PONE-D-20-00142

Impact of an Acceptance Facilitating Intervention on Psychotherapists’ Acceptance of Blended Psychotherapy

PLOS ONE

Dear Dr. Baumeister,

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Academic Editor

PLOS ONE

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Reviewers' comments:

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Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

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Reviewer #1: Yes

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: No

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This is an informative paper that addresses an important aspect of psychotherapeutical practice. The authors investigate how an acceptance-facilitating intervention affects psychotherapists' acceptance of blended therapy. Since internet- and mobile-based interventions are becoming an increasingly important element of psychotherapy, this research is highly relevant. The methodology is sound, What is missing is a brief discussion of the current state of research on the topic. The authors claim that their study is the first on acceptance-facilitating interventions regarding psychotherapists' acceptance of blended therapy. However, there are several studies on the attitudes vis-a-vis blended therapy and the acceptance thereof among psychotherapists (e.g. Schuster et al. 2018: https://www.jmir.org/2018/12/e11007/; Mayer et al. 2019: https://mental.jmir.org/2019/11/e14018/). Although the study presented by the authors is methodologically more sophisticated than many of the existing studies, which are mainly survey-based, the authors should mention the existing research on the topic. This helps the reader to better understand the relevance of the paper and it also shows the innovativeness of the study. A few short sentences and two or three sources will suffice.

As a minor point, I would suggest a language check by a native speaker. All in all, the language and style are appropriate, but at some points, the wording is odd or wrong (e.g. "normal distributed" instead of "normally distributed").

Reviewer #2: This is an interesting paper about the integration of technology with the traditional face-to-face way to work in psychotherapy. It could be an initial point to understand this phenomenon. The reduced psychotherapist sample and the absence of a pre-post analysis are the main problems of the research. Additionally there are different parts of the research needed of some explanation to improve the understanding of the paper.

The abstract inform that one of the aims of the study was to identify potential effect moderators. The analysis of moderators is more complex than a regression analysis. The use of this term could be generate confusion. They informed the use of an online questionnaire. It is no clear if is an ad hoc questionnaire or a well know questionnaire with an adequate validity and reliability.

In the introduction paragraph (line 55), they uses the acronym RR with no reference to his meaning.

There is a contradiction between the content of IG video. It is a video showing case (line 108) or a presenting information about blended psychotherapy (line 121)? How is produce the video: with real psychotherapist, actors, etc.? The video is not accessible to the URL provided. Nevertheless, the IG video has a positive orientation and the placebo video a clear negative orientation. Could these aspects affect to the results?

The primary outcome is about “blended psychotherapy”. Is it a term well known by the German psychotherapist?

There are a difference in acceptance baseline between CG and IG groups (line 226-229). A t-test show a significant difference t= 2.131, 231 d.f. p>.025. If there are a difference between groups before the experimental manipulation, the results could be reconsidered.

The authors use the title “effect on acceptance” (line 235) but this term is confused. If there is not a pre-post analysis is not correct to use the term “effect”. This confusion is also present in the “effect on secondary outcomes” paragraph.

There is not specific information about the number of variables introducing in the regression analysis. It is important because the higher the number, the higher the variance explained, but there are a specific ratio between variables and cases.

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Reviewer #1: Yes: Dr. Giovanni Rubeis

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.]

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PONE-D-20-00142R1

Impact of an acceptance facilitating intervention on psychotherapists’ acceptance of blended psychotherapy

PLOS ONE

Dear Dr. Baumeister,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Whiule reviewer 1 was satisfied with the revision of your manuscript, reviewer 3raised a few minor issues. Please adress these in your revision.

We would appreciate receiving your revised manuscript by May 29, 2020. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter.

To enhance the reproducibility of your results, we recommend that if applicable you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). This letter should be uploaded as separate file and labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. This file should be uploaded as separate file and labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. This file should be uploaded as separate file and labeled 'Manuscript'.

Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out.

We look forward to receiving your revised manuscript.

Kind regards,

Stephan Doering, M.D.

Academic Editor

PLOS ONE

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #3: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #3: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #3: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #3: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: (No Response)

Reviewer #3: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: All comments have been addressed by the authors. The paper is acceptable for publication in its present form

Reviewer #3: This is an interesting article to read, pointing to the importance of acceptance for blended psychotherapy in the treatment giver rather than receiver. Authors have made an effort to improve the manuscript by carefully considering previous reviewers comments. However, there are some points that I think still needs to be addressed.

1. Measures. The questionnaire used in this article, as well as its origins from UTAUT should be more thoroughly described in the method section. Readers who are unfamiliar with this instrument should be provided with enough information to evaluate the applicability of it. For instance, it would be helpful if you added more details on the original instrument, such as total amount of items and number of factors. Please describe how items (or factors) were chosen from the UTAUT, and in what manner they were adapted from the original version (such as; if items are rephrased completely, or adapted by changing some words in the items, and why inverted items were added). If your version is currently being evaluated for psychometric properties, it would be helpful if you mention this in the manuscript. Further, it is unclear where the items on internet anxiety were derived from; the UTAUT or developed by authors?

Since the result section describes deviance from the scale mean, the scale mean should also be stated here (or in the result section if you are referring to the mean of the study sample).

2. Materials and methods. It should be more clearly stated when data was collected, this will make the result section easier to understand, that results are exploring differences after manipulation, not baseline. (You provided this clearly in your answer to reviewer 2, however it is not as clearly described in the article).

3. Data analysis. Authors describe splitting acceptance in three categories (low/medium/high), for descriptive purposes. Could you clarify how you decided on these cut-offs? Are they based on the distribution of responses? Or theoretically derived? Is there any reason not to analyze difference in distributions on acceptance statistically? I think that a chi-square test would be informative on difference in level of acceptance. (seems to be a typo in the medium range where I suppose the range is above 9 and below 16? line 189)

4. In the result section you start by describing a rather high dropout rate in the intervention group. I think the article would benefit from an analysis on difference in characteristics between those who dropped out and those who were completers. This would give a hint if there is a bias in the study sample, if those who dropped out were mostly men, mostly from a specific therapeutic background and so on.

5. In Table 2 it seems as if there is a difference in distribution of gender between groups, with a higher ratio of women to men in the intervention group as compared to control group. Have you checked if this (or other demographics) is a statistically significant difference in distribution? Thoughts on implications if so? (In my version the tab-spacing made table 2 almost uninterpretable, be sure to double-check this before publication).

6. The concept of blended psychotherapy and blended therapy are used interchangeably throughout the manuscript (also blend therapy, line 93). I think it would enhance the readability if authors clarify what they refer to with both concepts, or to stick with only one of them.

7. Also as a minor point on the fluency of language; the sentence in line 75 – 79 I would consider rephrasing. Line 89-90 “it seems…” As a reader I am confused as to what “it” refers to. It is probably better to use AFIs/blended psychotherapy/ psychotherapists.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Dr. Giovanni Rubeis

Reviewer #3: Yes: Maria Fogelkvist

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step.

PONE-D-20-00142R2

Impact of an acceptance facilitating intervention on psychotherapists’ acceptance of blended therapy

PLOS ONE

Dear Dr. Baumeister,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that your manuscript is very cloce to acceptance. Since reviewer 1 is completely satisfied with you revision of the previous version of ypou manuscript, reviewer 3 raises some minor concerns. I assume, that it will not cause too much effort to include these few changes. Therefore, we invite you to submit another revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by July 11, 2020. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Stephan Doering, M.D.

Academic Editor

PLOS ONE

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Impact of an acceptance facilitating intervention on psychotherapists’ acceptance of blended therapy

PONE-D-20-00142R3

Dear Dr. Baumeister

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Academic Editor

PLOS ONE