What patients and therapists expect in a blended cognitive behavioral therapy (bCBT) program for depression?: Results from a formative qualitative study (Preprint)

BACKGROUND Blended cognitive behavioral therapy (bCBT)—the combination of digital elements and face-to-face psychotherapy—has been proposed to alleviate challenges patients and therapists face in conventional CBT. There is growing evidence that adding digital elements to face-to-face psychotherapy can contribute to better treatment outcomes. However, bCBT programs still show considerable shortcomings and knowledge on how to improve digital applications using a bCBT protocol is limited. OBJECTIVE This study aims to inductively identify functions and qualities that are expected from a bCBT treatment for depression in the eyes of patients and psychotherapists who were not currently receiving or practicing bCBT treatment. METHODS We employed a qualitative exploratory study design and conducted semi-structured interviews with 23 psychotherapists as well as 11 patients with a primary diagnosis of depression and currently undergoing CBT treatment. Themes and categories were established inductively from transcribed interview records based on a rigorous coding method. RESULTS Both therapists and patients expected a digital application to provide patients the opportunity to track their mood, work on therapeutic homework activities, easily access an intervention set for harder moments and efficiently facilitate administrative tasks. The desire to be able to customize bCBT protocols to individual patient circumstances was evident in both patient and therapist interviews. Patients differed with respect to what content and the amount of material the app should focus on as well as the method of recording experiences. Therapists viewed digital applications as potentially aiding in their documentation work outside of sessions. Different attitudes surfaced on the topic of data security, with patients not as concerned as therapists. CONCLUSIONS Both patients and therapists had substantially positive attitudes towards the option of an integrated bCBT treatment. Our study presents novel findings on the expectations and attitudes of patients and therapists.