title: Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study.
abstract: BACKGROUND
  Blending online modules into face-to-face therapy offers perspectives to enhance patient self-management and to increase the (cost-)effectiveness of therapy, while still providing the support patients need. The aim of this study was to outline optimal usage of blended care for depression, according to patients and therapists.
  
  
  METHODS
  A Delphi method was used to find consensus on suitable blended protocols (content, sequence and ratio). Phase 1 was an explorative phase, conducted in two rounds of online questionnaires, in which patients' and therapists' preferences and opinions about online psychotherapy were surveyed. In phase 2, data from phase 1 was used in face-to-face interviews with therapists to investigate how blended therapy protocols could be set up and what essential preconditions would be.
  
  
  RESULTS
  Twelve therapists and nine patients completed the surveys. Blended therapy was positively perceived among all respondents, especially to enhance the self-management of patients. According to most respondents, practical therapy components (assignments, diaries and psycho-education) may be provided via online modules, while process-related components (introduction, evaluation and discussing thoughts and feelings), should be supported face-to-face. The preferred blend of online and face-to-face sessions differs between therapists and patients; most therapists prefer 75% face-to-face sessions, most patients 50 to 60%. The interviews showed that tailoring treatment to individual patients is essential in secondary mental health care, due to the complexity of their problems. The amount and ratio of online modules needs to be adjusted according to the patient's problems, skills and characteristics. Therapists themselves should also develop skills to integrate online and face-to-face sessions.
  
  
  CONCLUSIONS
  Blending online and face-to-face sessions in an integrated depression therapy is viewed as a positive innovation by patients and therapists. Following a standard blended protocol, however, would be difficult in secondary mental health care. A database of online modules could provide flexibility to tailor treatment to individual patients, which asks motivation and skills of both patients and therapists. Further research is necessary to determine the (cost-)effectiveness of blended care, but this study provides starting points and preconditions to blend online and face-to-face sessions and create a treatment combining the best of both worlds.
authors.affiliation: Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands. r.vandervaart@fsw.leidenuniv.nl.|Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands. r.vandervaart@fsw.leidenuniv.nl.
authors.forename: Rosalie
authors.initials: R
authors.lastname: van der Vaart
authors.affiliation: Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands. m.witting@saxion.nl.|Lectorate Community Care & Youth, Saxion University of Applied Sciences, Enschede, the Netherlands. m.witting@saxion.nl.
authors.forename: Marjon
authors.initials: M
authors.lastname: Witting
authors.affiliation: Department of Clinical Psychology, VU University Amsterdam, Amsterdam, the Netherlands. h.riper@vu.nl.
authors.forename: Heleen
authors.initials: H
authors.lastname: Riper
authors.affiliation: Department of Clinical Psychology, VU University Amsterdam, Amsterdam, the Netherlands. l.c.kooistra@vu.nl.
authors.forename: Lisa
authors.initials: L
authors.lastname: Kooistra
authors.affiliation: Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands. e.t.bohlmeijer@utwente.nl.
authors.forename: Ernst T
authors.initials: ET
authors.lastname: Bohlmeijer
authors.affiliation: Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands. j.e.w.c.vangemert-pijnen@utwente.nl.
authors.forename: Lisette J E W C
authors.initials: LJ
authors.lastname: van Gemert-Pijnen
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002985:Clinical Protocols; D032921:Consensus; D003362:Cost-Benefit Analysis; D003697:Delphi Technique; D003866:Depressive Disorder / Q000191:economics / Q000523:psychology / Q000628:therapy*; D005260:Female; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009042:Motivation; D057240:Patient Preference; D017060:Patient Satisfaction; D010549:Personal Satisfaction; D011613:Psychotherapy / Q000191:economics / Q000379:methods*; D019114:Remote Consultation / Q000379:methods*; D012648:Self Care / Q000191:economics / Q000379:methods; D011795:Surveys and Questionnaires; D055815:Young Adult