{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T22:23:06Z","timestamp":1791325386836,"version":"4.3.1"},"reference-count":39,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Internet-based cognitive behavioral therapies (iCBTs) are typically categorized into 2 types: therapist-assisted and self-guided. Both formats have accumulated substantial evidence supporting their cost-effectiveness and efficacy in treating a range of mental health conditions. However, therapist-assisted iCBTs tend to show lower dropout rates than self-guided versions. The relatively high dropout rates in self-guided programs suggest that some degree of therapist involvement may be necessary to improve engagement and treatment adherence. Yet, the specific reasons for therapist support in iCBT and its functions in improving engagement and treatment adherence remain an underexplored area of research.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to explore patients\u2019 experiences with therapist-assisted iCBT to identify the elements they perceive as important for treatment adherence and to clarify the role of therapist support in the iCBT process.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This study draws on 89 semistructured in-depth interviews with iCBT users. Patients took part in 9 different therapist-assisted iCBT programs (depression [n=32], anxiety disorder [n=17], obsessive-compulsive disorder [n=10], bipolar disorder [n=5], social phobia [n=5], bulimia [n=3], alcohol abuse [n=1], panic disorder [n=10], and insomnia [n=6]), all provided nationwide by Helsinki University Hospital in Finland. The interviews were transcribed verbatim and analyzed with the qualitative Gioia method.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Three key categories help explain why users consider therapist support essential for adherence in iCBTs: (1) the strengthening of individual autonomy, (2) the therapist\u2019s commitment to strengthening the therapeutic alliance, and (3) assistance with emotion regulation. Therapist support was shown to be pivotal, often conveyed through small, text-based gestures that had a meaningful impact.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The role of the therapist should not be diminished in the pursuit of digitalization, as human support remains a critical element of effective iCBT.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/71852","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T14:10:08Z","timestamp":1750947008000},"page":"e71852-e71852","source":"Crossref","is-referenced-by-count":11,"title":["Therapists\u2019 Role in Patient Adherence to Internet-Based Cognitive Behavioral Therapy: Qualitative Study"],"prefix":"10.2196","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4096-0407","authenticated-orcid":false,"given":"Henriikka Anne-Mari","family":"Seittu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8483-2319","authenticated-orcid":false,"given":"Tomas","family":"Falk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0912-4769","authenticated-orcid":false,"given":"Kushagra","family":"Bhatnagar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3555-9958","authenticated-orcid":false,"given":"Suoma Eeva","family":"Saarni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,9,10]]},"reference":[{"issue":"10","key":"R1","doi-asserted-by":"publisher","first-page":"883","DOI":"10.1016\/S2215-0366(20)30308-4","article-title":"Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population","volume":"7","author":"Pierce","journal-title":"Lancet Psychiatry"},{"key":"R2","doi-asserted-by":"crossref","unstructured":"Rudd BN Beidas RS . 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