Patient and therapist expectations for a blended cognitive behavioral therapy program for depression: qualitative exploratory study
Open accessAbstract
BACKGROUND: Blended cognitive behavioral therapy (bCBT)-the combination of digital elements and face-to-face psychotherapy-has been proposed to alleviate challenges that patients and therapists face in conventional cognitive behavioral therapy. There is growing evidence that adding digital elements to face-to-face psychotherapy can contribute to better treatment outcomes. However, bCBT programs still show considerable shortcomings, and knowledge on how to improve digital apps using a bCBT protocol is limited. OBJECTIVE: This study aimed to inductively identify functions and qualities that are expected from a bCBT treatment for depression in the eyes of patients and psychotherapists who were not currently receiving or practicing bCBT treatment. METHODS: We used a qualitative exploratory study design and conducted 3 focus group interviews (n=6 in each) and 5 semistructured in-depth interviews with therapists as well as 11 individual interviews with patients with a primary diagnosis of depression and currently undergoing cognitive behavioral therapy treatment in Germany. Themes and categories were established inductively from transcribed interview records based on a rigorous coding method. RESULTS: Both therapists and patients expected a digital app to provide patients with the opportunity to track their mood, work on therapeutic homework activities, easily access an intervention set for harder moments, and efficiently facilitate administrative tasks. The desire to be able to customize bCBT protocols to individual patient circumstances was evident in both patient and therapist interviews. Patients differed with respect to what content and the amount of material the app should focus on as well as the method of recording experiences. Therapists viewed digital apps as potentially aiding in their documentation work outside of sessions. Different attitudes surfaced on the topic of data security, with patients not as concerned as therapists. CONCLUSIONS: Both patients and therapists had substantially positive attitudes toward the option of an integrated bCBT treatment. Our study presents novel findings on the expectations and attitudes of patients and therapists.
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Findings from Germany, the Netherlands, and Denmark indicate that blended care was acceptable to CBT-based therapists and psychologists before and during the COVID-19 pandemic.
“Findings from Germany, the Netherlands, and Denmark indicate that blended care was acceptable to CBT-based therapists and psychologists before and during the COVID-19 pandemic [28-31].”
From Needs and Expectations for the myNewWay Blended Digital and Face-to-Face Psychotherapy Model of Care for Depression and Anxiety (Part 2): Participatory Design Study including Mental Health Professionals (2025) · cites this paper as [28]
The Results (Therapist Interviews; page unavailable) say the CBT-oriented therapists interviewed in Germany were open to using a blended CBT program. The Methods (Ethics Approval; page unavailable) date those interviews to February–May 2021, during the COVID-19 pandemic. This paper does not provide findings from the Netherlands or Denmark, or from before the pandemic; those parts of the multi-citation claim are not supported by this source. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAdequate training and minimizing the time burden of DMHI use with clients is important to European mental health professionals.
“Adequate training and minimizing the time burden of DMHI use with clients is also important to European mental health professionals [283138-40undefinedundefined].”
From Needs and Expectations for the myNewWay Blended Digital and Face-to-Face Psychotherapy Model of Care for Depression and Anxiety (Part 2): Participatory Design Study including Mental Health Professionals (2025) · cites this paper as [28]
The Results > Therapist Interviews section (page not provided) says therapists wanted apps to ease organizational work and preserve limited session time, supporting the time-burden part of the claim. It does not report that adequate training was important to them, and findings from the interviewed therapists do not establish a preference among European mental health professionals generally. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe European research suggests that blended care is scalable and could enhance mental health professionals' acceptance of DMHI use in routine care, as well as improve client engagement by increasing DMHI uptake and adherence.
“The European research suggests that blended care is scalable and could enhance mental health professionals’ acceptance of DMHI use in routine care, as well as improve client engagement by increasing DMHI uptake and adherence.”
From Needs and Expectations for the myNewWay Blended Digital and Face-to-Face Psychotherapy Model of Care for Depression and Anxiety (Part 2): Participatory Design Study including Mental Health Professionals (2025) · cites this paper as [28]
The Results (Therapist Interviews; page not provided) describe therapists as open to blended CBT apps, and the Discussion (Principal Findings; page not provided) says patients and therapists were eager to try an app that might help with homework adherence. The paper does not establish that blended care is scalable or that it increases professionals’ acceptance in routine care, DMHI uptake, or adherence to the digital intervention itself. (LLM, conf=0.86)
Experimental — accuracy not yet measuredQualitative research by Atik and colleagues on blended care found that clients were not concerned about sharing personal data within a DMHI, provided their data were used only for treatment purposes.
“Despite this, the data sharing findings align with qualitative research by Atik and colleagues [28] on blended care, who found that clients were not concerned about sharing personal data within a DMHI, provided their data were used only for treatment purposes.”
From Needs and Expectations for the myNewWay Blended Digital and Face-to-Face Psychotherapy Model of Care for Depression and Anxiety (Part 2): Participatory Design Study including Mental Health Professionals (2025) · cites this paper as [28]
The Results (Patient Interviews, “Sharing of Therapy-Related Data”) say patients were generally willing to share personal data through the app and were not greatly concerned about doing so. But the stated conditions for sharing with app providers were that data be anonymous, secure, and not used for other purposes; the paper also discusses sharing to improve the program, so it does not establish a treatment-only condition. (LLM, conf=0.88)
Experimental — accuracy not yet measuredTailored interventions seem to be a prerequisite to increasing university students' intention to use mental health services because one-size-fits-all approaches are unlikely to be effective for everyone.
“Tailored interventions also seem to be a prerequisite to increasing university students’ intention to use mental health services because one-size-fits-all approaches are unlikely to be effective for everyone [37,38].”
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 [38]
The Results (Patient Interviews; page unavailable) report that patients wanted a digital app tailored to individual needs. The Discussion (Principal Findings; page unavailable) also argues against giving different patients identical intervention content. But this study interviewed patients receiving psychotherapy for depression, not university students, and did not establish that tailoring is a prerequisite for increasing students’ intention to use mental health services. (LLM, conf=0.87)
Experimental — accuracy not yet measured
European research shows that local mental health professionals value blended DMHIs that are flexible to use, can be customized to suit client needs, and help clients with symptom tracking and homework completion between therapy sessions.
“European research also shows that local mental health professionals value blended DMHIs that are flexible to use [3839], can be customized to suit client needs [283140], and help clients with symptom tracking and homework completion between therapy sessions [2838].”
A few studies have focused on therapists' perspectives regarding their expectations for and experiences with bCBT, but to date, there is little qualitative research on patients in general and with students in particular.
“A few studies have focused on therapists’ perspectives regarding their expectations for and experiences with bCBT [38,40], but to date, there is little qualitative research on patients in general and with students in particular.”
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 experience with blended formats.
“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].”
Participants in this bCBT program called for more interactive therapeutic activities, which patients inexperienced in bCBT did not mention as a preference.
“However, participants also called for more interactive therapeutic activities, which patients inexperienced in bCBT did not mention as a preference [38].”
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 [38]
The Results (Patient Interviews, page unavailable) list engaging with therapy activities and gamification among patients’ preferences, but do not establish whether they requested more interactive therapeutic activities. The Limitations (page unavailable) say patients were not asked about prior use of digital therapy programs. Our copy therefore cannot verify the claim about what patients inexperienced in bCBT did not prefer. (LLM, conf=0.72)
Experimental — accuracy not yet measuredThese results align with a blended care qualitative study [65], which found that clients were not concerned about sharing personal data via an app if their data were kept secure, anonymous, and private.
“These results align with a blended care qualitative study [65], which found that clients were not concerned about sharing personal data via an app if their data were kept secure, anonymous, and private.”
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Atik, E., Kalde, J., Stricker, J. H., Schückes, M., Neudeck, P., Pietrowsky, R., & Pittig, A. (2025) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2025.2503834 · Cited by 2 · see citing works
Self-citationLu, J., Mao, H., & Luo, G. (2024) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228241297413 · Cited by 2 · see citing works
Eicher, S., Fenski, F., Behr, S., Hammelrath, L., Boettcher, J., Schaeuffele, C., & Knaevelsrud, C. (2026) · npj Digital Medicine · doi:10.1038/s41746-026-02546-0 · Cited by 1 · see citing works
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Prospects for Disseminating Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder in Japan
Matsumoto, K. (2023) · Anxiety Disorder Research · doi:10.14389/jsad.15.1_38
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Self-citationPsychotherapeutic Competencies in Blended Care Psychotherapy: Development of a Competence Framework
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- Authors
- Atik, E., Schückes, M., & Apolinário-Hagen, J.
- Affiliations
- Ruhr University Bochum (DE)
- University of Mannheim (DE)
- Heinrich Heine University Düsseldorf (DE)
- Corresponding author
- Schückes, Magnus
- Venue
- JMIR Mental Health
- Publisher
- JMIR Publications Inc.
- Published
- 2022-12-30
- Volume
- 9
- Issue
- 12
- Pages
- e36806
- ISSN
- 2368-7959 (ISSN-L)
- PMC
- PMC9840101
- OpenAlex
- W4313364247
- Cited by
- 22
- References
- 59
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 4 · 2023: 5
- FWCI
- 3.75
- 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)
- MADOC (University of Mannheim) (acceptedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- depression, mental health apps, patient expectations, therapist expectations, mood tracking, data security, treatment documentation, personalized treatment protocols
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