JMIR Publications

ABSTRACT

Background:

Blending online with face-to-face psychological interventions (blended therapy) provides an opportunity to increase access to treatment, improve therapy uptake and adherence due to added flexibility for patients resulting in better therapy outcomes. However, research is scarce regarding structure, content and ratio of blended therapy components to inform future blended therapy models.

Objective:

This systematic review synthesises the blended therapy intervention literature to identify and assess the structure, content and ratio of face to face and online sessions presented in blended therapy models for treatment of psychological disorders in adult patients. The review also assessed intervention outcomes.

Methods:

PsycINFO; CINAHL; EMBASE; ProQuest; MEDLINE databases were searched using keywords and MeSH terms related to blended therapy (e.g. ‘blended’; ‘face-to-face’; ‘online’; ‘psychological distress or disorder’). Review eligibility included articles published in English to March 2023 which described digital and face-to-face elements as part of one intervention plan for treating psychological disorders in adult patients. Quantitative data was analysed using narrative synthesis. A coding framework was developed to characterise the structure and content of blended therapy interventions. Qualitative data related to barriers and facilitators to blended therapy intervention implementation was thematically analysed. The review was registered with PROSPERO (CRD42021258977) and followed the PRISMA guidelines.

Results:

Database searches identified 8436 articles and data was extracted from 29 studies. Structure and content distribution of blended therapy interventions were analysed and classified according to: i) mode of interaction between digital/face-to-face components (integrated vs sequential); ii) role of the components in the treatment (core vs supplementary); iii) mode of component delivery (alternate vs case-by-case) and iv) digital materials assignment mode (standardised vs personalised). Our findings suggest that a blended intervention presenting integrated; alternate; core and standardised design provides an optimal balance between effectiveness and engagement. Most studies (n=24) reported data for blended therapy interventions based on Cognitive Behavioural Therapy approaches for treatment of anxiety and/or depression. Blended therapy was reported to be more effective or non-inferior to face-to-face treatment, with high working alliance; high patient satisfaction; high uptake and adherence rates.

Conclusions:

This review confirmed blended therapy models with face to face and online components integrated into treatment and delivered in an alternating presentation are both feasible to deliver and result in higher patient adherence to treatment. Future studies assessing outcomes across different psychological disorders and therapeutic approaches are required.