Design Considerations for the Integrated Delivery of Cognitive Behavioral Therapy for Depression: User-Centered Design Study
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Abstract
Background: Adherence to computerized cognitive behavioral therapy (cCBT) programs in real-world settings can be poor, and in the absence of therapist support, effects are modest and short term. Moreover, because cCBT systems tend toward limited support and thus low-intensity treatment, they are typically most appropriate for people experiencing mild to moderate mental health difficulties. Blended therapy, that is, combining direct therapist contact with cCBT or psychoeducational materials, has been identified as one possible approach to address these limitations and widen access to individual CBT for depression. Building on the initial success of blended therapy, we explore an integrated approach that seeks to seamlessly combine face-to-face contact, electronic contact, and between-session activities. Integration also considers how the technology can support therapists’ workflow and integrate with broader health care systems. The ultimate aim is to provide a structure within which therapists can deliver high-intensity treatments, while also greatly reducing face-to-face contact. Objective: The research aimed to explore patients’ and therapists’ views on using a system for the delivery of individual treatment for depression that integrates face-to-face therapist contact with access to online resources and with synchronous online therapy sessions that allow collaborative exercises, and to establish design requirements and thus key design considerations for integrated systems that more seamlessly combine different modes of communication. Methods: We conducted a series of four user-centered design studies. This included four design workshops and seven prototype testing sessions with 18 people who had received CBT for depression in the past, and 11 qualitative interviews and three role-play sessions with 12 CBT therapists experienced in the treatment of depression. Studies took place between July and December 2017 in Bristol, United Kingdom. Results: Workshops and prototyping sessions with people who had received CBT identified three important requirements for integrated platforms delivering CBT therapy for depression as follows: (1) features that help to overcome depression-related barriers, (2) features that support engagement, and (3) features that reinforce learning and support the development of new skills. Research with therapists highlighted the importance of the therapist and client working together, the impact of technology on therapists’ workflow and workload, challenges and opportunities related to the use of online resources, and the potential of technology to support patient engagement. We use these findings to inform 12 design considerations for developing integrated therapy systems. Conclusions: To meet clients’ and therapists’ needs, integrated systems need to help retain the personal connection, support both therapist- and patient-led activities, and provide access to materials and the ability to monitor progress. However, developers of such systems should be mindful of their capacity to disrupt current work practices and increase therapists’ workload. Future research should evaluate the impact of integrated systems on patients and therapists in a real-world context.
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Technology used in bCBT needs to provide simple, easy-to-understand content to prevent potential barriers owing to, for example, lack of drive.
“This result supports the findings of Stawarz et al [57], who claimed that the technology used in bCBT needs to provide simple, easy-to-understand content to prevent potential barriers owing to, for example, the lack of drive.”
The ability to monitor therapy progress could have potentially increased user engagement and therapy adherence.
“According to Stawarz et al [57], the ability to monitor the therapy progress could have potentially increased user engagement and therapy adherence, which was also mentioned by some participants.”
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- Authors
- Stawarz, K., Preist, C., Tallon, D., Wiles, N., Kessler, D., Turner, K., Shafran, R., & Coyle, D.
- Affiliations
- Cardiff University (GB)
- University of Bristol (GB)
- University College London (GB)
- University College Dublin (IE)
- Corresponding author
- Stawarz, Katarzyna
- ORCID
- Venue
- JMIR Mental Health
- Publisher
- JMIR Publications Inc.
- Published
- 2020-09-03
- Volume
- 7
- Issue
- 9
- Pages
- e15972
- ISSN
- 2368-7959 (ISSN-L)
- PMC
- PMC7499168
- OpenAlex
- W3048382620
- Cited by
- 24
- References
- 45
- Citations by year
- 2025: 6 · 2024: 7 · 2023: 8 · 2022: 2 · 2020: 1
- FWCI
- 2.49
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Mental Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
- Bristol Research (University of Bristol) (acceptedVersion, cc-by)
- Explore Bristol Research (acceptedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- Research Repository UCD (University College Dublin) (submittedVersion, cc-by)
- Funders
- United Kingdom Clinical Research Collaboration
- University Hospitals Bristol NHS Foundation Trust
- NIHR Bristol Biomedical Research Centre
- National Institute for Health and Care Research (NIHR200268, RP-PG-0514-20012)
- Department of Health and Social Care
- University of Bristol
- Medical Research Council (MR/K025643/1)
- Great Ormond Street Institute of Child Health
- Programme Grants for Applied Research (RP-PG-0514-20012)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Physical Sciences › Computer Science › Human-Computer Interaction › Usability and User Interface Design
- Keywords
- cognitive behavioral therapy, depression, blended therapy, patient engagement, user-centered design, design requirements, client-therapist collaboration, online psychoeducation, mental health technology, progress monitoring, skill development, barriers to treatment adherence, prototype testing
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