Patient Perspectives on Blended Internet-based and Face-to-Face Cognitive Behavioral Therapy for Alcohol Use Disorder: A Qualitative Study (Preprint)

BACKGROUND Harmful alcohol consumption has been identified as a major contributor to disease, mortality, and social harm, accounting for 5.3% of worldwide deaths annually. In Denmark, an estimated 150,000 people suffer from Alcohol Use Disorder (AUD), but a low proportion seek treatment due to person-related and treatment-related barriers. Internet-based Cognitive Behavioral Therapy (iCBT) has shown positive effects on the treatment gap, with patients reporting benefits such as increased knowledge and flexibility. However, there is a lack of research on blended Cognitive Behavioral Therapy (bCBT), which combines face-to-face Cognitive Behavioral Therapy (FtF CBT) and iCBT for AUD. OBJECTIVE The aim of this study is to investigate user experiences of bCBT. More specifically, to explore user experienced advantages and disadvantages of using bCBT for AUD and their motivations for choosing to receive treatment via this format. METHODS A total of 30 patients who had participated in the Blend-A study and received the intervention were contacted and offered the opportunity to participate in semi-structured individual telephone interviews. Of these, 12 patients consented to participate. Furthermore, an additional participant was approached at a municipal clinic and agreed to engage in an individual face-to-face interview. The final sample consisted of 13 patients. The interviews explored their background, experiences with digital technology, motivations for choosing internet-based treatment, and experiences with the program during AUD treatment. The interviews were audio-recorded and transcribed in full length and analyzed using thematic analysis. All data was anonymized and securely stored. RESULTS We found that user experienced advantages of using iCBT for a larger part of the treatment course were increased anonymity and privacy to treatment but most importantly flexibility to the treatment course and enabling the patients to focus on their rehabilitation process at their own pace. The patients liked the availability of written text in the online program and found it helpful for acquiring knowledge and information about AUD and how AUD affects the drinking person. They emphasized how the assignments could assist them in fully engaging themselves in treatment by firstly acknowledging to have a problem with alcohol and secondly to spend time for self-reflection prior to face-to-face sessions leaving time for further discussions with the therapist. They liked the reminders they were given as these motivated them to perform their assignments. CONCLUSIONS All in all, patients considered there to be more benefits than disadvantages by using bCBT. In its essence, bCBT offers the patient a form of assisted autonomy that cannot be captured using solely iCBT or solely by FtF CBT. Only in their combination the patient is allowed to value the benefits they gain from treatment, because they have the time for self-reflection albeit assisted by the therapist in between FtF CBT sessions. CLINICALTRIAL Clinicaltrials.gov.: NCT04535258