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In the qualitative data, the following themes emerged from the open-ended responses: (1) concerns about relative effectiveness for digital treatment compared to in-person treatment; (2) access barriers; (3) skepticism specific to self-guided therapy; (4) social anxiety; (5) preference for in-person treatment (6) concerns about confidentiality or privacy; and (7) concerns specific to peer support.Table 3 illustrates themes and subthemes, along with the percentages of sample endorsing these codes.Most notable was the issue of cost (Box 2, extract 1).Participants reconfirmed that known in-person access barriers remained (e.g.: scheduling conflicts, and competing demands (e.g., family responsibilities (Box 2, extract 2).Although 17.7% of respondents endorsed concerns with individual in-person psychotherapy, more than a quarter (27.4%) of the sample endorsed concerns about self-guided digital treatment, 36.8% of the sample endorsed concerns about digital treatment supplemented with peer support, and 36.8% expressed concerns regarding digital treatment supplemented with expert support. Preference for digital versus in-person psychotherapy did not vary by rural/urban status, racial/ethnic minority status, or by age.However, 91.4% of those who had previously had in-person psychotherapy with a licensed clinician were more likely to re-consider this treatment in the future, compared to 64.4% of those without previous in-person psychotherapy experience (t(160) = −3.56, p ≤ 0.001).Subthemes were identified by at least three of the 164 respondents.Sixty two percent of the participants raised questions or concerns regarding the relative efficacy or effectiveness of digital psychotherapy and in-person psychotherapy.

Participants were 164 adults living in the United States who had previously used or considered psychotherapy for depression.

Rural-dwelling and racial/ethnic minority (Native American, African American, and Spanish-speaking) respondents were purposively sampled.

Participants were asked their preferences for and opinions about four treatment modalities: self-guided digital, peer-supported digital, expert-guided digital, or in-person psychotherapy.

Seventy three percent of the sample would likely try individual in-person psychotherapy and 72% would try digital psychotherapy in the future.

When forced to choose between modalities, the majority (44.5%) preferred individual in-person psychotherapy.

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Future development of digital psychotherapy will need to address concerns regarding efficacy, privacy, data security, and methods to enhance motivation to use these treatments.

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