Blending Face-to-Face and Internet-Based Interventions for the Treatment of Mental Disorders in Adults: Systematic Review

• Published in: Journal of medical Internet research Vol. 19; no. 9; p. e306
• Main Authors: Erbe, Doris, Eichert, Hans-Christoph, Riper, Heleen, Ebert, David Daniel
• Format: Journal Article
• Language: English
• Published: Canada Gunther Eysenbach MD MPH, Associate Professor 15-09-2017; JMIR Publications
• Subjects: Abstinence; Adult; Anxiety; Anxiety disorders; Clinical trials; Concepts; Cost analysis; Dropping out; Drug abuse; Effectiveness; Female; Humans; Inpatient care; Internet; Internet - statistics & numerical data; Intervention; Long term; Male; Medical research; Mental depression; Mental disorders; Mental Disorders - therapy; Mental health; Mental health services; Original Paper; Outpatient treatment; Psychotherapy; Psychotherapy - methods; Residential institutions; Residential treatment; Substance abuse; Suicides & suicide attempts; Systematic review; Therapy; Treatment methods; Treatment outcomes; blended treatment; Internet; psychotherapy; mental health
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/jmir.6588

Many studies have provided evidence for the effectiveness of Internet-based stand-alone interventions for mental disorders. A newer form of intervention combines the strengths of face-to-face (f2f) and Internet approaches (blended interventions).
The aim of this review was to provide an overview of (1) the different formats of blended treatments for adults, (2) the stage of treatment in which these are applied, (3) their objective in combining face-to-face and Internet-based approaches, and (4) their effectiveness.
Studies on blended concepts were identified through systematic searches in the MEDLINE, PsycINFO, Cochrane, and PubMed databases. Keywords included terms indicating face-to-face interventions ("inpatient," "outpatient," "face-to-face," or "residential treatment"), which were combined with terms indicating Internet treatment ("internet," "online," or "web") and terms indicating mental disorders ("mental health," "depression," "anxiety," or "substance abuse"). We focused on three of the most common mental disorders (depression, anxiety, and substance abuse).
We identified 64 publications describing 44 studies, 27 of which were randomized controlled trials (RCTs). Results suggest that, compared with stand-alone face-to-face therapy, blended therapy may save clinician time, lead to lower dropout rates and greater abstinence rates of patients with substance abuse, or help maintain initially achieved changes within psychotherapy in the long-term effects of inpatient therapy. However, there is a lack of comparative outcome studies investigating the superiority of the outcomes of blended treatments in comparison with classic face-to-face or Internet-based treatments, as well as of studies identifying the optimal ratio of face-to-face and Internet sessions.
Several studies have shown that, for common mental health disorders, blended interventions are feasible and can be more effective compared with no treatment controls. However, more RCTs on effectiveness and cost-effectiveness of blended treatments, especially compared with nonblended treatments are necessary.