Online cognitive behavioural therapy (CBT) can be as effective at treating depression as traditional CBT, new research has shown.
In an international study, scientists found that internet-based CBT often has the same effects for treating depression as traditional, in-person CBT. However, they have warned that some online treatments contain elements that can be harmful.
The findings have been published in The Lancet Psychiatry.
To investigate the efficacy and potential limitations of internet CBT (iCBT), researchers carried out a systematic review and meta-analysis based on 76 randomised controlled trials (RCTs) in Sweden and elsewhere. In total, the RCTs included 17,521 patients, 71% of whom were women.
CBT is one of the most common treatments for a range of mental health conditions, such as anxiety, depression, and bipolar disorder. The process involves talking with a therapist about how thoughts, beliefs, and attitudes affect feelings and behaviour. The treatment teaches coping skills for dealing with different problems.
With web-based access to treatment materials, online CBT also involves modifying patients’ thoughts, feelings and behaviours that are obstacles in their lives and impair their mood. During the treatment, which often lasts about ten weeks, they are given tasks and exercises to perform on their own.
As good as conventional CBT
Co-author Cecilia Björkelund, Senior Professor of Family Medicine at the University of Gothenburg’s Sahlgrenska Academy, said: “In mild or moderate depression, the effect of iCBT is as good as that of conventional CBT. For many, it’s a superb way of getting access to therapy without having to go to a therapist. We also saw that it was especially good for the elderly — a finding we didn’t entirely expect.”
The factor that proved most significant for the prognosis was the depth of depression at the start of treatment. In milder depression, better results were obtained. Therapist support and text-message reminders increased the proportion of patients who completed the therapy.
“If you’re going to use iCBT in healthcare, the programmes have to be regulated just as well as drugs are, but that’s not the case today. With this study, we’re taking a real step forward. First, the study surveys what’s most effective. Second, it provides knowledge of how to design a programme and adapt its composition to patients’ problems,” Professor Björkelund added.
Contact is crucial
Researchers did, however, highlight the potential limitations of iCBT as a treatment for depression. They stressed the importance of continuous therapeutic contact during iCBT, allowing the therapist to track improvements and ensure that it is working as intended. Professor Björkelund also suggests that internet-mediated therapy would not be appropriate in severe cases of depression.
The study highlights the danger of using iCBT with programmes that include relaxation therapy. Rather than being beneficial, this may have negative effects, exacerbating depressive symptoms and causing “relaxation-induced anxiety”.
“For a depressed person, it isn’t advisable. Relaxation programmes shouldn’t be used as part of depression treatment in healthcare,” Professor Björkelund added.
