06, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-06 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
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 ›
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