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Background: Though internet based cognitive behaviour therapy is proven to be effective, e-health is applied only in a minority of treatments in specialised mental health care. The low application rates are associated with therapists’ attitudes towards e-health. One of the major concerns is limitations in the therapeutic relation and communication between patient and therapist. Since therapist involvement is important in an effective e-health treatment, negative attitudes towards e-health can be a risk for effective e-health application. Aims: This study aimed to examine the relationship between patients’ e-health usage as well as patients’ attitudes towards e-health and the therapeutic alliance. The possible influence of therapists’ attitudes on patients’ e-health usage is also examined. Method: In an outpatient mental health setting, patients attended a blended treatment program for major depressive disorder and completed questionnaires on attitudes towards e-health and the therapeutic alliance. Therapists completed an alliance and attitude questionnaire as well. Results: Patients with more positive attitudes used the e-health application more intensively. Higher work alliance rates were related to sharing digital homework assignments and seeking contact with their therapist. Also, when treated by therapists with more positive attitudes towards e-health, patients shared more assignments with their therapist. Patients with high symptom rates at start, had more negative attitude rates and tended to use the e-health application less frequently. Conclusions: In a treatment cohesion in which therapists are positive about blended e-health, patients’ attitudes are positively related to e-health usage and therefore a factor of interest in improvement of effective e-health application. Patients with severe symptoms may need extra attention like active support and iteration to promote adherence to the e-health program.

Blended e-Health in Cognitive Behavioural Therapy: Usage Intensity, Attitude and Therapeutic Alliance in Clinical Practice