Therapists' time allocation in guided digital mental health interventions – A scoping review and case study

Background: Digital Mental Health Interventions (DMHIs) that include therapist support achieve higher adherence and greater effectiveness than fully self-help applications. Compared to face-to-face therapy, guided DMHIs can expand access by reducing the amount of therapist time required while still supporting a therapeutic relationship. However, "therapist time" is operationalised inconsistently. Many studies appear to report only direct patient contact (e.g., messaging, calls) or platform-based monitoring, leaving uncertainty about whether other patient-related tasks, such as documentation, are included.This scoping review examined how much therapist or other health-care professional (HCP) time is reported when delivering guided DMHIs or stepped/blended care interventions with a core digital component. A secondary aim was to describe the categories of time allocated. A case study from the Norwegian eTreatment service complemented the review. Methods: Following PRISMA-ScR guidelines, we searched for studies that quantitatively reported therapist or HCP time in guided or blended DMHIs. Eligible studies were in English, used a core digital treatment component with human support, and targeted mental health conditions. Pure self-help apps and teletherapy-only interventions were excluded. Results: Fifty-four studies published between 2005 and 2026 were included. Therapists spent a mean of 214.57 min (3 h 35 m; SD 214.76; range 46-1198; median 146; IQR 142.98) per patient per intervention, with an average program duration of 10.6 weeks. Forty-eight studies quantified only direct patient-related work such as calls, messaging, or platform monitoring. Other time categories were rarely quantified. In the case study, 73.7% of patient-related time occurred outside the platform, including diagnostic interviews. Conclusions: Studies predominantly report direct contact and monitoring, likely underestimating actual time use. Still, guided DMHIs appear to offer meaningful time savings compared to face-to-face therapy. More comprehensive reporting of direct, indirect, and administrative time would better support scaling and implementation.