This web-based program incorporates cognitive behavioral therapy (CBT) and behavioral activation techniques to reduce mild-to-moderate depression in adults.
This 10-week long program includes modules covering behavioral activation, cognitive restructuring, defining goals and values, coping with anxiety and worries, improving sleep and physical health, and relapse prevention. Users complete a quiz after each module, which tests their knowledge. Results are sent to a clinician, who responds with feedback through email within 24 hours. Users are assigned homework after each module and are asked to complete activity sheets, improve sleep hygiene, and manage automatic thoughts. This program has also been adapted for preventing depression relapses in individuals with partially-remitted depression.
Cognitive Behavioral Therapy (CBT)
Quality of Life (QOL)
Comorbid mental health symptoms
Young Adults (18-30)
Internet-based self-help for depression: Randomised controlled trial.
Andersson G, Bergstrom J, Carlbring P, Kaldo V, Ekselius L. British Journal of Psychiatry. 2005. 187: 456-461. PMID: 16260822.
Summary: In this randomized controlled trial, the authors examined the efficacy of a web-based self-help program for depression. Swedish adults were recruited through press releases and newspaper articles. Any interested volunteers were screened for depression using an online questionnaire. Individuals with mild-to-moderate depression, and without severe mental illness, recent changes to antidepressants, and previous experiences with cognitive behavioral therapy (CBT), were enrolled (n=117). Each participant was randomized to the group receiving the self-help internet CBT program (iCBT) or to a waitlist control. The waitlist control had access to the web-based self-help program after completing the post-treatment assessment. Both groups could participate in a moderated, online discussion group. Depression, anxiety, and quality of life (QOL) were assessed pre-treatment, post-treatment, and at a 6-month follow-up.
Overall, 65% of the iCBT group completed the web-based treatment program. The control group posted more frequently in the online discussion forum, and focused more of their posts on depression symptoms. At the post-treatment assessment, the iCBT group had significantly greater reductions in depressive symptoms. The intervention group also had lower anxiety symptoms, though the two groups reported similar QOL scores. No significant differences in depression, anxiety, or QOL were detected at the 6-month follow-up.
Take Away: A web-based, self-help CBT treatment program demonstrated short-term efficacy for reducing depressive symptoms in adults with mild-to-moderate depression.
Internet administered guided self-help versus individualized e-mail therapy: A randomized trial of two versions of CBT for major depression.
Vernmark K, Lenndin J, Bjarehed J, Carlsson M, Karlsson J, Oberg J, Carlbring P, Eriksson T, Andersson G. Behaviour Research and Therapy. 2010. 48(5): 368-376. PMID: 20152960.
Summary: Swedish adults with depression were recruited through newspaper and web-based advertisements, posters, and radio interviews for this randomized controlled trial. Individuals with current suicidal ideation, with recent changes in their antidepressant medication, or who received other forms of depression treatment were excluded. Eligible participants (n=88) were randomly assigned to one of three treatment conditions: 1) email therapy; 2) internet-based CBT (iCBT) program; or 3) a waitlist control group. The email therapy group received weekly therapy emails based on cognitive behavioral therapy (CBT) for depression. Data on depression, anxiety, and quality of life (QOL) were collected at pre-treatment, post-treatment, and 6-month follow-up. The waitlist control group had access to the web-based self-help program after completing the post-treatment assessment. At the post-treatment follow-up, both the iCBT and email therapy groups had significantly larger reductions in depression than the waitlist control. While 83% of the email therapy group and 74% of the iCBT group showed clinically significant reductions in depression, only 25% of the control group showed such changes. By the 6-month follow-up, depression scores were comparable across all three groups, as the waitlist control had accessed treatment. There were no significant differences in anxiety symptoms or QOL between the three groups at the post-treatment or 6-month follow-up assessments.
Take Away: The iCBT program and email therapy both demonstrated short-term efficacy for treating depression.
Experiences of guided internet-based cognitive-behavioural treatment for depression: A qualitative study.
Bendelin N, Hesser H, Dahl J, Carlbring P, Nelson KZ, Andersson G. BMC Psychiatry. 2011. 11:107. PMCID: PMC3142491.
Summary: This qualitative study interviewed participants from the Vernmark et al (2010) study of an internet-based, guided, self-help cognitive behavioral therapy (iCBT) program for depression. A purposive sampling method was used to select twelve participants from the study who had been assigned to iCBT and had diverse outcomes. Using qualitative analysis methods, the participants were categorized by the way they worked with the program material. Each of the twelve participants was grouped as either: 1) Readers; 2) Strivers; or 3) Doers. The Readers reported that the program helped them gain awareness of their depression, but they were unable to incorporate the skills into their life. After completing the program, Readers were disappointed by their lack of progress and wished for more help with their depression. Strivers read the material and started incorporating it into their lives, but were skeptical about the effectiveness of the program and ambivalent about really utilizing their new skills. Although the Strivers gained understanding about depression and some skills to deal with symptoms, they still wished for more therapy. The Doers applied the skills they learned in the program to their own lives and were highly motivated. Their depression symptoms improved over the course of the program and they gained both understanding and self-sufficiency.
Take Away: Users may interact with web-based CBT programs in differing ways, which can impact the program’s effectiveness in treating depression.
Tailored vs. standardized internet-based cognitive behavior therapy for depression and comorbid symptoms: A randomized controlled trial.
Johansson R, Sjoberg E, Sjogren M, Johnsson E, Carlbring P, Andersson T, Rousseau A, Andersson G. PLoS One. 2012. 7(5): e36905. PMCID: PMC3352859.
Summary: Standardized and tailored versions of the internet-based self-help cognitive behavioral therapy (iCBT) program were evaluated in this randomized controlled trial. Individuals awaiting internet treatment were screened for depression and comorbid insomnia, stress, and psychiatric diagnoses. After screening, 121 participants were randomized to standardized iCBT treatment, individualized iCBT treatment, or a control group. The standardized iCBT treatment group received the 8 standard self-help modules. The individualized iCBT treatment group received 8-10 modules tailored to their own psychiatric symptomology based on screening results.. The control group only had access to an online discussion group initially, and then had access to the standardized version of the program after 10 weeks. Depression, anxiety, and quality of life (QOL) were measured at baseline, 10-week, and 6-month assessments.
At 10-weeks, both the tailored and standardized iCBT groups demonstrated lower depression than the control group. The standardized and tailored iCBT programs were also more effective than the control condition in reducing anxiety symptoms and improving QOL. No significant differences between the tailored and standardized groups were detected, except for participants with severe depression. The tailored iCBT program was significantly more effective for participants with severe depression. No significant group differences were found at the 6-month follow-up.
Take Away: Both standardized and tailored iCBT programs were effective in reducing depression in the short term. Tailored self-help programs may be more effective for individuals with severe depression.
Choosing between Internet-based psychodynamic versus cognitive behavioral therapy for depression: A pilot preference study.
Johansson R, Nyblom A, Carlbring P, Cuijpers P, Andersson G. BMC Psychiatry. 2013. 13:268. PMCID: PMC3852703.
Summary: The authors compared the efficacy of the internet-based self-help cognitive behavioral therapy (iCBT) program with internet-based psychodynamic treatment (IPDT) for major depression in this pilot study. Participants in the control group of a randomized trial of IPDT were invited to participate in this study after completion of the final follow-up. All participants were Swedish adults with major depression. In this study, participants were allowed to choose either IPDT or iCBT. Out of 44 participants, 68% selected the iCBT program and 32% selected IPDT. Depression, anxiety, and quality of life (QOL) were measured pre-treatment, post-treatment, and at 7-month follow-up. Depression improved comparably for both groups over time. There were no significant differences in reduction of depressive symptoms between the two groups at both follow-ups. The iCBT group did continue to have significant improvement between the post-treatment and 7-month follow-up, unlike the IPDT group. Compared to participants getting IPDT, participants getting iCBT also had significantly larger improvements in QOL at the post-treatment and 7-month follow-ups. Participants’ preference for a certain treatment at intake was related to their program adherence.
Take Away: Although both iCBT program and IPDT reduced depression in adults, the iCBT program was more effective in improving QOL. Participants’ treatment preferences appear to impact their treatment adherence.
Randomized trial of internet-based relapse prevention for partially remitted depression.
Hollandare F, Johnsson S, Randestad M, Tillfors M, Carlbring P, Andersson G, Engstrom I. Acta Psychiatrica Scandanavia. 2011. 124(4): 285-294. PMID: 21401534.
Summary: The internet-based self-help cognitive behavioral therapy (iCBT) program was modified for relapse prevention and tested in this randomized controlled trial. Swedish adults with partially remitted depression were recruited through newspaper advertisements. Those screening positive for depression in partial remission (n=84) were randomly assigned to iCBT or a control condition. Participants in the control group had no access to iCBT, but could receive non-specific email support from a therapist. Depression was assessed pre-treatment, post-treatment, and 6-months post-treatment. By 6-month follow-up, participants receiving iCBT had a significantly reduced depression relapse rate relative to the control group. The iCBT group also had larger reductions in depressive symptoms compared to the control.
Take Away: iCBT is more effective than non-specific email support in preventing relapses to depression.
Two-year outcome of internet-based relapse prevention for partially remitted depression.
Hollandare R, Anthony SA, Randestad M, Tillfors M, Carlbring P, Andersson G, Engstrom I. Behaviour Research and Therapy. 2013. 51(11): 719-722. PMID: 24021360.
Summary: This study continued following the 84 participants enrolled in the Hollandare et al. (2011) study. Participants randomized to the internet-based self-help cognitive behavioral therapy (iCBT) program or a control group were followed. Depression was assessed again two years post-randomization. At the two year follow-up, 14% of iCBT participants and 61% of control group participants had relapsed and met criteria for a major depressive episode. This difference was statistically significant. Changes in depressive symptoms from the pre- to post-treatment assessment predicted the risk of relapse to depression at two years. Participants in iCBT were also more likely to be in full remission from depression. While 69% of the iCBT group met criteria for full remission from depression on the Beck Depression Inventory (BCI), only 44% of the control group met criteria.
Take Away: Reductions in the risk of relapse to a major depressive episode endure for two years after completion of internet-based cognitive behavioral therapy (iCBT).