Program Overview
MoodGYM is a free, web-based program that treats and prevents depression and anxiety through cognitive behavioral therapy (CBT).
Over five CBT training modules, users of MoodGYM are taught about how thinking impacts mood and ways of overcoming dysfunctional thinking patterns. Each module requires about 30-45 minutes to complete. Modules contain interactive exercises, animated diagrams, assessments, games, and downloadable relaxation tapes to help users change negative thinking patterns, cope with life stresses, and improve self-esteem and assertiveness.
Link to commercial site here.
Last Updated: 06/28/2024
Delivery:
Web-based
Theoretical Approaches:
Cognitive Behavioral Therapy (CBT)
Target Outcome(s):
Depression
Anxiety
Symptom severity
Dysfunctional thinking patterns
Ages:
Adolescents (11-17)
Young Adults (18-30)
Adults (30+)
Genders:
Male
Female
Races/Ethnicities:
Caucasian
Asian
Black
Multiracial
Other
Setting:
Remote Access
Geographic Location:
Urban
Suburban
Rural
Country:
Australia
England
Norway
United States
Asia
Europe
Language:
English
Finnish
Norweigan
Dutch
Chinese
Evaluations
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Summary: In this randomized controlled trial, the authors compared the effects of MoodGYM with a psychoeducational website (BluePages) and an attention control. Australian citizens screening positive for psychological distress (n=525) were recruited to participate. Participants were randomized to MoodGYM, BluePages, or an attentional control for six weeks. Interviewers contacted both MoodGYM and BluePages participants weekly by telephone to help facilitate the programs and retain participants. The attentional control consisted of weekly phone interviews about lifestyle factors, such as exercise, education, and health habits. BluePages was a website with written information on depression. Depressive and anxiety symptoms were measured at randomization and 6-weeks post-intervention. Participants that received MoodGYM or BluePages had greater reductions in depressive symptoms than those in the control. Compared to other groups, the MoodGYM group had larger decreases in dysfunctional thinking patterns and greater increases in knowledge about cognitive behavioral therapy.
Take Away: MoodGYM has comparable effects on depression severity as a psychoeducational website, but is associated with larger decreases in dysfunctional thinking patterns.
Follow-up of previous study
Comparative randomized trial of online cognitive-behavioural therapy and an information website for depression: 12-month outcomes.
Summary: In this article, the authors continued following participants recruited for the randomized controlled trial comparing MoodGYM, BluePages (a psychoeducational website), and an attentional control (See Christensen et al., 2004). Depressive symptoms were assessed at 6- and 12-month follow-ups. At the 6-months, the MoodGYM participants had greater reductions in depressive symptoms than control participants. By 12-months, participants in the BluePages group had significantly larger reductions in depressive symptoms than the control group. No significant differences were found between MoodGYM and BluePages. These findings remained consistent when the authors only examined data from participants with moderate or severe depression.
Take Away: One year after treatment, MoodGYM is not significantly better at reducing depressive symptoms than either a psychoeducational website.
A comparison of changes in anxiety and depression symptoms of spontaneous users and trial participants of a cognitive behavior therapy website.
Summary: The researchers examined data from the 121 participants assigned to the MoodGYM intervention during the RCT. They compared the demographic characteristics and treatment outcomes of these RCT participants with data from 3,055 MoodGYM users from the general public who spontaneously enrolled in the program. Both groups of users completed assessments prior to Module 1 and after program completion. The researchers found no demographic differences between study participants and general public users. Both groups of MoodGYM users had significant declines in overall depression symptoms. Despite these similarities, users from the MoodGYM study were significantly more likely to be engaged in the program. Perhaps due to the weekly phone calls from study staff, 66% of study participants completed two or more sessions. Conversely, only 16% of general public users completed two or more MoodGYM sessions.
Take Away: Although MoodGYM appears to reduce depression in study participants and users from the general public, weekly phone calls may be an important part of retaining participants in the program.
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Summary: Six versions of MoodGYM were compared in this randomized controlled trial. Three versions shortened the program and included only one brief cognitive behavioral therapy (CBT) session. The other three versions contained extended CBT, and offered multiple CBT sessions. Each version also included different add-on components, such as stress management, problem solving, or behavioral strategies. Participants (n=2,794) were recruited through the MoodGYM website, randomly assigned to receive one of the six versions, and given pre- and post-test assessments. Twenty percent of study participants completed the program. Participants receiving the versions of MoodGYM with extended CBT had larger decreases in depression than participants only getting brief CBT. For participants that received extended CBT, no differences were found between programs with add-on components.
Take Away: MoodGYM with more CBT sessions is more effective in reducing depressive symptoms than MoodGYM with single-session CBT.
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Summary: Six versions of MoodGYM were compared in this randomized controlled trial. Three versions shortened the program and included only one brief cognitive behavioral therapy (CBT) session. The other three versions contained extended CBT, and offered multiple CBT sessions. Each version also included different add-on components, such as stress management, problem solving, or behavioral strategies. Participants (n=2,794) were recruited through the MoodGYM website, randomly assigned to receive one of the six versions, and given pre- and post-test assessments. Twenty percent of study participants completed the program. Participants receiving the versions of MoodGYM with extended CBT had larger decreases in depression than participants only getting brief CBT. For participants that received extended CBT, no differences were found between programs with add-on components.
Take Away: MoodGYM with more CBT sessions is more effective in reducing depressive symptoms than MoodGYM with single-session CBT.
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Summary: To test the effects of MoodGYM on depression in adolescent males, a school-based controlled trial was conducted. Males (n=121) in grade 9 were randomly assigned to study classes, called “tutor groups”. Each tutor group was randomized to MoodGYM or to a control group. The MoodGYM group went to a computer lab and completed the MoodGYM program for five weekly sessions; the control group had study time or engaged in physical activities. Depression was measure pre-intervention, post-intervention, and 16-weeks post intervention. Forty percent of students receiving MoodGYM completed three or more sessions. No significant differences in depression, attributional style, self-esteem, or attitudes toward depression were found between the MoodGYM and control groups at either follow-up. Students getting MoodGYM had a 17% decrease in the risk of being classified as depressed at the post-intervention follow-up, while students in the control group had no reduction. This finding was not sustained at the 16-week follow-up assessment.
Take Away: MoodGYM was not associated with statistically significant decreases in depression for adolescent males completing the program in a school-based setting.
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Summary: To examine predictors of adherence to the MoodGYM program, the authors analyzed data from community users (n=59,453) registered on the MoodGYM website in 2006 and 2007. Information on demographic and mental health characteristics was collected pre-intervention and after Module One. Overall, 63% of users completed no MoodGYM modules. While 27% of users completed one module, only 10% completed two or more modules. Younger age, higher educational attainment, and being female were associated with better completion rates. Users living in Oceania or Europe were more likely to adhere than users living in North America. Users with more severe baseline depression and anxiety were more adherent to MoodGYM.
Take Away: Age, gender, location, and mental health severity are associated with adherence to the MoodGYM program.
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Summary: Female students in grade 9 (age 15-16) were recruited to participate in a school-based controlled trial of MoodGYM. One-hundred fifty-seven students were enrolled and assigned to either 6 weeks of MoodGYM or a personal development control group, based on the development group. The first three personal development courses completing their usual curriculum were assigned to complete MoodGYM, while the other personal development course groups completed activities on nutrition. Depressive symptoms were measured pre-intervention, immediately post-intervention, and at a 20-week follow-up. Only 30% of the MoodGYM group completed three or more modules. Despite this, students getting MoodGYM had faster declines in depressive symptoms than the control group. Although there was no significance difference in depressive symptoms immediately post-intervention, the MoodGYM group had greater decreases in depression at 20 weeks. No significant between-group differences were detected in changes in attributional style, attitudes and knowledge about depression.
Take Away: Despite the low completion rates, MoodGYM may reduce depressive symptoms in adolescent females. Interpretation of results are limited by lack of randomization.
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Summary: In this cluster randomized trial of MoodGYM, 32 Australian secondary schools were randomly assigned to offer students MoodGYM or a wait-list control. Students receiving MoodGYM (n=563) were given time in school to complete the program for five weeks, while students in the control group (n=914) had no access to MoodGYM and received usual school programming. All participating students completed questionnaires assessing depression and anxiety at a pre-intervention assessment and 1- and 6-month follow-ups. At MoodGYM schools, 62% of students completed three or more modules. Thirty-three percent of students completed the entire MoodGYM program. Students at schools implementing MoodGYM had significantly greater declines in anxiety symptoms at the 1- and 6-month follow-ups. Although no differences between MoodGYM and controls were detected for depression, males receiving MoodGYM had larger decreases in depressive symptoms at the 1- and 6-month follow ups. MoodGYM and the control condition resulted in comparable decreases in depressive symptoms for females.
Take Away: MoodGYM is associated with significant decreases in anxiety symptomology in secondary school students. MoodGYM was also associated with decreased depression in males but not females.
Follow-Up of Previous Study
Predictors of adherence by adolescents to a cognitive behavior therapy website in school and community-based settings.
Summary: Data collected from 1,000 students in the YouthMood Project was combined with data collected from 7,207 adolescents from the community who registered on the MoodGYM website. The authors used data from pre-intervention assessments to determine predictors of adherence to MoodGYM. Adolescents accessing MoodGYM in a school-setting were significantly more likely to be retained in the MoodGYM program. While 55% of adolescents in the school-based setting completed three or more MoodGYM modules, 89% of community adolescents dropped out after completing one or fewer modules. In the school setting, adolescents completed an average of 9.38 MoodGYM exercises. Community adolescents completed an average of 3.10 exercises. Using linear regression models, the authors determined that gender and setting were significant predictors of adherence to MoodGYM. Females and adolescents in a school setting were significantly more likely to adhere to MoodGYM.
Take Away: For adolescents, implementation setting impacts adherence to MoodGYM. Adolescents accessing the program as part of school-based program were more likely to be retained.
Adherence to the MoodGYM program: Outcomes and predictors for an adolescent school-based population.
Summary: Predictors and the impact of treatment adherence were explored in this secondary analysis of the YouthMood Project. Students (n=1,477) at thirty Australian secondary schools were divided into three groups based on their randomization and treatment adherence to MoodGYM: 1) Control, 2) Low adherence, or 3) High adherence. Students with high adherence to MoodGYM had greater reductions in anxiety than students in the control group, or students with low adherence to MoodGYM. Males with high adherence to MoodGYM also had larger decreases in depression than males with low adherence or males in the control group. For females, adherence was not related to depression outcomes. Students with higher baseline depressive symptoms and self-esteem were more adherent to MoodGYM. Additionally, living in a rural area and being in the 9th year of school were associated with higher adherence levels.
Take Away: For secondary school students, adherence to MoodGYM impacts treatment outcomes. Depression severity, self-esteem, location, and grade were associated with adherence.
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Summary: In this randomized controlled trial, callers to an Australian 24-hour telephone counseling service were screened for depression. Non-suicidal callers who screened positive for depression (n=155) were randomly assigned to one of four conditions: 1) Web therapy only; 2) Web therapy plus telephone tracking; 3) Telephone tracking only; or 4) Control. Participants assigned to either condition with web therapy received 6 weeks of cognitive behavioral therapy online. During Week 1, participants completed the BluePages psychoeducational website. Weeks two through six were spent completing the MoodGYM program. Participants receiving telephone tracking were called weekly by research staff. Participants spent 10 minutes discussing lifestyle factors that may impact MoodGYM adherence or depression. The control group received no telephone calls and no web-based therapy sessions. Depression was measured at baseline, post-intervention, and a 6-month follow-up. Results showed that participants in the web only and web plus tracking conditions had greater decreases in depression than participants in the control group. At 6 months, 91% of control participants continued meeting criteria for depression, while only 44% of web-only participants and 50% of web plus tracking participants met criteria for depression.
Take Away: For individuals with depression, MoodGYM is effective in lowering depressive symptoms with or without weekly tracking phone calls.
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Summary: The authors conducted a pilot to examine the efficacy of MoodGYM in comparison to an online support group (MoodGarden). Undergraduates at the University of Sydney with low to moderate psychiatric distress were recruited and randomized (n=39) to either MoodGYM, MoodGarden, or a control group. Control participants received no treatment. Participants in the MoodGYM and MoodGarden groups spent 60 minutes per week engaged in the program. The MoodGYM participants completed one MoodGYM session each week. The MoodGarden participants were instructed to post on the message board, where they would receive peer support and encouragement. Depression, anxiety, psychiatric distress, and treatment satisfaction were measured at baseline and 3-week follow-up. Results showed that MoodGYM and MoodGarden decreased anxiety symptoms more than the control condition. All three groups had equivalent declines in depression. While participants in the MoodGYM group reported liking that the program helped them identify negative thoughts and emotions, they disliked the redundancy of the program. More than half of MoodGYM participants stated that they did not enjoy the program.
Take Away: MoodGYM and MoodGarden both appear to decrease anxiety in undergraduate students, but did not impact depressive symptoms. Acceptability of MoodGYM by college students was low, which could influence engagement and impact.
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Summary: A randomized controlled non-inferiority trial was conducted to compare the efficacy of Interpersonal Psychotherapy (IPT) from e-Couch, cognitive behavioral therapy (CBT) from e-Couch, and the CBT-based MoodGYM program. e-Couch is another online program designed to treat mood disorders. Adults with depression (n=1,929) were recruited from the e-Couch website and randomly assigned to receive one of the three web-based therapies. Participants in all three conditions (IPT, e-Couch CBT, and MoodGYM) had access to a new module each week for a month. The IPT modules included topics on grief, role disputes, role transitions, and interpersonal deficits. The CBT e-Couch modules covered negative thoughts and behavioral activation.
Depression, demographic characteristics, and treatment satisfaction were assessed pre-intervention, post-intervention and 6-month follow-up. Participants in all three conditions had significant improvements in depressive symptoms from pre-intervention to 6-month follow-up. The three programs had moderate effects on depression when all randomized participants were included in the analyses. Although MoodGYM had a significantly higher attrition rate than IPT and e-Couch CBT, participants in the MoodGYM and e-Couch CBT groups were more satisfied with treatment than those in the IPT group.
Take Away: MoodGYM and the Interpersonal Therapy (IPT) and cognitive behavioral therapy (CBT) modules from the e-Couch program have comparable effects on reducing depressive symptoms.
Follow-Up of Previous Study
Predictors and moderators of response to internet-delivered Interpersonal Psychotherapy and Cognitive Behavior Therapy for depression
Summary: In this secondary analysis of data (Donder, Bennett, Bennett et al., 2003), the authors examined predictors and moderators of treatment response to the different e-treatment programs. Females and participants with lower dysfunctional attitudes had greater improvement in depression across all three interventions. There was an age-moderated treatment response. For the e-Couch IPT intervention, older participants had significantly greater improvements in depression than younger participants. The reverse was true for MoodGYM. Younger participants assigned to MoodGYM had larger improvements in depressive symptoms than older participants.
Take Away: Participant age, gender, and level of dysfunctional attitudes may impact response to MoodGYM and other web-based programs for depression.
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Summary: Primary care patients with mild to moderate depression were assigned to a waitlist control or MoodGYM plus therapist-support. The MoodGYM intervention consisted of 6 weeks of the online program, plus seven brief (15-30 minute) sessions in-person with a therapist at a primary care clinic. Therapy sessions were designed to support MoodGYM and focused on depressive symptoms and facilitation of the MoodGYM program. Participants in the waitlist control had access to MoodGYM plus therapist support after seven weeks. All participants had access to usual primary care interventions, including antidepressant medications and referral to therapy. Depression and quality of life were assessed pre-intervention, post-intervention, and 6-months post-intervention. At post-intervention, participants who received MoodGYM had larger improvements in depression and quality of life than the control group. After exposure to MoodGYM, the waitlist control group also had significant improvements in depressive symptoms and quality of life.
Take Away: For primary care patients with mild or moderate depression, MoodGYM plus in-person therapist support had short term impact on depression and quality of life indicators.
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Summary: College students with depressive symptoms (n=163) were randomized to MoodGYM, BluePages (an informational website), or waitlist control. Assessments were conducted pre- and post-intervention. Although post-intervention assessments were completed only two months after randomization, 37% of participants dropped out of the study. Participants assigned to MoodGYM were more likely to dropout, as were participants reporting that they had not sought depression treatment before because the problem wasn’t serious enough. Despite the dropout rate, MoodGYM participants had lower depressive symptoms, higher depression literacy, and fewer automatic negative thoughts than control participants at follow-up.
Take Away: MoodGYM is effective in reducing depressive symptoms among university students, but is associated with high attrition rates.
Follow-Up of Previous Study
Evaluating the translation process of an internet-based self-help intervention for prevention of depression: A cost-effectiveness analysis.
Summary: A cost-effectiveness analysis was conducted using data collected during the Lintvedt et al (2013) randomized controlled trial of MoodGYM plus BluePages. Major study costs included the translation of MoodGYM into Norwegian and the website development. Quality of life and depression data collected during the pre- and post-intervention assessments were used to calculate Quality Adjusted Life Years (QALYs). Using cost and QALY data, cost effectiveness ratios were derived to compare the cost-effectiveness of MoodGYM and the waitlist control. Results showed that each participant getting MoodGYM gained an average of 0.018 QALYs. For every 1,000 participants treated with MoodGYM and BluePages, 16 QALYs were gained overall, and the cost of the initial investment was returned nine times. This contributed to a cost-effectiveness ratio of €3,432 per QALY for MoodGYM.
Take Away: Even including the cost of language translation, MoodGYM is a cost-effective treatment for depression.
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Summary: Students at four high schools in Norway were invited to participate and were randomly assigned to one of four study arms: 1) Control (n=180), 2) MoodGYM with no reminders (n=176), 3) MoodGYM with standard email reminders (n=176), or 4) MoodGYM with personalized email reminders (n=175). The control group had no access to MoodGYM until after completing the study. Participants getting standard reminders received weekly emails with information on the upcoming MoodGYM module. Participants getting tailored reminders received weekly emails with information on MoodGYM and feedback on depression, self-esteem, and self-efficacy from the baseline assessment. Depression, self-esteem, and self-efficacy were assessed at baseline and a 6-week follow-up.
Attrition rates were high. Only 8.5% of participants in the MoodGYM arms signed onto the program. Receiving reminders did not improve adherence to MoodGYM. After completing a survey about engagement, the majority of participants noted that the lack of private computer access, concerns about anonymity, and lack of psychiatric symptom severity contributed to their lack of engagement in MoodGYM. No significant differences in depressive symptoms were found between the control and intervention groups.
Take Away: Engagement is a major concern for high schools interested in adopting MoodGYM.
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Summary: Patients on waiting lists at six mental health clinics in Ireland were invited to participate in this randomized controlled trial of MoodGYM. Any patients with internet access who presented with symptoms of depression, stress, or anxiety were eligible. The authors randomized participants (n=149) to a waitlist control or to MoodGYM. Online assessments were sent to participants at baseline, 32-days, and 12-weeks follow-ups. While 55% of participants assigned to MoodGYM completed three or more sessions, only 27% completed all five sessions. Results from the 32-day follow-up showed that MoodGYM participants had larger reductions in overall psychiatric distress and stress than control participants. No differences in depression, anxiety, or daily functioning were detected. Because only 9 participants completed the 12-week follow-up assessments, the authors were unable to analyze the efficacy of MoodGYM at 12-weeks.
Take Away: For patients awaiting psychiatric care, MoodGYM may be effective in reducing psychiatric distress and stress. MoodGYM is be less effective in decreasing depression, anxiety, or improving daily functioning for those seeking mental health services.
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Free range users and one hit wonders: Community users of an internet-based cognitive behavior therapy program. Christensen H, Griffiths K, Groves C, Korten A. Australian and New Zealand Journal of Psychiatry. 2006. 40(1): 59-62. 16403040.
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Evaluation of an online cognitive behavioural therapy program by patients with traumatic brain injury and depression. Topolovec-Vranic J, Cullen N, Michalak A, Ouchterlony D, Bhalerao S, Masanic C, Cusimano MD. Brain Injury. 2010. 24(5): 762-772. PMID: 20370383.
Patients’ experiences of helpfulness in guided internet-based treatment for depression: Qualitative study of integrated therapeutic dimensions. Lillevoll KR, Wilhelmsen M, Kolstrup N, Hoifodt RS, Waterloo K, Eisemann M, Risor MB. Journal of Medical Internet Research. 2013. 15(6): e126. PMCID: PMC3713917.
Motivation to persist with internet-based cognitive behavioural treatment using blended care: A qualitative study. Wilhelmsen M, Lillevoll K, Risor MB, Hoifodt R, Johansen ML, Waterloo K, Eisemann M, Kolstrup N. BMC Psychiatry. 2013. 13: 296. PMCID: PMC4226213.
Fibromyalgia: Can online cognitive behavioral therapy help? Menga G, Ing S, Khan O, Dupre B, Dornelles AC, Alarakhia A, Davis W, Zakem J, Webb-Detiege T, Scopelitis E, Quinet R. The Ochsner Journal. 2014. 14(3): 343-349. PMCID: PMC4171792.
Acceptability of online self-help to people with depression: Users’ views of MoodGYM versus informational websites. Schneider J, Sarrami Foroushani P, Grime P, Thronicroft G. Journal of Medical Internet Research. 2014. 16(3): e90. PMCID: PMC4004160.
Norwegian general practitioners’ perspectives on implementation of a guided web-based cognitive behavioural therapy for depression: A qualitative study. Wilhelmsen M, Hoifodt RS, Kolstrup N, Waterloo K, Eisemann M, Chenhall R, Risor MB. Journal of Medical Internet Research. 2014. 16(9): e208. PMCID: PMC4180343.
Implementing internet-based cognitive behavioural therapy (moodgym) for African students with symptoms of low mood during the COVID-19 pandemic: a qualitative feasibilty study. Ncheka JM, Menon JA, Davies EB, et al. Psychiatry. 2024;24(1):92. doi:10.1186/s12888-024-05542-4
Use and acceptability of Moodgym for postpartum depression in pediatric settings. Gen Hosp Psychiatry. Boyd RC, Barcak D, Morales KH, et al. 2023;84:1-2. doi:10.1016/j.genhosppsych
Apparent Lack of Benefit of Combining Repetitive Transcranial Magnetic Stimulation with Internet-Delivered Cognitive Behavior Therapy for the Treatment of Resistant Depression: Patient-Centered Randomized Controlled Pilot Trial. Adu MK, Shalaby R, Eboreime E, et al. Brain Sci. 2023;13(2)doi:10.3390/brainsci13020293
The cost-effectiveness of delivering an e-health intervention, MoodGYM, to prevent anxiety disorders among Australian adolescents: A model-based economic evaluation. Lee YY, Le LK-D, Lal A, Engel L, Mihalopoulos C. Mental Health & Prevention. 2021;24doi:10.1016/j.mhp.2021.200210
Randomized controlled trial of online interventions for co-occurring depression and hazardous alcohol consumption: Primary outcome results. Cunningham JA, Godinho A, Hendershot CS, et al. Internet Interv. 2021;26:100477. doi:10.1016/j.invent.2021.100477
Engagement and Usability of a Cognitive Behavioral Therapy Mobile App Compared With Web-Based Cognitive Behavioral Therapy Among College Students: Randomized Heuristic Trial. Purkayastha S, Addepally SA, Bucher S. JMIR Hum Factors. 2020;7(1):e14146. doi:10.2196/14146
Addition of MoodGYM to physical treatments for chronic low back pain: A randomized controlled trial. Petrozzi MJ, Leaver A, Ferreira PH, Rubinstein SM, Jones MK, Mackey MG. Chiropr Man Therap. 2019;27:54. doi:10.1186/s12998-019-0277-4
A randomized controlled trial of Internet-delivered CBT and attention bias modification for early intervention of depression. McDermott R, Dozois DJA. Journal of Experimental Psychopathology. 2019;10(2)doi:10.1177/2043808719842502