Doing the groundwork at home, working through it together: patient experiences of blended cognitive therapy for PTSD in routine care.

There is limited access to evidence-based treatment for posttraumatic stress disorder (PTSD) in routine care. Therefore, scalable and resource-efficient treatment formats that are effective and acceptable are needed. We developed a blended format of cognitive therapy for PTSD, combining online modules with a limited number of therapy sessions, to improve resource efficiency, while maintaining the benefits of in-person therapy. This study aimed to explore patients' experiences of blended trauma-focused cognitive therapy (bTF-CT) in routine care.

Semi-structured interviews were conducted with 11 participants following completion or dropout from bTF-CT, as part of an open feasibility study. Interviews were transcribed and analysed using qualitative content analysis.

Participants described the treatment as helpful and flexible, and valued the combination of online modules and therapist sessions. Trauma-focused treatment components were experienced as both particularly beneficial and emotionally demanding, especially when conducted independently. Some participants reported disengagement related to emotional intensity, unmet needs and time pressure, suggesting room for improvement. However, engagement and satisfaction were facilitated by factors such as in-person therapist support, motivation and valued therapeutic gains.

This is the first study exploring patient experiences of blended trauma-focused cognitive therapy in regular clinical settings. The results suggest that bTF-CT may be acceptable and helpful across primary and secondary care; however, refinements related to therapist support, treatment content, and tailoring treatment to personal needs may improve engagement and acceptability.Trial registration: ClinicalTrials.gov identifier: NCT04881643.

Participants described blended cognitive therapy as helpful and flexible, with trauma-focused components experienced as both the most demanding – particularly when conducted independently online – and the most beneficial, while in-person therapist support was described as crucial for sustaining engagement and retention.Possible improvements include better individual tailoring of treatment, particularly related to therapist support, pacing and sequencing of modules, and allowing greater flexibility for multi-trauma presentations.The findings inform how accessible, resource-efficient treatment formats can be developed and refined to better meet the needs of a broad PTSD population in routine care.