Acceptance of e-mental health services for different application purposes among psychotherapists in clinical training in Germany and Switzerland: secondary analysis of a cross-sectional survey
Open accessAbstract
Background Despite solid evidence supporting the efficacy of electronic mental health (EMH) services, their acceptance among psychotherapists is limited and uptake rates remain low. However, the acceptance of different EMH services has yet barely been examined in future generations of psychotherapists in a differentiated manner. The aims of this study were (1) to elaborate the intention to use various EMH services for different application purposes and (2) to determine predictors of EMH service acceptance among psychotherapists in clinical training (PiT). Materials and Methods Our paper is based on a secondary data analysis of a cross-sectional survey. Respondents were recruited via recognized educational institutions for psychotherapy within Germany and the German-speaking part of Switzerland between June and July of 2020. The survey contained items on the intention to use different EMH services (i.e., guided and unguided programs, virtual reality, psychotherapy by telephone and videoconference) for various application purposes (i.e., prevention, treatment addition, treatment substitute, aftercare). Potential predictors of EMH service acceptance (e.g., barriers and advantages) were examined based on an extension of the Unified Theory of Acceptance and Use of Technology (UTAUT). Results Most of the n = 216 respondents were female (88.4%) and located in Germany (72.2%). General acceptance of EMH was moderate (M = 3.4, SD = 1.12, range 1–5), while acceptance of psychotherapy via videoconference was highest (M = 3.7, SD = 1.15) and acceptance of unguided programs was lowest (M = 2.55, SD = 1.14). There was an interaction effect of EMH service and application purpose (η2 = 0.21). Barriers and advantages both had a uniform influence on EMH service acceptance (Pr > 0.999), while impersonality, legal concerns, concerns about therapeutic alliance, simplified information provision, simplified contact maintenance, time flexibility, and geographic flexibility were significant predictors (all p < 0.05). Results showed that the extended UTAUT model was the best fitting model to predict EMH service acceptance (Pr > 0.999). Conclusions The intention to use different EMH services varied between application purposes among PiT. To increase acceptance of EMH services and reduce misconceptions, we identified predictors that should be addressed in future acceptance-facilitating interventions when educating PiT.
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The prominence of social influence in predicting Korean counselor adoption-comparable to performance expectancy-contrasts with Western studies where performance expectancy and facilitating conditions often dominate.
“The prominence of social influence in predicting Korean counselor adoption—comparable to performance expectancy—contrasts with Western studies where performance expectancy and facilitating conditions often dominate [46].”
From Exploring Predictors of Counselors’ Acceptance of Virtual Reality Exposure Therapy With Resistance and Job Contexts as Moderators: Cross-Sectional Mixed Methods Study (2025) · cites this paper as [46]
The Introduction (page unavailable) says performance expectancy is supposed to be the strongest predictor, and Results Table 5 finds a larger coefficient for it than for social influence among psychotherapy trainees in Germany and Switzerland. The paper does not establish that facilitating conditions often dominate in Western studies; its own results also identify social influence as a significant predictor, so they do not substantiate the asserted contrast. (LLM, conf=0.86)
Experimental — accuracy not yet measuredAn extended UTAUT study of e-mental health service acceptance among German and Swiss psychotherapists found that effort expectancy and facilitating conditions were not significant predictors, while performance expectancy and context-specific barriers and advantages emerged as primary factors.
“An extended UTAUT study of e–mental health service acceptance among German and Swiss psychotherapists found that effort expectancy and facilitating conditions were not significant predictors, while performance expectancy and context-specific barriers and advantages emerged as primary factors [46].”
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Onlinetherapie bei depressiven Störungen
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Dockweiler, C., Kupitz, A., & Hornberg, C. (2017) · Das Gesundheitswesen · doi:10.1055/s-0043-119287 · Cited by 12 · see citing works
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Richter, L. 1., Silberzahn, T., & McKinsey & Company (Düsseldorf) (n.d.) · Cited by 1 · see citing works
Flagged first, then by citations
2 of the 99 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Bassi, E. M., Bright, K. S., Norman, L., Pintson, K., Daniel, S., Sidhu, S., Gondziola, J., Bradley, J., Fersovitch, M., Stamp, L. K., et al. (2024) · Digital Health · doi:10.1177/20552076241253093 · Cited by 19 · see citing works
“The perceptions of the mental health professionals in our study are consistent with fi ndings which show that certain conditions, as described by therapists, may not be a “ good fi t ” with dMH and MBC. 72 While dMH interventions are increasingly available, there is limited knowledge regarding the effectiveness of dMH f…”
ResultInfluentialTan, C.-H., Koo, A. C., Rahmat, H., Siew, W. F., Cheang, A. W. O., & Sharji, E. A. (2022) · International Journal of Mental Health Promotion · doi:10.32604/ijmhp.2022.025004 · Cited by 13 · see citing works
Braun, P., Schwientek, A.-K., Angerer, P., Guthardt, L., Icks, A., Loerbroks, A., & Apolinário-Hagen, J. (2023) · Digital Health · doi:10.1177/20552076231173568 · Cited by 13 · see citing works
“This early acquisition also seems important in regards to giving future HCPs the possibility to gain practical experience with dMHS during their studies, which has been shown to be a determinant of dMHSs’ acceptance.(17) Second, future HCPs will represent the gatekeepers of healthcare delivery because they are the pri…”
BackgroundResultGupta, N., Leuba, S., Seifritz, E., Berger, T., & Kawohl, W. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1417784 · Cited by 10 · see citing works
Grüneberg, C., Bäuerle, A., Karunakaran, S., Darici, D., Dörrie, N., Teufel, M., Benson, S., & Robitzsch, A. (2024) · JMIR Medical Education · doi:10.2196/58183 · Cited by 9 · see citing works
Veirman, A. E. M. D., Thewissen, V., Spruijt, M. G., & Bolman, C. A. W. (2022) · JMIR Formative Research · doi:10.2196/34754 · Cited by 7 · see citing works
Barker, M., Hews‐Girard, J., Pinston, K., Daniel, S., Volcko, L., Norman, L., Bassi, E. M., Bright, K. S., Hickie, I. B., Iorfino, F., et al. (2025) · Digital Health · doi:10.1177/20552076241310341 · Cited by 6 · see citing works
Stalujanis, E., Engesser, D., Kemmerer, P., Dotzauer, L., der Salm, S. M. A. V., Scheibe, S., Mergenthal, K., Voigt, K., & Singer, S. (2025) · Journal of Medical Internet Research · doi:10.2196/78597 · Cited by 4 · see citing works
“In our study, psychotherapists estimated the need for DHA-MDs as low, which is in line with a previous study [35] conducted with psychotherapists in training, where acceptance of e–mental health services was found to be lowest for unguided programs, comparable to DHA-MDs, conceptualized as…”
Sahan, F., Panitz, K., Wagenaar, C., Kairies‐Schwarz, N., Vomhof, M., Zinn, M., Guthardt, L., Bau, J., Loerbroks, A., Pischke, C. R., et al. (2025) · BMC Family Practice · doi:10.1186/s12875-025-03115-2 · Cited by 5 · see citing works
“The guide was developed grounded in empirical research [45–47] and iteratively refined based on internal feedback.”
Staeck, R., Stüble, M., & Drüge, M. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1296449 · Cited by 4 · see citing works
Neumann, A., König, H., & Hajek, A. (2025) · JMIR Mental Health · doi:10.2196/65238 · Cited by 3 · see citing works
“All of the UTAUT dimensions were identified as determinants of provider attitude, particularly performance expectancy [76,77,80].”
Badeja, D., Schier, F., McGinity, M., & Hoyer, J. (2026) · Psychotherapy Research · doi:10.1080/10503307.2025.2534978 · Cited by 2 · see citing works
“Additionally, applied items were derived from eMH context applications (Baumeister et al., 2020; Braun et al., 2022) rather than strictly from Venka-tesh et al. (2003).”
InfluentialWalter, N., Rupp, M., Delgado, A. R. L., Mena, A. E. C., Hinterberger, T., & Loew, T. H. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.04.020 · Cited by 2 · see citing works
Büsch, K., ten Hoor, G. A., Paschke, K., Thomasius, R., & Arnaud, N. (2025) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-025-02640-w · Cited by 2 · see citing works
“However, previous studies identified higher acceptance for specific types of DMHIs [24, 42] and some degree of heterogeneity among care providers.”
Meyer-Keirath, C., Wallis, H., Kaus, M., Schenk, M., Holzhaus, J., Rometsch, C., Buntrock, C., Apfelbacher, C., & Junne, F. (2026) · Journal of Medical Internet Research · doi:10.2196/89177 · Cited by 2 · see citing works
Yirmiya, K., Refoua, E., Truscott, A., Reeve, H. M., Fonagy, P., & Elyoseph, Z. (2026) · Scientific Reports · doi:10.1038/s41598-026-47934-4 · Cited by 2 · see citing works
“Ratings exceeded thresholds typically indicative of readiness for technology adoption in clinical implementation research e.g. 49,50 .”
Erus, S. M., & Uğur, E. Ç. (2024) · Cukurova University Faculty of Education Journal · doi:10.14812/cuefd.1421214 · Cited by 2 · see citing works
Panitz, K., Wagenaar, C., Sahan, F., Kairies‐Schwarz, N., Guthardt, L., Bau, J., Loerbroks, A., Vomhof, M., Zinn, M., Pischke, C. R., et al. (2026) · Frontiers in Digital Health · doi:10.3389/fdgth.2026.1656614 · Cited by 2 · see citing works
The Use of Mobile Apps in Adolescent Psychotherapy: Assessment of Psychotherapists’ Perspectives
Wüllner, S., Hermenau, K., Hecker, T., & Siniatchkin, M. (2025) · JMIR Formative Research · doi:10.2196/65788 · Cited by 1 · see citing works
“Like the development of the LAMH model, previous research on drivers and barriers has primarily focused on the theoretical perspectives of psychotherapists [9,24,44,45,47].”
Kneubühler, A. M., von Känel, E., Grgić, K., Munkovic, E., Berger, T., & Bielinski, L. L. (2026) · JMIR Mental Health · doi:10.2196/78079 · Cited by 1 · see citing works
“A mean value was calculated from all 3 items to quantify the acceptance of BT. Based on prior research [22], the mean acceptance score was categorized as low (”
InfluentialBlended Care für Jugendliche mit depressiven Erkrankungen aus der Sicht von Behandelnden
Lincke, L., Kilb, H., Martin-Döring, T., Bienioschek, S., Nolkemper, D., Daunke, A., Reis, O., & Kölch, M. G. (2025) · Kindheit und Entwicklung · doi:10.1026/0942-5403/a000484 · Cited by 1 · see citing works
Kim, M., Jeon, M., Lee, Y., Lee, S., Kim, H., & Jung, D. (2025) · Journal of Medical Internet Research · doi:10.2196/81803
“An extended UTAUT study of e–mental health service acceptance among German and Swiss psychotherapists found that effort expectancy and facilitating conditions were not significant predictors, while performance expectancy and context-specific barriers and advantages emerged as primary factors [46].”
Mayer, G., Lemmer, D., von Koenigsmarck, B. G., Friederich, H., & Bauer, S. (2026) · Journal of Eating Disorders · doi:10.1186/s40337-025-01518-1
Towards co-located multi-user mixed reality exposure therapy for anxiety disorders
Schier, F., Badeja, D., Hoyer, J., & McGinity, M. (2026) · Virtual Reality · doi:10.1007/s10055-025-01279-x
“Questions were adapted from Venkatesh et al. ( 2003 ) and Hennemann et al. ( 2017 ), implemented as in Braun et al. ( 2022 ) and Baumeister et al. ( 2020 ) to provide a balanced yet efficient assessment.”
InfluentialSchwientek, A.-K., Drüge, M., Terhorst, Y., Kabrel, M., Sahan, F., & Apolinário-Hagen, J. (2026) · Advances in experimental medicine and biology · doi:10.1007/978-981-95-6872-7_29
Responsibly adopting workplace mental well-being platforms
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Volland, C., Plescher, F., Raszke, P., Friedrich, L., Speckemeier, C., Schlierenkamp, S., Minor, M., Abels, C., Höfer, K., Wasem, J., et al. (2026) · Journal of Medical Internet Research · doi:10.2196/99203
“This aligns with findings by Braun et al [41], who demonstrate that the acceptance of e-mental health services among psychotherapists is shaped by social influence.”
Unlocking New Avenues in Inpatient Care: The Digital Mental Health transformation in India
Devulkar, N., Ray, S. P., Nadaf, H. K., Nadaf, H., & Jabade, M. (2026) · Investigación y Educación en Enfermería · doi:10.17533/udea.iee.v44n2e06
- Authors
- Braun, P., Drüge, M., Hennemann, S., Nitsch, F. J., Staeck, R., & Apolinário-Hagen, J.
- Affiliations
- Heinrich Heine University Düsseldorf (DE)
- University of Zurich (CH)
- Johannes Gutenberg University Mainz (DE)
- INSEAD (FR)
- Corresponding author
- Braun, Pia
- ORCID
- Venue
- Frontiers in Digital Health
- Publisher
- Frontiers Media SA
- Published
- 2022-02-28
- Volume
- 4
- Pages
- 840869-840869
- ISSN
- 2673-253X (ISSN-L)
- PMC
- PMC8918841
- OpenAlex
- W4214656451
- Cited by
- 27
- References
- 99
- Citations by year
- 2026: 10 · 2025: 8 · 2024: 6 · 2023: 1 · 2022: 2
- FWCI
- 3.75
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Digital Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- Heinrich-Heine-Universität Düsseldorf
- 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 › Social Psychology › Mental Health Treatment and Access
- Keywords
- psychotherapists, clinical teaching, technology acceptance, UTAUT, intention to use, telephone psychotherapy, virtual reality therapy, therapeutic relationship, follow-up care, prevention, psychotherapy training, Germany, Switzerland, cross-national comparison, digital mental health
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