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Patients' perspectives on implementing fixed and flexible variants of blended therapy in routine care: A qualitative

Theresa Sextl-Plötz^1,2, Ingrid Titzler³, Juliane Schmidt-Hantke²

¹Department of Sports and Health Sciences, Professorship Psychology and Digital Mental Health Care, Technical University of Munich, Munich, Germany.

|September 22, 2025

Abstract

Objective:

Research on effective implementation options and key factors in blending face-to-face (FTF) psychotherapy with online treatment elements (i.e., blended therapy, BT) remains limited. This study aimed to explore patients' experiences and to identify relevant factors in implementing BT in routine care.

Methods:

Qualitative semi-structured interviews were conducted with 40 patients (10.7% of N = 375) from the PSYCHOnlineTHERAPY trial. The patients were adults with diagnosed anxiety or depressive disorders and received one of two versions of BT based on cognitive behavioral therapy, differing in the flexibility to decide on the sequence and ratio of BT elements (FTF sessions and online self-help sessions). The interviews were audio-recorded, transcribed, and analyzed using a deductive-inductive qualitative content analysis approach, partly theory-based on the "Efficiency Model of Support."

Results:

The analysis revealed 163 theme codes, categorized into 30 subcategories. The main categories were "motivation and expectations," "active components, mechanisms of change, and effects," "blending scenarios," "therapeutic alliance," "negative effects," "fit," "facilitators and barriers for engagement and daily life transfer," "usability," and "optimization possibilities." Key findings highlight positive outcomes of BT, the important role of the therapist, the transformative interaction of FTF and online sessions, and the distinctive functions and benefits of each element, suggesting BT's added value over stand-alone treatments. Various patient, therapeutic, and treatment characteristics emerged as relevant facilitators and barriers across different domains. Heterogeneity in patient preferences emphasized the importance of personalization.

Conclusion:

Overall, these results provide valuable insights for the practical implementation and further research on BT.

Trial Registration:

German clinical trial register (DRKS00023973, date of registration: December 28, 2020), https://www.drks.de/search/de/trial/DRKS00023973.

Keywords:

Blended therapy anxiety depression patients’ perspectives routine care

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