Background: Though internet based cognitive behaviour therapy is proven to\nbe effective, e-health is applied only in a minority of treatments in specialised\nmental health care. The low application rates are associated with therapistsâ??\nattitudes towards e-health. One of the major concerns is limitations in the\ntherapeutic relation and communication between patient and therapist. Since\ntherapist involvement is important in an effective e-health treatment, negative\nattitudes towards e-health can be a risk for effective e-health application.\nAims: This study aimed to examine the relationship between patientsâ?? e-health\nusage as well as patientsâ?? attitudes towards e-health and the therapeutic alliance.\nThe possible influence of therapistsâ?? attitudes on patientsâ?? e-health usage\nis also examined. Method: In an outpatient mental health setting, patients attended\na blended treatment program for major depressive disorder and completed\nquestionnaires on attitudes towards e-health and the therapeutic alliance.\nTherapists completed an alliance and attitude questionnaire as well.\nResults: Patients with more positive attitudes used the e-health application\nmore intensively. Higher work alliance rates were related to sharing digital\nhomework assignments and seeking contact with their therapist. Also, when\ntreated by therapists with more positive attitudes towards e-health, patients\nshared more assignments with their therapist. Patients with high symptom\nrates at start, had more negative attitude rates and tended to use the e-health\napplication less frequently. Conclusions: In a treatment cohesion in which\ntherapists are positive about blended e-health, patientsâ?? attitudes are positively\nrelated to e-health usage and therefore a factor of interest in improvement\nof effective e-health application. Patients with severe symptoms may need extra\nattention like active support and iteration to promote adherence to the\ne-health program.
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