Woods AP, Stults CB, Terry RL, Rego SA. (2017). Strengths and limitations of internet-based cognitive-behavioral treatments for anxiety disorders. Pragmatic Case Studies in Psychotherapy. 13(5): 271-283. doi: 10.14713/pcsp.v13i3.2015
In this discussion paper, researchers highlighted strengths and limitations of internet-based cognitive behavioral therapy (ICBT) based on 4 case studies of patients receiving ICBT for anxiety disorders with varying levels of success. The authors found that ICBT was well suited for this group of patients with anxiety disorders, particularly younger patients, and was a good alternative to face-to-face therapy for those who were unlikely to initiate face-to-face therapy. One patient was afraid to leave their home, so ICBT was a good alternative. Another patient felt encouraged to initiate face-to-face therapy after completing ICBT. In some cases, ICBT was limited by lack of contact with a therapist, lack of therapeutic alliance, and heavy reliance on patient motivation to complete modules. Patients encountered particular difficulty with exposure therapy modules. Three patients took breaks prior to beginning to modules, resisted beginning the modules, and/or used safety behaviors (e.g. bringing a friend) that can impede the effect of exposure therapy. Researchers suggest ICBT programs should address patient readiness prior to beginning CBT modules and dedicate additional time to better prepare patients for exposure therapy and support them during the process. The authors also noted that ICBT programs should address co-morbidities that may require modifications to treatment protocols.