In July 2015, we started with the recruitment of patients for the E-Compared trial in the Netherlands where blended treatment is compared to usual care for depression in routine specialized mental healthcare. Within the blended treatment, Cognitive Behavioural Therapy (CBT) is provided by integrating individual face-to-face sessions and online sessions delivered via the Moodbuster platform. The treatment is also supported by a mobile application, for the monitoring of patients’ state and for motivational messages and reminders. Patients receive weekly alternating face-to-face (10) and online sessions (9) over a period of 19-20 weeks. For patients allocated to ‘treatment as usual’, we will not interfere with usual care provided at the participating mental health centres, but we do monitor carefully treatment utilisation.

bCBT training

All participating therapist from the different treatment locations are trained in the blended treatment by the research team. During the training, therapists learn:

  • how to use and work with the online platform Moodbuster
  • how to deliver the blended treatment
  • skills for written feedback

Therapists are provided with manuals for the online platform (therapist and patient portal) and the mobile app, where all functions are described in detail. Also, a treatment manual is made available with guidelines for the face-to-face and online sessions. Moodbuster allows for some flexibility. Therapists are required to include all four elements of CBT (psycho-education, cognitive restructuring, behavioural activation and relapse prevention), but are free to decide how many sessions are spent on each module, if they want to repeat a module, or add optional modules.

Experiences from therapists so far

During the trial, regular supervisions take place between the therapists and the researchers. These meetings provide a lot of useful information and feedback on user experiences with Moodbuster. First impressions are positive:

“In getting acquainted with Moodbuster as a therapist, I felt that it was straightforward and user-friendly.”

“Moodbuster is easy to use and gives me, as a therapist, a good overview.”

“… I also feel it

[Moodbuster] enhances treatment fidelity as clients are more prone to do the exercises online. This is partly due to the attractiveness of the platform, but also because they can access their own data and the feedback from their therapist at any time. Furthermore, the explanation to the different elements is insightful and comprehensible.”

“The program is accessible and the content is clear and easy to understand. This is especially important for patients who are not in good condition, as feelings of failure should be prevented as much as possible.”

However, one of the therapists stated:

“I do feel that the interventions could go into a little bit more depth, e.g. the cognitive therapy intervention is restricted to an online version of the thought journal, whereas in regular therapy, I will use lots of other different exercises with my patients, such as thought experiments, exposure and other behavioral exercises to gather more information to feed back into the reappraisal of cognitions.”

Face-to-face contacts are important to complement the online part:

“ During the face-to-face session, patients often bring in interesting information triggered by the online sessions. Often I look with the patient at the exercises they made, which gives us the opportunity to elaborate more on them together.”

The integration of the online and face-to-face sessions within a blended treatment format is overall viewed as a positive and challenging way of providing CBT:

“The online program provides structure and support to work according to protocol. It is handy that practical components of treatment, such as the homework tasks, are provided through the online environment. This ensures that it is regulated.”    

The flexibility of Moodbuster is an advantage:

“I also like the fact that the platform is flexible in the sense that the order in which the different interventions and the type of intervention that is chosen can easily be adapted to the patient’s individual needs or desires.”

Some patients may need more frequent sessions:

“A lot of patients that visit our clinic are severely ill and have difficulties to engage in treatment. What happens with the blended treatment, is that they don’t complete the online sessions. I then find it difficult to create commitment and build on a good therapeutic relationship if I only see them once every two weeks.”

In sum, first experiences with Moodbuster are positive, the system is perceived as user-friendly and flexible. It helps therapists to adhere to treatment protocol. However, some aspects need further attention such as the frequency of sessions and the optimal way of blending face-to-face and online sessions.


Lise Kemmeren & Anneke van Schaik
GGZ inGeest, Amsterdam
The Netherlands