JMIR Publications

ABSTRACT

Background:

Blended care therapy models are intended to increase the efficiency and effectiveness of evidence-based psychotherapy by combining synchronous and asynchronous components of care.

Objective:

This retrospective cohort study evaluated the clinical effects of synchronous video therapy sessions and asynchronous guided practice session elements on anxiety and depression in a blended care therapy program, with a novel focus on asynchronous provider feedback messages.

Methods:

Participants were N=33,492 adults with clinical symptoms of anxiety (Generalized Anxiety Disorder-7 (GAD-7) score ≥8) and/or depression (Patient Health Questionnaire-9 (PHQ-9) score ≥10) at intake. Symptom trajectories were evaluated via individual growth curve models. Time-varying covariates evaluated effects of synchronous video session attendance and the presence/absence of each guided practice session element occurring within 7 days and 8-14 days prior to each outcome assessment. Guided practice session elements included client digital lesson completion, client digital exercise completion, and feedback messages sent by providers.

Results:

86.6% of clients met criteria for clinical improvement by end of care (median 6 synchronous sessions (IQR 4-8)). Synchronous video session attendance and client digital lesson completion in the past 7 days and the past 8-14 days were each uniquely and significantly associated with lower GAD-7 and PHQ-9 scores (Ps<.001). Client digital exercise completion in the past 8-14 days was significantly associated with lower GAD-7 scores (P<.001), but exercise completion in the 7 days prior to outcome assessment was not (P=.89). Exercise completion in the past 7 days was significantly associated with lower PHQ-9 scores (P<.001), but exercise completion in the past 8-14 days was not (P=.09). Provider feedback messaging in the past 7 days and 8-14 days was significantly associated with lower GAD-7 and PHQ-9 scores, respectively (Ps≤.01).

Conclusions:

Provider feedback between synchronous therapy sessions provided significant benefit for symptom reduction, beyond the effects of client digital engagement and synchronous video sessions. With guided practice sessions well-integrated into care, blended care therapy provides meaningful improvements upon the traditional, synchronous-session-only therapy model. Provider guidance and feedback for clients between synchronous sessions supports more efficient and effective mental health care overall.