Blended e-Health in Cognitive Behavioural Therapy: Usage Intensity, Attitude and Therapeutic Alliance in Clinical Practice
Open accessAbstract
Background: Though internet based cognitive behaviour therapy is proven to be effective, e-health is applied only in a minority of treatments in specialised mental health care. The low application rates are associated with therapists’ attitudes towards e-health. One of the major concerns is limitations in the therapeutic relation and communication between patient and therapist. Since therapist involvement is important in an effective e-health treatment, negative attitudes towards e-health can be a risk for effective e-health application. Aims: This study aimed to examine the relationship between patients’ e-health usage as well as patients’ attitudes towards e-health and the therapeutic alliance. The possible influence of therapists’ attitudes on patients’ e-health usage is also examined. Method: In an outpatient mental health setting, patients attended a blended treatment program for major depressive disorder and completed questionnaires on attitudes towards e-health and the therapeutic alliance. Therapists completed an alliance and attitude questionnaire as well. Results: Patients with more positive attitudes used the e-health application more intensively. Higher work alliance rates were related to sharing digital homework assignments and seeking contact with their therapist. Also, when treated by therapists with more positive attitudes towards e-health, patients shared more assignments with their therapist. Patients with high symptom rates at start, had more negative attitude rates and tended to use the e-health application less frequently. Conclusions: In a treatment cohesion in which therapists are positive about blended e-health, patients’ attitudes are positively related to e-health usage and therefore a factor of interest in improvement of effective e-health application. Patients with severe symptoms may need extra attention like active support and iteration to promote adherence to the e-health program.
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The blended care delivery model used in this study could have provided a sense of connectedness with the research team for the participants.
“The blended care delivery model used in this study, although simple, promoting knowledge that the research team is only one phone call or text message away, could also have provided a sense of connectedness with the research team for the participants [62,63].”
From Short-Term Findings From Testing EPIO, a Digital Self-Management Program for People Living With Chronic Pain: Randomized Controlled Trial (2023) · cites this paper as [62]
The Intervention section describes blended face-to-face and online care in which patients could message their therapist. The Discussion reports that a stronger therapeutic alliance was associated with more therapist contact. These passages support a possible connection through blended care, but they do not address participants feeling connected to a research team or being able to reach it by phone or text. (LLM, conf=0.82)
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- Authors
- Aerts, J. E. M., & Dam, A. V.
- Affiliations
- Tilburg University (NL)
- Venue
- Psychology
- Publisher
- Scientific Research Publishing, Inc.
- Published
- 2018
- Volume
- 09
- Issue
- 10
- Pages
- 2422-2435
- ISSN
- 2152-7180 (ISSN-L)
- 2152-7199
- OpenAlex
- W2889916527
- Cited by
- 16
- References
- 42
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 5 · 2023: 3 · 2022: 1 · 2021: 1 · 2019: 2
- FWCI
- 0.95
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Psychology (publishedVersion, cc-by)
- Research portal (Tilburg University) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (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
- internet-based cognitive behavioral therapy, therapeutic relationship, major depressive disorder, therapist attitudes, outpatient psychiatric care, medication adherence
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