Why Uptake of Blended Internet-Based Interventions for Depression Is Challenging: A Qualitative Study on Therapists’ Perspectives

Abstract

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.

Barriers and Facilitators for Referrals of Primary Care Patients to Blended Internet-Based Psychotherapy for Depression: Mixed Methods Study of General Practitioners’ Views

“…The interviewed GPs reported not to be familiar with bPT, to have little knowledge of it, and to prefer more information and training. This is in accordance with the results of studies on bPT in GPs [ 58 ] and psychotherapists [ 56 ] and stand-alone IMIs in GPs [ 42 , 60 ] and health professionals [ 61 ]. GPs also asked for more feedback and professional exchange regarding the treatment, consistent with requests by professionals in previous research on IMIs [ 57 ] and with GPs’ reported facilitators for referrals to IMIs [ 41 ].…”

“…The most frequently named barriers by the interviewed GPs concerned the use of new technologies within blended treatments, as most assumed that some patients would not be familiar with internet and technology or would be skeptical and uncertain as to whether an internet-based intervention could help them. These findings are in line with earlier research on barriers to the use of bPT by psychotherapists [ 34 , 35 , 55 , 56 ] as well as IMIs by clinicians (psychiatrists or GPs or psychologists) [ 57 ] or by GPs [ 42 ]. Furthermore, GPs’ concerns regarding data safety were also mentioned in previous research on bPT by GPs [ 58 ] and psychotherapists [ 34 , 35 , 55 ] as well as on IMIs by GPs [ 42 ] and psychotherapists [ 59 ].…”

“…GPs’ attitudes that patients are suitable for bPT if they are familiar with modern technologies or are affected by minor-to-moderate depression were in line with previous research on bPT with psychotherapists [ 34 , 35 , 56 ] and GPs [ 58 ] and on IMIs with professionals [ 57 , 61 ]. The latter corresponds with treatment guidelines for depression [ 7 , 8 ].…”

Organisational Implementation Climate in implementing internet-based Cognitive Behaviour Therapy for depression

“…Of particular interest is the concept of organisational implementation climate which can be de ned as the shared meaning (or disagreement) staff members attach to organisational events, practices and procedures they experience and the behaviours they see being rewarded, supported, and expected in implementing evidencebased practices [23][24][25][26]. Organisational implementation climates are possibly relevant to investigate as they are known to shape staff members' attitudes towards adopting and implementing evidence-based interventions into daily practice [24,25,27] and professionals perceptions are of particular interest in successfully implementing new interventions [28,29].…”

Innovative Technology Based Interventions for Psychological Treatment of Common Mental Disorders

“…Despite the challenges, the authors are highly optimistic about the potential of DMHS to reduce the global burden of the high prevalence of mental health disorders. Elaborating on dissemination of Internet-delivered treatment in routine care, the paper of Mol et al [ 4 ] describes a qualitative study targeting therapists’ perspectives of blended Internet-delivered interventions, specifically, cognitive behavioural therapy (CBT). In blended Internet-delivered interventions, face-to-face treatment with a therapist was combined with online therapy.…”