Therapists' time allocation in guided digital mental health interventions - A scoping review and case study

Digital Mental Health Interventions (DMHIs) that include therapist support achieve higher adherence and greater effectiveness than fully self-help applications. Compared to face-to-face therapy, guided DMHIs can expand access by reducing the amount of therapist time required while still supporting a therapeutic relationship. However, "therapist time" is operationalised inconsistently. Many studies appear to report only direct patient contact (e.g., messaging, calls) or platform-based monitoring, leaving uncertainty about whether other patient-related tasks, such as documentation, are included.This scoping review examined how much therapist or other health-care professional (HCP) time is reported when delivering guided DMHIs or stepped/blended care interventions with a core digital component. A secondary aim was to describe the categories of time allocated. A case study from the Norwegian eTreatment service complemented the review.

Following PRISMA-ScR guidelines, we searched for studies that quantitatively reported therapist or HCP time in guided or blended DMHIs. Eligible studies were in English, used a core digital treatment component with human support, and targeted mental health conditions. Pure self-help apps and teletherapy-only interventions were excluded.

Fifty-four studies published between 2005 and 2026 were included. Therapists spent a mean of 214.57 min (3 h 35 m; SD 214.76; range 46-1198; median 146; IQR 142.98) per patient per intervention, with an average program duration of 10.6 weeks. Forty-eight studies quantified only direct patient-related work such as calls, messaging, or platform monitoring. Other time categories were rarely quantified. In the case study, 73.7% of patient-related time occurred outside the platform, including diagnostic interviews.

Studies predominantly report direct contact and monitoring, likely underestimating actual time use. Still, guided DMHIs appear to offer meaningful time savings compared to face-to-face therapy. More comprehensive reporting of direct, indirect, and administrative time would better support scaling and implementation.