Blending Face-to-Face and Internet-Based Interventions for the Treatment of Mental Disorders in Adults: Systematic Review

Abstract

BackgroundMany studies have provided evidence for the effectiveness of Internet-based stand-alone interventions for mental disorders. A newer form of intervention combines the strengths of face-to-face (f2f) and Internet approaches (blended interventions).ObjectiveThe aim of this review was to provide an overview of (1) the different formats of blended treatments for adults, (2) the stage of treatment in which these are applied, (3) their objective in combining face-to-face and Internet-based approaches, and (4) their effectiveness.MethodsStudies on blended concepts were identified through systematic searches in the MEDLINE, PsycINFO, Cochrane, and PubMed databases. Keywords included terms indicating face-to-face interventions (“inpatient,” “outpatient,” “face-to-face,” or “residential treatment”), which were combined with terms indicating Internet treatment (“internet,” “online,” or “web”) and terms indicating mental disorders (“mental health,” “depression,” “anxiety,” or “substance abuse”). We focused on three of the most common mental disorders (depression, anxiety, and substance abuse).ResultsWe identified 64 publications describing 44 studies, 27 of which were randomized controlled trials (RCTs). Results suggest that, compared with stand-alone face-to-face therapy, blended therapy may save clinician time, lead to lower dropout rates and greater abstinence rates of patients with substance abuse, or help maintain initially achieved changes within psychotherapy in the long-term effects of inpatient therapy. However, there is a lack of comparative outcome studies investigating the superiority of the outcomes of blended treatments in comparison with classic face-to-face or Internet-based treatments, as well as of studies identifying the optimal ratio of face-to-face and Internet sessions.ConclusionsSeveral studies have shown that, for common mental health disorders, blended interventions are feasible and can be more effective compared with no treatment controls. However, more RCTs on effectiveness and cost-effectiveness of blended treatments, especially compared with nonblended treatments are necessary.

Therapist-related feasibility of blended group therapy (bGT): Mixed methods study of a brief online- and mobile-supported group intervention for major depression (Preprint)

“…To further increase treatment success, different forms of online aftercare [23,24] could easily be integrated into bGT. As long term treatment effects on depression have not been investigated yet, further research is warranted.…”

“…After a follow-up period of three months, the reduction of self-reported depression (CES-D) remained stable (F (1,23.556) = 29.98, p < .001), and 78% of participants exhibited reliable change (RCI) (deteriorations = 7.4 %). Regarding self-reported psychological distress (GHQ-12), participants showed a significant decrease from pre-to follow-up, F (1,22.758) = 4.82, p = .039, and reliable change (RCI) was found in 52% of participants (deteriorations = 11.1 %).…”

“…computer-, or mobilesupported interventions) the spectrum of possible applications ranges from adjuncts to psychotherapy [22], which can be applied prior, after or during treatment [23,24], to more integrated forms of therapy, in which online-or mobile-elements and personal sessions are more deeply intertwined into one treatment rationale [25][26][27]. A growing number of studies shows that blended interventions can lead to shortened treatments, in which less therapist time is needed to achieve substantial effects [23,26,28]. Simultaneously, online-or mobileelements can be deployed in order to optimize the therapeutic process, to foster transfer, and to boost effects of classical treatments.…”

“…While most blended research focuses on individual therapy [23], less is known about its potential for group therapy. Psychological groups have a broad range of applications in inand outpatient settings [33]; and the spectrum ranges from informational groups, over psychoeducational groups, to group counselling and group psychotherapy [34].…”

Therapeutic alliance and different treatment formats when delivering internet-based CBT for depression

“…It has the advantage of preserving the face-to-face relation with patients and individualizing treatment, with the addition of easily accessible and well-structured online material. Recent attempts have been made to differentiate between integrated blended interventions, where online material and face-to-face session are provided within the same time period, and sequential blended interventions where online material is provided before or after face-to-face treatment such as in stepped care approaches (Erbe, Eichert, Riper, & Ebert, 2017). Erbe and colleagues would consider the blended treatment used in Paper IV an integrated blended intervention based on their definition.…”