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A qualitative study of a blended therapy using problem solving therapy with a customised smartphone app in men who present to hospital with intentional self-harm
  1. Craig Mackie1,
  2. Nicole Dunn1,
  3. Sarah MacLean1,
  4. Valerie Testa1,
  5. Marnin Heisel2,
  6. Simon Hatcher1
  1. 1 Department of Psychiatry, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
  2. 2 Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
  1. Correspondence to Dr Simon Hatcher, Department of Psychiatry, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; shatcher{at}


Background Blended therapy describes the use of computerised therapy combined with face-to-face therapy to extend the depth, range and nature of the face-to-face therapy. We wanted to develop a treatment manual for a randomised trial of blended therapy combining face-to-face problem solving and a smartphone app in men who present to hospital with self-harm.

Objective To develop a treatment manual and to describe the experience of receiving and delivering a blended therapy.

Methods After completion of the blended therapy, semistructured qualitative interviews were conducted with participants to describe their experience of the treatment. Two independent coders analysed the material using a thematic, grounded theory approach.

Findings Seven men were enrolled in the study, and six completed the qualitative interviews. The two main themes identified were of trust and connection. Participants attended 85% of their appointments.

Conclusions In the treatment manual, we emphasised the themes of trust and connection by allowing time to discuss the app in the face-to-face to sessions, ensuring that therapists are familiar with the app and know how to respond to technical queries. Identification of trust and connection generates novel questions about the importance of the therapeutic alliance with technology rather than with people.

Clinical implications Clinicians and app developers need to pay attention to the therapeutic relationship with technology as trust and good communication can be easily damaged, resulting in disengagement with the app. Blended therapy may result in increased adherence to face-to-face sessions.

Trial registration number NCT02718248

  • qualitative research
  • world wide web technology

Statistics from


  • Funding Ontario SPOR Support Unit IMPACT Award.

  • Competing interests VT: receipt of unrestricted educational grant from Lundbeck Canada for unrelated research project. Lundbeck funds covered travel and accommodation costs to present at the Canadian Psychiatric Association conference (September 2016).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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