Patients' Experiences of Web- and Mobile-Assisted Group Therapy for Depression and Implications of the Group Setting: Qualitative Follow-Up Study

Raphael Schuster; Sophia Sigl; Thomas Berger; Anton-Rupert Laireiter

doi:10.2196/mental.9613

Patients' Experiences of Web- and Mobile-Assisted Group Therapy for Depression and Implications of the Group Setting: Qualitative Follow-Up Study

JMIR Ment Health. 2018 Jul 11;5(3):e49. doi: 10.2196/mental.9613.

Authors

Raphael Schuster^#¹, Sophia Sigl², Thomas Berger³, Anton-Rupert Laireiter^{1

2}

Affiliations

¹ Center for Clinical Psychology, Psychotherapy and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria.
² Faculty of Psychology, University of Vienna, Vienna, Austria.
³ Department of Clinical Psychology and Psychotherapy, University of Berne, Berne, Switzerland.

^# Contributed equally.

Abstract

Background: Blended group therapy combines group sessions with Web- and mobile-based treatment modules. Consequently, blended group therapy widens the choice within blended interventions at reasonable costs. This is the first qualitative study on blended group therapy.

Objective: The objective of this study was to investigate the patient-centered feasibility of blended group therapy for major depression, with special emphasis on the fit and dynamic interplay between face-to-face and internet-based elements.

Methods: A total of 22 patients who had a variety of experiences through participating in one of the two blended group therapy interventions were interviewed following a semistructured interview guide. In-depth interviews were analyzed by three trained psychologists, using thematic analysis and a rule-guided internet-based program (QCAmap). The transcript of the interviews (113,555 words) was reduced to 1081 coded units, with subsequent extraction of 16 themes.

Results: Web- and mobile-based elements were described as a treatment facilitator and motivator, increasing the salience and consolidation of cognitive behavioral therapy materials, resulting in in- and inter-session alignment to the treatment. Additionally, patients valued the option of intimate Web-based self-disclosure (by lateral patient-therapist communication), and therapists were provided with tools for between-session monitoring and reinforcement of exercising. In this context, group phenomena seemed to back up therapists' efforts to increase treatment engagement. The dissonance because of noncompliance with Web-based tasks and the constriction of in-session group interaction were considered as possible negative effects. Finally, issues of tailoring and structure seemed to fulfill different preconditions compared with individual therapy.

Conclusions: Blended group therapy constitutes a structured and proactive approach to work with depression, and the integration of both modalities initiates a beneficial interplay. Results support the patient-centered value of blended group therapy and provide the first insight into blended group therapy's role in fostering therapeutic treatment factors. However, potential negative effects should be considered carefully.

Keywords: blended therapy; cognitive behavioral therapy; computer-assisted therapy; depression; internet; smartphone-assisted therapy; therapeutic process; working alliance.

©Raphael Schuster, Sophia Sigl, Thomas Berger, Anton-Rupert Laireiter. Originally published in JMIR Mental Health (http://mental.jmir.org), 11.07.2018.