Video Chat Therapist Assistance in an Adaptive Digital Intervention for Anxiety and Depression: Reflections From Participants and Therapists.

The purpose of this article is to qualitatively explore participant and therapist experiences of the therapeutic alliance, perceived benefits, challenges, and areas for improvement when using video chat as a mode of therapist assistance within an adaptive digital mental health intervention. In total, 74 semistructured interviews were completed with participants and therapists who participated in an adaptive clinical trial. The participant interviews explored experiences of attending a clinical assessment via video chat and experiences of receiving low- or high-intensity therapist assistance via video chat. Interviews completed with therapists explored their experience of administrating a clinical assessment tool and delivering therapist assistance, both via video chat. Reflexive thematic analysis identified four themes: using video chat, characteristics of therapeutic relationships, task-specific experiences, and utility and adoption of video chat. Both participants and therapists were able to adapt to the modality of video chat and develop positive therapeutic alliances. They reported satisfaction with video chat for conducting clinical assessments and delivering therapist assistance. Concerns were identified by both participants and therapists with low-intensity therapist assistance. This study identified elements of task-specific experiences and human characteristics as more influential in participant and therapist experience than the modality of video chat technology. Implications for assessing suitability for the modality of video chat and low- and high-intensity models of therapist assistance are discussed. Public Significance Statement: This study advances the field of digital mental health intervention as it qualitatively explores participant and therapist experiences of clinical assessments and therapist assistance delivered via video chat technology. It highlights the adaptability and effectiveness of using video chat as a mode of therapist assistance and the utility of this support to increase program motivation and engagement for participants. Clinicians can use the insights to improve experiences of video chat therapy both within digital mental health interventions and therapy more broadly. [ABSTRACT FROM AUTHOR]