Design Considerations for the Integrated Delivery of Cognitive Behavioral Therapy for Depression: A User-Centered Design Study

Katarzyna Stawarz*, Chris Preist, Debbie Tallon, Nicola J Wiles, David Kessler, Katrina M Turner, Roz Shafran, David Coyle

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

11 Citations (Scopus)
59 Downloads (Pure)


Background: Adherence to computerized Cognitive Behavioral Therapy (cCBT) programs in real world settings can be poor and, in the absence of therapist support, effects are modest and short-term. Moreover, because cCBT systems tend towards limited support and thus low-intensity treatment, they are typically most appropriate for people experiencing mild to moderate mental health difficulties. Blended therapy, i.e. combining direct contact with a therapist with cCBT or psychoeducational materials, has been identified as one possible approach to addressing these limitations and widening access to individual CBT for depression. Building on the initial success of blended therapy, we explore an integrated approach that seeks to more seamlessly combine face-to-face contact, electronic contact, and between-session activities. Integration also considers how the technology can support therapists’ workflow and integrate with broader healthcare systems. The ultimate aim is provide a structure within which therapists can deliver high-intensity treatments, whilst also significantly reducing face-to-face contact.

Objective: First, to explore patients’ and therapists’ views on using a system for the delivery of individual treatment for depression that integrates face-to-face contact with a therapist with access to online resources and with synchronous online therapy sessions that allow collaborative exercises. Second, to establish design requirements and thus key design considerations for integrated systems that more seamlessly combine different modes of communication.

Methods: We conducted a series of four user-centered design studies. This included 4 design workshops and 7 prototype testing sessions with 18 people who had received CBT for depression in the past, and 11 qualitative interviews and 3 role-play sessions with 12 CBT therapists experienced in the treatment of depression. Studies took place between July and December 2017 in Bristol, UK.

Results: Workshops and prototyping sessions with people who had received CBT identified three important requirements for integrated platforms delivering CBT therapy for depression: 1) features that help to overcome depression-related barriers, 2) features that support engagement, and 3) features that reinforce learning and support the development of new skills. Research with therapists highlighted the importance of the therapist and client working together, the impact of technology on therapists’ workflow and workload, challenges and opportunities related to the use of online resources, and the potential of technology to support patient engagement. We use these findings to inform 12 design considerations for developing integrated therapy systems.

Conclusions: To meet clients’ and therapists’ needs, integrated systems need to help retain the personal connection, support both therapist- and patient-led activities, provide access to materials and the ability to monitor progress. However, developers of such systems should be mindful of their capacity to disrupt current work practices and increase therapists’ workload. Future research should evaluate the impact of integrated systems on patients and therapists in a real-world context.
Original languageEnglish
Article numbere15972
Number of pages15
JournalJMIR Mental Health
Issue number9
Publication statusPublished - 3 Sept 2020

Structured keywords

  • BRTC


  • Cognitive behavioral therapy
  • Depression
  • Mental health
  • blended therapy
  • integrated therapy
  • User-centered design
  • Qualitative research


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