The Advantages and Disadvantages of Online and Blended Therapy: Survey Study Amongst Licensed Psychotherapists in Austria
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Abstract
BACKGROUND Web-based and blended (face-to-face plus Web-based) interventions for mental health disorders are gaining significance. However, many licensed psychotherapists still have guarded attitudes toward computer-assisted therapy, hindering dissemination efforts. OBJECTIVE The objective of this study was to provide a therapist-oriented evaluation of Web-based and blended therapies and identify commonalities and differences in attitudes toward both formats. Furthermore, it aimed to test the impact of an information clip on expressed attitudes. METHODS In total, 95 Austrian psychotherapists were contacted and surveyed via their listed occupational email address. An 8-minute information video was shown to half of the therapists before 19 advantages and 13 disadvantages had to be rated on a 6-point Likert scale. RESULTS The sample resembled all assessed properties of Austrian psychotherapists (age, theoretical orientation, and region). Therapists did not hold a uniform overall preference. Instead, perceived advantages of both interventions were rated as neutral (t94=1.89, P=.06; d=0.11), whereas Web-based interventions were associated with more disadvantages and risks (t94=9.86, P<.001; d=0.81). The information clip did not excerpt any detectable effect on therapists’ attitudes (r95=−.109, P=.30). The application of modern technologies in the own therapeutic practice and cognitive behavioral orientation were positively related to the given ratings. CONCLUSIONS This study is the first to directly compare therapists’ attitudes toward Web-based and blended therapies. Positive attitudes play a pivotal role in the dissemination of new technologies, but unexperienced therapists seem to lack knowledge on how to benefit from technology-aided treatments. To speed up implementation, these aspects need to be addressed in the development of new interventions. Furthermore, the preference of blended treatments over Web-based interventions seems to relate to avoidance of risks. Although this study is likely to represent therapists’ attitudes in countries with less advanced electronic health services, therapists’ attitudes in more advanced countries might present differently.
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Based on the above average baseline acceptance found in this study, the fundamental precondition for implementation of online elements into on-site psychotherapy, namely psychotherapists' acceptance towards blended therapy, seems to be given.
“Based on the above average baseline acceptance found in this study the fundamental precondition for the implementation of online elements into on-site psychotherapy, namely psychotherapists´ acceptance towards blended therapy, seems to be given, which is in line with previous findings [27].”
From Impact of an acceptance facilitating intervention on psychotherapists' acceptance of blended therapy (2020) · cites this paper as [27]
Split into 2 atoms — 0 confirmed, 1 partially supported, 1 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
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Experimental — accuracy not yet measuredAcceptance is a fundamental precondition for implementing blended therapy in routine care.
“A fundamental precondition to implement blended therapy in routine care would be that both patients and psychotherapists are willing to use blended therapy [23–27].”
From Impact of an acceptance facilitating intervention on psychotherapists' acceptance of blended therapy (2020) · cites this paper as [27]
The Discussion (Principal Findings) links therapists’ expectations about blended therapy to its uptake, and the Conclusion says positive beliefs and preferences are pivotal to dissemination. The paper does not establish that patient willingness to use blended therapy is a precondition for implementation in routine care; its reference to patient acceptance concerns previous Web-based therapy studies. (LLM, conf=0.83)
Experimental — accuracy not yet measuredSchuster and colleagues reported evidence for general acceptance of blended therapy with no preference of psychotherapists' attitudes towards web-based or blended therapy compared to face-to-face therapy.
“Schuster and colleagues [27] reported evidence for the general acceptance of blended therapy with no preference of psychotherapists’ attitudes towards web-based or blended therapy compared to face-to-face therapy [27].”
From Impact of an acceptance facilitating intervention on psychotherapists' acceptance of blended therapy (2020) · cites this paper as [27]
The Discussion (Principal Findings; page unavailable) reports no overall preference between Web-based and blended therapy and describes therapists’ ratings as neutral. It does not report no preference between those formats and traditional face-to-face therapy; the Discussion conclusion describes general attitudes as neutral to cautious, rather than establishing general acceptance of blended therapy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredRecent surveys and qualitative studies amongst psychotherapists indicate that blended therapy approaches would be acceptable considering perceived advantages over conventional psychotherapy.
“Recent surveys and qualitative studies amongst psychotherapists indicate that blended therapy approaches would be acceptable considering perceived advantages over conventional psychotherapy, including e.g., bridging distances, flexibility, patient empowerment, and therapist support by standardized materials (17, 18, 23, 24).”
From Clinical and Cost-Effectiveness of PSYCHOnlineTHERAPY: Study Protocol of a Multicenter Blended Outpatient Psychotherapy Cluster Randomized Controlled Trial for Patients With Depressive and Anxiety Disorders (2021) · cites this paper as [18]
The Results (Comparison Between Both Interventions; page not provided) rank bridging distances and flexibility among perceived advantages of blended therapy. But the Discussion (Principal Findings; page not provided) describes therapists’ overall views as neutral to cautious and says many doubted blended therapy would support their work. The survey therefore supports some listed advantages, but not an unqualified conclusion that therapists found blended therapy acceptable because of advantages over conventional psychotherapy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredStudies on the acceptance of IMIs show that willingness to be treated via IMIs applies to only a small part of the target population regarding both patients and therapists.
“Studies on the acceptance of IMIs show that this only applies to a small part of the target population regarding both patients (13–16) and therapists (17, 18).”
From Clinical and Cost-Effectiveness of PSYCHOnlineTHERAPY: Study Protocol of a Multicenter Blended Outpatient Psychotherapy Cluster Randomized Controlled Trial for Patients With Depressive and Anxiety Disorders (2021) · cites this paper as [18]
The Introduction (page unavailable) reports low therapist preference for Web-based treatment—6.4% or 17.5% depending on prior experience—which supports the idea of limited preference. But preference is not the same as willingness to use IMIs: the paper also reports that professionals in another survey were likely to integrate computer-supported therapy, and its Conclusion describes the surveyed therapists’ attitudes as neutral to cautious. It does not establish that only a small fraction of therapists would accept IMIs. (LLM, conf=0.79)
Experimental — accuracy not yet measured
Acceptance rates are seemingly higher amongst psychotherapists with a background in cognitive behavioral therapy (CBT) compared to other therapeutic backgrounds.
“Acceptance rates are seemingly higher amongst psychotherapists with a background in cognitive behavioral therapy (CBT) compared to other therapeutic backgrounds (17, 18).”
bCBT has been found to be better received by both providers and patients than iCBT.
“bCBT has been found to be better received by both providers and patients than iCBT, because the face-to-face contact in the blended format makes the treatment more personal, better addresses the needs of patients with complex symptomatology, and may help improve adherence rates [15, 19–21].”
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- Authors
- Schuster, R., Pokorny, R., Berger, T., Topooco, N., & Laireiter, A.-R.
- Affiliations
- University of Salzburg (AT)
- University of Vienna (AT)
- University of Bern (CH)
- Linköping University (SE)
- Corresponding author
- Schuster, Raphael
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2018-12-18
- Volume
- 20
- Issue
- 12
- Pages
- e11007
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC6315274
- OpenAlex
- W2809940040
- Cited by
- 121
- References
- 52
- Citations by year
- 2026: 7 · 2025: 15 · 2024: 19 · 2023: 10 · 2022: 28 · 2021: 15 · 2020: 21 · 2019: 5 · 2018: 1
- FWCI
- 13.25
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Phaidra (Universität Wien) (submittedVersion, cc-by-nc-nd)
- DiVA (Linkoping University) (submittedVersion, other-oa)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- online therapy, blended therapy, therapist attitudes, online intervention, computer-assisted therapy, information video, cognitive behavioral therapy
- MeSH terms
- Adult, Attitude of Health Personnel, Austria, Female, Humans, Male, Psychotherapy, Surveys and Questionnaires
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