Table 2.

Benefits and pitfalls of DHI (as compared to face-to-face therapy)

Aspect	Benefits	Pitfalls
Accessibility	To (specialized) psychotherapists, especially in areas with limited availability of psychotherapists	Slow internet connection
	To psychotherapy for patients and family members with restricted mobility (e.g. somatic diseases) or fear of stigmatisation	Risk of reinforcing avoidance behaviour, e.g. for patients with the fear of leaving their house
	In times of lockdown or contact restrictions (e.g. SARS-CoV2-19 pandemic)	Barrier for patients with diminished competences in using technology, e.g. small children, older parents/caregivers, low IQ
Interventions	Broad range of methods: e.g. video conferencing, chat and e-mails, online psychoeducation, app-based interventions	Due to e.g. a webcam’s limited angular field, non-verbal behaviour (including also avoidance behaviour in therapeutic expositions) is more difficult to interpret
	Sessions with family members irrespective of their place of residence	Limited options to de-escalate emotionally difficult situations
	Facilitated possibility to conduct expositions with reaction management at the place where the problems occur	Need for involvement of a regionally located professional as backup for de-escalation
Evidence	Online psychotherapy can be as effective as face-to-face therapy	Limited evidence for some disorders and some devices such as apps
		Research gaps with regard to the influence of specific characteristics of DHI, e.g. the influence of the extent of therapeutic support within a particular DHI
		Overview of evidence-based interventions for practitioners is lacking
Economic Aspects	DHI can improve cost and time effectiveness (especially self-guided interventions or asynchronous messaging)	Initial costs for the psychotherapist (e.g. technical infrastructure)
		Reimbursement of DHI by public health insurance providers is not guaranteed in every country