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DIGITAL PSYCHOLOGICAL INTERVENTIONS,
RECOMMENDATIONS FOR POLICY & PRACTICE
by the EFPA project group on eHealth
January 2020
European Federation of Psychologists Associations EFPA
Grasmarkt 105/39 | B-1000 Brussels | Belgium|www.efpa.eu
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Table of Contents
Background ............................................................................................................................................. 4
Overview of recommendations .............................................................................................................. 5
Developers .......................................................................................................................................... 5
Users ................................................................................................................................................... 5
Psychologists ....................................................................................................................................... 6
Health services .................................................................................................................................... 7
Publications by the project group ........................................................................................................... 8
Members of the project group ............................................................................................................... 8
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Background
This consensus statement from the different members of the EFPA project group on E-health aims to
provide general rules of thumb concerning the dissemination in and use of digital psychological
interventions in practice. These recommendations are considered important points of attention when
working with digital interventions. Not surprisingly, some of these good practices are already in place
in several member countries.
Throughout the document we will consequently be referring to psychologists, these
recommendations are however, of course also applicable to other (mental) healthcare professionals
active in this domain. Finally, we have highlighted the most important points of attention here, but in
no way claim this overview to be fully exhaustive.
This document is explicitly practice-oriented and specifically aimed at all EFPA psychologists’
associations and their respective members. When referring to this document, important national
points of attention may be highlighted by respective member associations to adapt it further to the
local context. Together with these national adaptations and caveats, it can serve as a source of
inspiration for (inter)national policy makers. Although all recommendations are based on the
extensive experience and knowledge of literature and practice of the project group members, these
are currently kept very brief. We decided to not substantiate this document with elaborate references
to literature, mainly to keep it concise. In due time, a more extensive peer-reviewed publication will
follow. In the meantime, any questions can be addressed directly to the project group. References to
two relevant publications by the project group and to relevant publications by project group members
can also be found below for an academic state-of-the-art and to provide additional insights.
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Overview of recommendations
Digital psychological interventions can be effective and can be delivered in various forms. Knowing
that digital psychological interventions can remove some of the traditional obstacles to psychological
interventions, their development and implementation should be fostered. To obtain maximal and
positive effects, however, some general rules of thumb and a few specific points of attention should
be taken into consideration.
This document grouped recommendations into four (arbitrary) categories, concerning:
1) developers
2) users
3) psychologists and other healthcare professionals, and
4) health services.
Developers
● Development of digital psychological interventions should always be a multidisciplinary
endeavour, combining efforts and expertise of both psychologists and professionals with a
background in information and communications technology. In order to realise effective
behaviour change, interventions need to be grounded in theory: this requires developers
receiving input concerning theory of psychological processes and behaviour change, and
psychologists receiving input in technological theory of how to develop engaging interventions
(e.g., gamification theory, persuasive technology).
● Digital psychological interventions should be adapted to the local context of application and
only be implemented when conditions for proper use are available (e.g., access to digital
means and digital literacy, choice of adequate targets of intervention, consideration of the
severity of mental disorders).
● Digital psychological interventions need to comply with all legal and ethical requirements
and assure a safe service.
Users
● In order to increase uptake, users need easy access to reliable information. Creating
(inter)national or EU-wide guidelines and reporting standards for digital psychological
interventions, is therefore strongly recommended. Characteristics of interventions to be
reported could encompass: 1) background and credibility of the content creators, 2) detailed
overview of specific intervention features, 3) adherence to data protection and privacy
regulation (i.e., GDPR) , current evidence-base for both efficacy and effectiveness, 4) cost, and
5) specific conditions for adequate and efficient usage (e.g. level of support required).
● Some users might be unwilling, lack necessary skills, or computer literacy to be able to use
digital interventions. Difficulties in use of technological means may relate to personal
considerations or practical limitations (e.g., absence of internet connection). Initial reluctance
should, however, not be a reason to dismiss online interventions altogether. Nevertheless, a
strong disliking or refusal should be acknowledged, and alternatives (e.g. non-technological
approaches) should be explored.
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● When vulnerable users, particularly children, are involved, additional caution is required.
Approval of parents or guardians should be assured, according to the legal majority age,
confidentiality parameters, and other criteria to access psychological services as per national
legislation parameters.
● Given that little is currently known as to what works for whom and under what conditions, be
sure to monitor the progress of users carefully and tailor treatment accordingly utilizing a
stepped-care approach.
● When one approach proves to be ineffective or harmful (e.g., negative side effects), switching
to another intervention should be made easy for the user. For example, if a specific low-
intensity unguided intervention is not having the desired effects, do not hesitate to proactively
explore and make available other options such as a more intensive therapist guided program.
Also, ideally users should be able to transfer their data to different platforms.
Psychologists
● When using internet-delivered interventions in which, at least partially, there is a component
of self-administration, assure frequent pre-scheduled guidance (e.g., weekly contacts), as
empirical evidence for the effectiveness of unguided, stand-alone interventions is currently
limited.
● Gathering and assessing patient-reported outcomes should be done on a continuous basis.
● Protocols for handling crisis (e.g., suicidal ideation) before, during and after treatment should
be pre-planned and readily available.
● Working with online interventions does not exempt you of good standard professional
practices, which for example includes peer intervision and supervision, ideally with
colleagues operating in similar areas.
● In all forms of digital psychological interventions, it is important to make clear to users who is
the psychologist and/or organization to be held responsible for conducting the treatment.
● Psychologists should assure they receive sufficient continuous education to keep up with this
rapidly changing field. This does not only relate to technology, but also theory, knowledge,
and skills necessary for delivering adequate care that properly fits clients’ needs.
● Digital psychological interventions should not overburden psychologists. Online
interventions, especially when guided, are not a low-effort equivalent to conventional care:
sufficient time should be taken for follow-up and boundaries should be set in terms of
availability for users in case of questions.
● When psychologists make use of digital means to provide care to users in other countries than
the one from where they are licensed, they need to ensure that they follow that countries’
rules regarding digital practice across borders.
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Health services
● For a digital psychological intervention to be adopted within routine health care system
service, intervention effectiveness and efficacy be evaluated, utilizing state of the art
assessment methodologies (e.g., feasibility and pilot studies, randomized controlled clinical
trials, implementation studies and/or trials in routine practice). At the very least, an
intervention should be able to provide proof of peer-reviewed research.
● Reimbursement (e.g., of an app, or of a therapist) is a prerequisite for sustainability of digital
psychological interventions. However, when applied to (un)guided internet-delivered
interventions, this should, however, be considered with caution.
● Similarly, only healthcare professionals with adequate background and sufficient continuous
education should deploy such interventions. Given that specific standard EU trainings are
currently lacking, local quality criteria for professionals should ideally be determined. In the
long term, however, EU-wide certification of quality should be established.
● Health services should assure adequate conditions for optimal use of digital interventions,
both for psychologists and users (e.g., providing suitable location and equipment for
psychologists, allowing psychologists sufficient time for (online) follow-up of users of digital
interventions, and assuring interventions are only provided to users with sufficient facilities,
knowledge, and skills for proper use).
● Maintaining platform continuity and continuously updating it to current standards is
important. This will avoid: 1) users’ and service providers suddenly losing (data on) the
progress made and 2) reduce this risk of data security threats.
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Publications by the project group
Karekla, M., Kasinopoulos, O., Neto, D., Ebert, D. D., Van Daele, T., Nordgreen, T., Höfer, S.,
Oeverland, S., & Jensen, K. L. (2019). Best Practices and Recommendation for Digital
Interventions to Improve Engagement and Adherence in Chronic Illness Sufferers. European
Psychologist, 24(1), 49-67. doi:10.1027/1016-9040/a000349
Ebert, D. D., Van Daele, T., Nordgreen, T. Karekla, M., Compare, T. A., Zarbo, C., … (on behalf of the
EFPA E-Health Taskforce) & Baumeister, H. (2018). Internet and mobile-based psychological
interventions: applications, efficacy and potential for improving mental health. A report of
the EFPA e-health taskforce. European Psychologist, 23, 167-187.
doi:10.1027/1016-9040/a000318
Members of the EFPA project group eHealth 2019-2020
Angelo Compare (University of Bergamo, Italy)
Andreas Schwerdtfeger (University of Graz, Austria)
Asli Carkoglu (Kadir Has University, Turkey)
David Daniel Ebert (FAU Erlangen-Nuremberg, Germany)
Glauco Trebbi (Société Lux. de Psychologie, Luxemburg)
Iben Sejerøe-Szatkowski (Clinical psychologist S/E, Denmark)
João Manuel Castro Faria Salgado (Instituto Univ. da Maia, Portugal)
Lise Haddouk (Rouen University, France)
Maria Karekla (University of Cyprus, Cyprus)
Per Carlbring (Stockholm University, Sweden)
Svein Oeverland (Forensic Unit for Man. Care, Norway)
Tine Nordgreen (University of Bergen, Norway)
Tom Van Daele (Thomas More University of Applied Sciences, Belgium)
Valerija Vidovic (University of Zagreb, EFPSA, Croatia)
