Reidar Nævdal, Christiaan Vis, Robin Maria Francisca Kenter
Background: Internet-delivered cognitive behavioral therapy (iCBT) has been available in Norwegian specialist mental health care for a decade. Despite strong evidence and national support, uptake remains limited, with little known about therapists delivering iCBT or factors influencing engagement. Objective: Using an extended Technology Acceptance Model (TAM), this study aimed to provide a national overview of therapists delivering iCBT, their work environment, and acceptance, as well as explore group differences between clinics established through different implementation approaches. Methods: The study identified all therapists using iCBT in routine care. Using a cross-sectional survey, data regarding therapists' characteristics, their context, and TAM constructs was collected. Therapists were grouped by whether their clinics used bottom-up or top-down implementation approaches and compared on all TAM constructs. Results: Sixty-seven therapists were identified as actively delivering iCBT nationally. Of these, 45 therapists from 18 clinics responded (67 % response rate). Therapists were experienced clinicians with varying backgrounds and work environments. High acceptance was found across all TAM dimensions except for Image. Therapists in clinics with structured top-down implementation and ongoing supervision reported highest acceptance. Conclusion: Despite high therapist acceptance of iCBT, experienced loss in professional regard presents a cultural barrier hindering widespread adoption. Despite a decade of use, iCBT remains a small part of routine care. However, successful implementation across diverse therapist backgrounds is achievable, and mandated top-down implementation appears useful when supported by experienced supervision. Trial registration: Haukeland University Hospital e-procotol, project ID: 4696-4696.