Why uptake of blended internet-based interventions for depression is challenging: a qualitative study on therapists’ perspectives
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(1) Background: Blended cognitive behavioral therapy (bCBT; online and face-to-face sessions) seems a promising alternative alongside regular face-to-face CBT depression treatment in specialized mental health care organizations. Therapists are key in the uptake of bCBT. This study focuses on therapists’ perspectives on usability, satisfaction, and factors that promote or hinder the use of bCBT in routine practice; (2) Methods: Three focus groups (n = 8, n = 7, n = 6) and semi-structured in-depth interviews (n = 15) were held throughout the Netherlands. Beforehand, the participating therapists (n = 36) completed online questionnaires on usability and satisfaction. Interviews were analyzed by thematic analysis; (3) Results: Therapists found the usability sufficient and were generally satisfied with providing bCBT. The thematic analysis showed three main themes on promoting and hindering factors: (1) therapists’ needs regarding bCBT uptake, (2) therapists’ role in motivating patients for bCBT, and (3) therapists’ experiences with bCBT; (4) Conclusions: Overall, therapists were positive; bCBT can be offered by all CBT-trained therapists and future higher uptake is expected. Especially the pre-set structure of bCBT was found beneficial for both therapists and patients. Nevertheless, therapists did not experience promised time-savings—rather, the opposite. Besides, there are still teething problems and therapeutic shortcomings that need improvement in order to motivate therapists to use bCBT.
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Adequate 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 [31]
The Results (§3.3, page unavailable) say therapists needed more ongoing support after fragmented training and that time constraints were the most frequently cited barrier to blended CBT uptake. The Discussion (§4.2, page unavailable) also reports that online feedback was time-consuming. The evidence comes from therapists at seven Dutch mental health organizations using blended CBT for depression, so it does not establish the same priorities for European mental health professionals generally or for all DMHIs. (LLM, conf=0.86)
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 [31]
The Background (page unavailable) describes the potential for blended CBT to save therapist time and allow more patients to be treated, but also says uptake in routine care remains limited. The Discussion §4.3 reports therapists’ perceptions of better protocol adherence and possible future acceptance; the Results §3.3 say many therapists doubted it would save time or shorten waiting lists. The paper therefore supports potential benefits, not an established claim that blended care is scalable or increases DMHI uptake and client engagement. (LLM, conf=0.86)
Experimental — accuracy not yet measuredFindings 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 [31]
The Results (§3.2) report that 94% of participating therapists were mostly or very satisfied with blended CBT, supporting acceptability among therapists in the Netherlands before the pandemic. The Methods (§2.1) identify participants as CBT-trained psychologists, mental health nurses, or psychiatrists. This paper does not provide findings from Germany or Denmark, or from during COVID-19. (LLM, conf=0.88)
Experimental — accuracy not yet measuredEuropean 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].”
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- Authors
- Mol, M., van Genugten, C., Dozeman, E., van Schaik, D. J. F., Draisma, S., Riper, H., & Smit, J. H.
- Affiliations
- Amsterdam Public Health (NL)
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, 1081 Amsterdam, The Netherlands
- University of Southern Denmark (DK)
- Corresponding author
- Mol, Mayke
- ORCID
- Venue
- Journal of Clinical Medicine
- Publisher
- MDPI AG
- Published
- 2019-12-30
- Volume
- 9
- Issue
- 1
- Pages
- 91
- ISSN
- 2077-0383 (ISSN-L)
- PMC
- PMC7019532
- OpenAlex
- W2996846236
- Cited by
- 61
- References
- 39
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 12 · 2023: 7 · 2022: 13 · 2021: 7 · 2020: 5 · 2018: 1
- FWCI
- 7.06
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Clinical Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, cc-by)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- VU Research Portal (publishedVersion, other-oa)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- European Commission (621000)
- 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
- depression treatment, online intervention, therapist perspectives, implementation barriers and facilitators, usability, therapist satisfaction, patient motivation, time savings, mental health care organization
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