Blended psychotherapy

Charlotte Schütz

Charlotte Schütz

, Update from

In this article you will learn about the interlocked psychotherapy approach. You will also get an overview of other digital health applications and their differences. You will learn about the benefits of interlocked psychotherapy and the evidence provided by the current state of research. You will also be introduced to the use of our digital health application elona therapy in interlocked psychotherapy.

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What is interlocking psychotherapy?

Blended psychotherapy (bCBT) is the combination of traditional face-to-face cognitive-behavioural therapy (also called face-to-face or treatment as usual) and internet- or mobile-based interventions. This means that therapy sessions take place as usual between psychotherapist:in and patient:in and are additionally supplemented by digital approaches, such as smartphone apps or virtual reality glasses. Interlocked psychotherapy can be designed with sequential or integrated interlocked interventions, which are used depending on the indication.

Sequentially interlocked interventions are characterised by the fact that the digital intervention either precedes the therapy sessions or is connected to them. These interventions are used, for example, to bridge waiting times or as aftercare following (inpatient) treatment. 

In the integrated approach, the internet or mobile-based interventions are incorporated into the psychotherapy. This means that both therapy sessions and digital interventions take place in the same period and interact with each other. This approach can expand and intensify psychotherapy, with the aim of increasing the effectiveness of treatment. 

How does interlocking psychotherapy differ from other digital health apps (DiGAs)?

In addition to the interlocked psychotherapy approach (bCBT), internet and computer-based interventions (iCT or cCBT) have been developed. These are different modules based on evidence-based treatment approaches of Cognitive Behavioural Therapy (CBT). Patients can use them via electronic devices such as a PC, laptop, tablet or smartphone. In contrast to interlocked psychotherapy, not all applications are accompanied by psychotherapists and are not integrated into routine psychotherapeutic care. 

The iCBT and cCBT approaches allow for greater availability of therapeutic interventions, even over long distances. They are more time-efficient for therapists, can reduce stigma towards the use of psychotherapy and allow both therapists and patients to work from anywhere. However, it is not possible via digital health apps to meet patients with the same level of empathy and knowledge as is possible in a traditional psychotherapy session with interpersonal contact. Also, the level of credibility may be lower and misunderstandings and adverse reactions on the part of the patient may be difficult for the therapist to detect. For psychotherapists, dealing with crises is also a challenge.

A large number of randomised controlled trials are available for iCBT and cCBT therapy regarding effectiveness in the treatment of depression and anxiety disorders. The results of a meta-analysis show that for anxiety disorders, the interventions achieved better effects than no treatment and comparable results to face-to-face therapy. For depression, the interventions showed moderate effects. 

What are the advantages of interlocked psychotherapy?

Interlocking psychotherapy combines the advantages of face-to-face psychotherapy with the advantages of iCBT. At the same time, the respective disadvantages of the interventions can balance each other out. Thus, the therapy can be individually adapted to the patient and personal factors and comorbidities can be taken into account. By providing therapy content on the smartphone, it is available to patients in everyday life - exactly where it is needed. For example, it is possible to fill out mood or behavioural protocols directly in the situation. Patients can also repeat the content as often as they need. In addition, the workload of psychotherapists is reduced and the pre-structuring ensures a comparable level of psychoeducation and exercises for all patients. Interlocking psychotherapy can also maintain the flow of therapy by bridging sessions that are missed (e.g. due to illness or holidays).

"With elona therapy I can ensure with a few clicks that patients can use the time between sessions in the sense of their therapy - even during holidays".
Elli Bauer, Psychological Psychotherapist

What scientific findings are there on interlocked psychotherapy?

The field of interlocking psychotherapy is continuously being researched and the number of scientific studies is steadily increasing. 

Studies comparing traditional face-to-face psychotherapy with interlocked psychotherapy show partially equal effects between treatments, with patients in interlocked psychotherapy care showing shorter duration of therapy and better maintenance of progress. In other studies, interlocked psychotherapy showed greater effectiveness compared to conventional psychotherapy. 

Compared to iCBT interventions, interlocked psychotherapy showed significantly higher effectiveness and greater adherence rates in studies.

How is elona therapy used in interlocking psychotherapy? 

In interlinked psychotherapy with elona therapy, the face-to-face therapy sessions ofconventional therapeutic routine care, in which psychotherapeutic content is developed with the patient, are supplemented by the smartphone app elona therapy. After the sessions, suitable exercises can be activated by the psychotherapists and worked on independently by the patients until the next session. In this way, therapy content can be deepened and implemented in everyday life. In addition, therapists and patients can reflect on the session in elona therapy and note down important aspects or further questions. In the following session, aspects of the contents of elona therapy can be taken up if necessary or new contents can be developed, which the patient can then work on using further exercises in elona therapy. Through mood and symptom diaries, elona therapy can also provide insights into the patient's therapy progress. 

Interlocking psychotherapy with elona therapy is thus an integrated approach in which face-to-face sessionsand mobile-based content can complement and benefit from each other to make tomorrow's psychotherapy even more effective.

Diagram: elona therapy in interlocking psychotherapy.

Our conclusion

Interlocking psychotherapy is a new development in psychotherapeutic care that complements traditional face-to-face therapy sessionswith digital applications. In this way, the therapy content of the sessions can be transferred to the patient's everyday life and contribute to an intensification of the treatment. The therapy sessions can influence each other. The field of interlocked psychotherapy is continuously being scientifically investigated. Current findings indicate that interlocked psychotherapy can shorten the duration of therapy and implement therapy results more sustainably. elona therapy can be used as a digital health application in interlocked psychotherapy and thus help shape the psychotherapy of tomorrow. 


Development Study Elona (2021).

Erbe, D., Eichert, H. C., Riper, H., & Ebert, D. D. (2017). Blending face-to-face and internet-based interventions for the treatment of mental disorders in adults: systematic review. Journal of medical Internet research, 19(9), e306.

Leterme, A. C., Behal, H., Demarty, A. L., Barasino, O., Rougegrez, L., Labreuche, J., & Servant, D. (2020). A blended cognitive behavioural intervention for patients with adjustment disorder with anxiety: A randomized controlled trial. Internet interventions, 21, 100329.

Mathiasen, K., Andersen, T. E., Riper, H., Kleiboer, A. A., & Roessler, K. K. (2016).
Blended CBT versus face-to-face CBT: a randomised non-inferiority trial. BMC psychiatry, 16(1), 1-8.

Richards, D., & Richardson, T. (2012). Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clinical psychology review, 32(4), 329-342.

Schuster, R., Laireiter, A. R., Berger, T., Moritz, S., Meyer, B., Hohagen, F., & Klein, J. P. (2020).
Immediate and long-term effectiveness of adding an Internet intervention for depression to routine outpatient psychotherapy: Subgroup analysis of the EVIDENT trial. Journal of Affective Disorders, 274, 643-651.

Vigerland, Sarah, et al (2016). "Internet-delivered cognitive behaviour therapy for children and adolescents: a systematic review and meta-analysis." Clinical Psychology Review 50: 1-10.

Wright, J. H., Mishkind, M., Eells, T. D., & Chan, S. R. (2019). Computer-assisted cognitive-behavior therapy and mobile apps for depression and anxiety. Current psychiatry reports, 21(7), 1-9.


Charlotte Schütz

I am a psychologist and psychotherapist in private practice in Cologne. I completed my psychology studies at the Johannes Gutenberg University in Mainz. In addition to my psychotherapeutic work, I work for Elona Health in the area of content and magazine.

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All contents of our magazine are based on current scientific knowledge. Our articles are written by psychologists and reviewed before publication.

Any general advice published on our blog is for informational purposes only and is not intended to replace medical or doctor's advice. If you have any particular concerns or a situation arises where you need medical advice, you should consult a suitably trained and qualified health professional.

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