Abstract
The Internet has become a part of most people’s lives in many parts of the world. Since the late 1990s there has been an intensive research activity in which psychological treatments, such as cognitive behavior therapy (CBT), have been found to be effective when delivered via the Internet. Most research studies indicate that the effects are larger when some form of guidance is provided from a therapist, and unguided treatments tend to lead to more dropout and smaller effects. Guided Internet treatments often consists of book length text materials, but can also include other components such as audio files and video clips. Homework assignment is often included and feedback is given for completed homework. Guided Internet-based CBT (iCBT) has been found to work for problems such as depression, panic-, social anxiety-, and generalized anxiety disorders. There are many research trials in which participants have been recruited via media, and there has been less research conducted in representative clinical settings. Most research has been conducted on adults and in university settings with nationwide recruitment. There is a need for treatments and studies on older adults, children and adolescents. In conclusion, dissemination of the research findings on guided iCBT to regular clinical settings is warranted.
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Almlöv, J., Carlbring, P., Källqvist, K., Paxling, B., Cuijpers, P., & Andersson, G. (2011). Therapist effects in guided Internet-delivered CBT for anxiety disorders. Behavioural and Cognitive Psychotherapy, 39, 311–322.
Andersson, G. (2009). Using the Internet to provide cognitive behaviour therapy. Behaviour Research and Therapy, 47, 175–180.
Andersson, G., Bergström, J., Holländare, F., Carlbring, P., Kaldo, V., & Ekselius, L. (2005). Internet-based self-help for depression: A randomised controlled trial. British Journal of Psychiatry, 187, 456–461.
Andersson, G., Carlbring, P., Berger, T., Almlöv, J., & Cuijpers, P. (2009a). What makes Internet therapy work? Cognitive Behaviour Therapy, 38(S1), 55–60.
Andersson, G., Carlbring, P., & Cuijpers, P. (2009b). Internet interventions: Moving from efficacy to effectiveness. E-Journal of Applied Psychology, 5, 18–24.
Andersson, G., Carlbring, P., Furmark, T., & On behalf of the SOFIE Research Group. (2012a). Therapist experience and knowledge acquisition in Internet-delivered CBT for social anxiety disorder: A randomized controlled trial. PLoS ONE, 7(5), e37411.
Andersson, G., Carlbring, P., & Grimlund, A. (2008). Predicting treatment outcome in Internet versus face to face treatment of panic disorder. Computers in Human Behavior, 24, 1790–1801.
Andersson, G., Carlbring, P., Holmström, A., Sparthan, E., Furmark, T., Nilsson-Ihrfelt, E., et al. (2006). Internet-based self-help with therapist feedback and in vivo group exposure for social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74, 677–686.
Andersson, E., Enander, J., Andrén, P., Hedman, E., Ljótsson, B., Hursti, T., et al. (2012b). Internet-based cognitive behaviour therapy for obsessive–compulsive disorder: A randomised controlled trial. Psychological Medicine, 42, 2193–2203.
Andersson, G., Estling, F., Jakobsson, E., Cuijpers, P., & Carlbring, P. (2011a). Can the patient decide which modules to endorse? An open trial of tailored Internet treatment of anxiety disorders. Cognitive Behaviour Therapy, 40, 57–64.
Andersson, G., Hesser, H., Hummerdal, D., Bergman-Nordgren, L., & Carlbring, P. (2013a). A 3.5-year follow-up of Internet-delivered cognitive behaviour therapy for major depression. Journal of Mental Health, 22, 155–164.
Andersson, G., Hesser, H., Veilord, A., Svedling, L., Andersson, F., Sleman, O., Mauritzson, L., Sarkohi, A., Claesson, E., Zetterqvist, V., Lamminen, M., Eriksson, T., & Carlbring, P. (2013b). Randomized controlled non-inferiority trial with 3-year follow-up of Internet-delivered versus face-to-face group cognitive behavioural therapy for depression (submitted manuscript).
Andersson, E., Ljótsson, B., Hedman, E., Kaldo, V., Paxling, B., Lindefors, N., et al. (2011b). Internet-based cognitive behavior therapy for obsessive compulsive disorder: A pilot study. BMC Psychiatry, 11, 125.
Andersson, G., Paxling, B., Roch-Norlund, P., Östman, G., Norgren, A., Almlöv, J., et al. (2012c). Internet-based psychodynamic vs. cognitive behavioural guided self-help for generalized anxiety disorder: A randomised controlled trial. Psychotherapy and Psychosomatics, 81, 344–355.
Andersson, G., Paxling, B., Wiwe, M., Vernmark, K., Bertholds Felix, C., Lundborg, L., et al. (2012d). Therapeutic alliance in guided Internet-delivered cognitive behavioral treatment of depression, generalized anxiety disorder and social anxiety disorder. Behaviour Research and Therapy, 50, 544–550.
Andersson, G., Waara, J., Jonsson, U., Malmaeus, F., Carlbring, P., & Öst, L.-G. (2009c). Internet-based self-help vs. one-session exposure in the treatment of spider phobia: A randomized controlled trial. Cognitive Behaviour Therapy, 38, 114–120.
Andrews, G., Davies, M., & Titov, N. (2011). Effectiveness randomized controlled trial of face to face versus Internet cognitive behaviour therapy for social phobia. The Australian and New Zealand Journal of Psychiatry, 45, 337–340.
Aydos, L., Titov, N., & Andrews, G. (2009). Shyness 5: The clinical effectiveness of Internet-based clinician-assisted treatment of social phobia. Australasian Psychiatry, 17, 488–492.
Barak, A. (1999). Psychological applications on the Internet: A discipline on the threshold of a new millennium. Applied and Preventive Psychology, 8, 231–245.
Bennett, K., Bennett, A. J., & Griffiths, K. M. (2010). Security considerations for e-mental health interventions. Journal of Medical Internet Research, 12(5), e61.
Berger, T., Caspar, F., Richardson, R., Kneubühler, B., Sutter, D., & Andersson, G. (2011a). Internet-based treatment of social phobia: A randomized controlled trial comparing unguided with two types of guided self-help. Behaviour Research and Therapy, 48, 158–169.
Berger, T., Hämmerli, K., Gubser, N., Andersson, G., & Caspar, F. (2011b). Internet-based treatment of depression: A randomized controlled trial comparing guided with unguided self-help. Cognitive Behaviour Therapy, 40, 251–266.
Berger, T., Hohl, E., & Caspar, F. (2009). Internet-based treatment for social phobia: A randomized controlled trial. Journal of Clinical Psychology, 65, 1021–1035.
Bergström, J., Andersson, G., Karlsson, A., Andreewitch, S., Rück, C., Carlbring, P., et al. (2009). An open study of the effectiveness of Internet treatment for panic disorder delivered in a psychiatric setting. Nordic Journal of Psychiatry, 63, 44–50.
Bergström, J., Andersson, G., Ljótsson, B., Rück, C., Andréewitch, S., Karlsson, A., et al. (2010). Internet- versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting: A randomised trial. BMC Psychiatry, 10, 54.
Botella, C., Gallego, M. J., Garcia-Palacios, A., Guillen, V., Banos, R. M., Quero, S., et al. (2010). An Internet-based self-help treatment for fear of public speaking: A controlled trial. Cyberpsychology, Behavior and Social Networking, 13, 407–421.
Carlbring, P., Bergman Nordgren, L., Furmark, T., & Andersson, G. (2009). Long term outcome of Internet delivered cognitive-behavioural therapy for social anxiety disorder: A 30-month follow-up. Behaviour Research and Therapy, 47, 848–850.
Carlbring, P., Bohman, S., Brunt, S., Buhrman, M., Westling, B. E., Ekselius, L., et al. (2006). Remote treatment of panic disorder: A randomized trial of Internet-based cognitive behavioral therapy supplemented with telephone calls. American Journal of Psychiatry, 163, 2119–2125.
Carlbring, P., Brunt, S., Bohman, S., Austin, D., Richards, J. C., Öst, L.-G., et al. (2007a). Internet vs. paper and pencil administration of questionnaires commonly used in panic/agoraphobia research. Computers in Human Behavior, 23, 1421–1434.
Carlbring, P., Ekselius, L., & Andersson, G. (2003). Treatment of panic disorder via the Internet: A randomized trial of CBT vs. applied relaxation. Journal of Behavior Therapy and Experimental Psychiatry, 34, 129–140.
Carlbring, P., Gunnarsdóttir, M., Hedensjö, L., Andersson, G., Ekselius, L., & Furmark, T. (2007b). Treatment of social phobia: Randomized trial of Internet delivered cognitive behaviour therapy and telephone support. British Journal of Psychiatry, 190, 123–128.
Carlbring, P., Hägglund, M., Luthström, A., Dahlin, M., Kadowaki, Å., Vernmark, K., et al. (2013). Internet-based behavioral activation and acceptance-based treatment for depression: A randomized controlled trial. Journal of Affective Disorders, 148, 331–337.
Carlbring, P., Maurin, L., Törngren, C., Linna, E., Eriksson, T., Sparthan, E., et al. (2010). Individually tailored Internet-based treatment for anxiety disorders: A randomized controlled trial. Behaviour Research and Therapy, 49, 18–24.
Carlbring, P., Nilsson-Ihrfelt, E., Waara, J., Kollenstam, C., Buhrman, M., Kaldo, V., et al. (2005). Treatment of panic disorder: Live therapy vs. self-help via Internet. Behaviour Research and Therapy, 43, 1321–1333.
Carlbring, P., Westling, B. E., Ljungstrand, P., Ekselius, L., & Andersson, G. (2001). Treatment of panic disorder via the Internet—a randomized trial of a self-help program. Behavior Therapy, 32, 751–764.
Choi, I., Zou, J., Titov, N., Dear, B. F., Li, S., Johnston, L., et al. (2012). Culturally attuned Internet treatment for depression amongst Chinese Australians: A randomised controlled trial. Journal of Affective Disorders, 136, 459–468.
Christensen, H., Griffiths, K., Groves, C., & Korten, A. (2006a). Free range users and one hit wonders: Community users of an Internet-based cognitive behaviour therapy program. The Australian and New Zealand Journal of Psychiatry, 40, 59–62.
Christensen, H., Griffiths, K. M., Mackinnon, A. J., & Brittliffe, K. (2006b). Online randomized trial of brief and full cognitive behaviour therapy for depression. Psychological Medicine, 36, 1737–1746.
Cuijpers, P., van Straten, A.-M., & Andersson, G. (2008). Internet-administered cognitive behavior therapy for health problems: A systematic review. Journal of Behavioral Medicine, 31, 169–177.
Furmark, T., Carlbring, P., Hedman, E., Sonnenstein, A., Clevberger, P., Bohman, B., et al. (2009). Guided and unguided self-help for social anxiety disorder: Randomised controlled trial. British Journal of Psychiatry, 195, 440–447.
Golkaramnay, V., Bauer, S., Haug, S., Wolf, M., & Kordy, H. (2007). The exploration of the effectiveness of group therapy through an Internet chat as aftercare: A controlled naturalistic study. Psychotherapy and Psychosomatics, 76, 219–225.
Hedman, E., Andersson, E., Lindefors, N., Andersson, G., Rück, C., & Ljótsson, B. (2013). Cost-effectiveness and long-term effectiveness of Internet-based cognitive behaviour therapy for severe health anxiety. Psychological Medicine, 43, 363–374.
Hedman, E., Andersson, E., Ljótsson, B., Andersson, G., Andersson, E. M., Schalling, M., et al. (2012a). Clinical and genetic outcome determinants of Internet- and group-based cognitive behavior therapy for social anxiety disorder. Acta Psychiatrica Scandinavica, 126, 126–136.
Hedman, E., Andersson, G., Ljótsson, B., Andersson, E., Rück, C., Asmundson, G. J. G., et al. (2011a). Internet-based cognitive-behavioural therapy for severe health anxiety: Randomised controlled trial. British Journal of Psychiatry, 198, 230–236.
Hedman, E., Andersson, E., Ljótsson, B., Andersson, G., Rück, C., & Lindefors, N. (2011b). Cost-effectiveness of Internet-based cognitive behavior therapy vs. cognitive behavioral group therapy for social anxiety disorder: Results from a randomized controlled trial. Behaviour Research and Therapy, 49, 729–736.
Hedman, E., Andersson, G., Ljótsson, B., Andersson, E., Rück, C., Mörtberg, E., et al. (2011c). Internet-based cognitive behavior therapy vs. cognitive behavioral group therapy for social anxiety disorder: A randomized controlled non-inferiority trial. PLoS ONE, 6(3), e18001.
Hedman, E., Furmark, T., Carlbring, P., Ljótsson, B., Rück, C., Lindefors, N., et al. (2011d). Five-year follow-up of Internet-based cognitive behaviour therapy for social anxiety disorder. Journal of Medical Internet Research, 13(2), e39.
Hedman, E., Ljótsson, B., Andersson, E., Rück, C., Andersson, G., & Lindefors, N. (2010a). Effectiveness and cost offset analysis of group CBT for hypochondriasis delivered in a psychiatric setting—an open trial. Cognitive Behaviour Therapy, 39, 239–250.
Hedman, E., Ljotsson, B., & Lindefors, N. (2012b). Cognitive behavior therapy via the Internet: A systematic review of applications, clinical efficacy and cost-effectiveness. Expert Review of Pharmacoeconomics and Outcomes Research, 12, 745–764.
Hedman, E., Ljótsson, B., Rück, C., Bergström, J., Andersson, G., Kaldo, V., et al. (2013). Effectiveness of Internet-based cognitive behaviour therapy for panic disorder in routine psychiatric care. Acta Psychiatrica Scandinavica. doi:10.1111/acps.12079.
Hedman, E., Ljótsson, B., Rück, C., Furmark, T., Carlbring, P., Lindefors, N., et al. (2010b). Internet administration of self-report measures commonly used in research on social anxiety disorder: A psychometric evaluation. Computers in Human Behavior, 26, 736–740.
Holländare, F., Andersson, G., & Engström, I. (2010). A comparison of psychometric properties between Internet and paper versions of two depression instruments (BDI-II and MADRS-S) administered to clinic patients. Journal of Medical Internet Research, 12(5), e49.
Holländare, F., Johnsson, S., Randestad, M., Tillfors, M., Carlbring, P., Andersson, G., et al. (2011). Randomized trial of Internet-based relapse prevention for partially remitted depression. Acta Psychiatrica Scandinavica, 124, 285–294.
Johansson, R., & Andersson, G. (2012). Internet-based psychological treatments for depression. Expert Review of Neurotherapeutics, 12, 861–870.
Johansson, R., Ekbladh, S., Hebert, A., Lindström, M., Möller, S., Petitt, E., et al. (2012a). Psychodynamic guided self-help for adult depression through the Internet: A randomised controlled trial. PLoS ONE, 7(5), e38021.
Johansson, R., Sjöberg, E., Sjögren, M., Johnsson, E., Carlbring, P., Andersson, T., et al. (2012b). Tailored vs. standardized Internet-based cognitive behavior therapy for depression and comorbid symptoms: A randomized controlled trial. PLoS ONE, 7(5), e36905.
Kessler, D., Lewis, G., Kaur, S., Wiles, N., King, M., Weich, S., et al. (2009). Therapist-delivered Internet psychotherapy for depression in primary care: A randomised controlled trial. Lancet, 374, 628–634.
Kiropoulos, L. A., Klein, B., Austin, D. W., Gilson, K., Pier, C., Mitchell, J., et al. (2008). Is Internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT? Journal of Anxiety Disorders, 22, 1273–1284.
Klein, B., & Richards, J. C. (2001). A brief Internet-based treatment for panic disorder. Behavioural and Cognitive Psychotherapy, 29, 113–117.
Klein, B., Richards, J. C., & Austin, D. W. (2006). Efficacy of Internet therapy for panic disorder. Journal of Behavior Therapy and Experimental Psychiatry, 37, 213–238.
Lange, A., Rietdijk, D., Hudcovicova, M., van den Ven, J.-P., Schrieken, B., & Emmelkamp, P. M. G. (2003). Interapy: A controlled randomized trial of the standardized treatment of posttraumatic stress through the Internet. Journal of Consulting and Clinical Psychology, 71, 901–909.
Marks, I. M., Shaw, S., & Parkin, R. (1998). Computer-assisted treatments of mental health problems. Clinical Psychology: Science and Practice, 5, 51–170.
Mewton, L., Wong, N., & Andrews, G. (2012). The effectiveness of Internet cognitive behavioural therapy for generalized anxiety disorder in clinical practice. Depression and Anxiety, 29(10), 843–849.
Muñoz, R. F., Aguilera, A., Schueller, S. M., Leykin, Y., & Perez-Stable, E. J. (2012). From online randomized controlled trials to participant preference studies: Morphing the San Francisco stop smoking site into a worldwide smoking cessation resource. Journal of Medical Internet Research, 14, e64.
Nordin, S., Carlbring, P., Cuijpers, P., & Andersson, G. (2010). Expanding the limits of bibliotherapy for panic disorder. Randomized trial of self-help without support but with a clear deadline. Behavior Therapy, 41, 267–276.
Palmqvist, B., Carlbring, P., & Andersson, G. (2007). Internet-delivered treatments with or without therapist input: Does the therapist factor have implications for efficacy and cost? Expert Review of Pharmacoeconomics and Outcomes Research, 7, 291–297.
Paxling, B., Almlöv, J., Dahlin, M., Carlbring, P., Breitholtz, E., Eriksson, T., et al. (2011). Guided Internet-delivered cognitive behavior therapy for generalized anxiety disorder: A randomized controlled trial. Cognitive Behaviour Therapy, 40, 159–173.
Paxling, B., Lundgren, S., Norman, A., Almlöv, J., Carlbring, P., Cuijpers, P., et al. (2013). Therapist behaviours in Internet-delivered cognitive behaviour therapy: Analyses of e-mail correspondence in the treatment of generalized anxiety disorder. Behavioural and Cognitive Psychotherapy, 41, 280–289.
Perini, S., Titov, N., & Andrews, G. (2009). Clinician-assisted Internet-based treatment is effective for depression: Randomized controlled trial. The Australian and New Zealand Journal of Psychiatry, 43, 571–578.
Richardson, R., Richards, D. A., & Barkham, M. (2010). Self-help books for people with depression: The role of the therapeutic relationship. Behavioural and Cognitive Psychotherapy, 38, 67–81.
Riley, S., & Veale, D. (1999). The Internet and its relevance to cognitive behavioural psychotherapists. Behavioural and Cognitive Psychotherapy, 27, 37–46.
Robinson, E., Titov, N., Andrews, G., McIntyre, K., Schwencke, G., & Solley, K. (2010). Internet treatment for generalized anxiety disorder: A randomized controlled trial comparing clinician vs. technician assistance. PloS One, 5, e10942.
Ruwaard, J., Broeksteeg, J., Schrieken, B., Emmelkamp, P., & Lange, A. (2010). Web-based therapist-assisted cognitive behavioral treatment of panic symptoms: A randomized controlled trial with a three-year follow-up. Journal of Anxiety Disorders, 24, 387–396.
Ruwaard, J., Lange, A., Schrieken, B., Dolan, C. V., & Emmelkamp, P. (2012). The effectiveness of online cognitive behavioral treatment in routine clinical practice. PLoS ONE, 7(7), e40089.
Ruwaard, J., Lange, A., Schrieken, B., & Emmelkamp, P. (2011). Efficacy and effectiveness of online cognitive behavioral treatment: A decade of Interapy research. Studies in Health Technology and Informatics, 167, 9–14.
Ruwaard, J., Schrieken, B., Schrijver, M., Broeksteeg, J., Dekker, J., Vermeulen, H., et al. (2009). Standardized web-based CBT of mild to moderate depression: A randomized controlled trial with a long-term follow-up. Cognitive Behaviour Therapy, 38, 206–221.
Sanchez-Ortiz, V. C., Munro, C., Startup, H., Treasure, J., & Schmidt, U. (2011). The role of email guidance in Internet-based cognitive-behavioural self-care treatment for bulimia nervosa. European Eating Disorders Review, 19, 342–348.
Shandley, K., Austin, D. W., Klein, B., Pier, C., Schattner, P., Pierce, D., et al. (2008). Therapist-assisted, Internet-based treatment for panic disorder: Can general practitioners achieve comparable patient outcomes to psychologists? Journal of Medical Internet Research, 10(2), e14.
Silfvernagel, K., Carlbring, P., Kabo, J., Edström, S., Eriksson, J., Månson, L., et al. (2012). Individually tailored Internet-based treatment of young adults and adults with panic symptoms: A randomized controlled trial. Journal of Medical Internet Research, 14(3), e65.
Spek, V., Cuijpers, P., Nyklicek, I., Riper, H., Keyzer, J., & Pop, V. (2007). Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: A meta-analysis. Psychological Medicine, 37, 319–328.
Spence, S. H., Donovan, C. L., March, S., Gamble, A., Anderson, R. E., Prosser, S., et al. (2011a). A randomized controlled trial of online versus clinic-based CBT for adolescent anxiety. Journal of Consulting and Clinical Psychology, 79(5), 629–642.
Spence, J., Titov, N., Dear, B. F., Johnston, L., Solley, K., Lorian, C., et al. (2011b). Randomized controlled trial of Internet-delivered cognitive behavioral therapy for posttraumatic stress disorder. Depression and Anxiety, 28(7), 541–550.
Titov, N. (2010). Email in low intensity CBT interventions. In J. Bennett-Levy, H. Christensen, P. Farrand, K. Griffiths, D. Kavanagh, B. Klein, M. Lau, J. Proudfoot, D. Richards, J. White, & C. Williams (Eds.), Oxford guide to low intensity CBT interventions (pp. 287–293). Oxford: Oxford University Press.
Titov, N., Andrews, G., Davies, M., McIntyre, K., Robinson, E., & Solley, K. (2010). Internet treatment for depression: A randomized controlled trial comparing clinician vs. technician assistance. PLoS ONE, 5, e10939.
Titov, N., Andrews, G., Robinson, E., Schwencke, G., Johnston, L., Solley, K., et al. (2009). Clinician-assisted internet-based treatment is effective for generalized anxiety disorder: Randomized controlled trial. Australian and New Zealand Journal of Psychiatry, 43, 905–912.
Titov, N., Andrews, G., Schwencke, G., Drobny, J., & Einstein, D. (2008). Shyness 1: Distance treatment of social phobia over the Internet. The Australian and New Zealand Journal of Psychiatry, 42, 585–594.
Titov, N., Dear, B. F., Schwencke, G., Andrews, G., Johnston, L., Craske, M. G., et al. (2011). Transdiagnostic Internet treatment for anxiety and depression: A randomised controlled trial. Behaviour Research and Therapy, 49, 441–452.
Vernmark, K., Lenndin, J., Bjärehed, J., Carlsson, M., Karlsson, J., Öberg, J., et al. (2010). Internet administered guided self-help versus individualized e-mail therapy: A randomized trial of two versions of CBT for major depression. Behaviour Research and Therapy, 48, 368–376.
Watkins, P. L. (2008). Self-help therapies: Past and present. In P. L. Watkins & G. A. Clum (Eds.), Handbook of self-help therapies (pp. 1–24). New York: Routledge.
Watts, S., Mackenzie, A., Thomas, C., Griskaitis, A., Mewton, L., Williams, A., et al. (2013). CBT for depression: A pilot RCT comparing mobile phone vs. computer. BMC Psychiatry, 13, 49.
Williams, A. D., & Andrews, G. (2013). The effectiveness of Internet cognitive behavioural therapy (iCBT) for depression in primary care: A quality assurance study. PLoS ONE, 8, e57447.
Wims, E., Titov, N., Andrews, G., & Choi, I. (2010). Clinician-assisted Internet-based treatment is effective for panic: A randomized controlled trial. The Australian and New Zealand Journal of Psychiatry, 44(7), 599–607.
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Andersson, G., Carlbring, P., Ljótsson, B. et al. Guided Internet-Based CBT for Common Mental Disorders. J Contemp Psychother 43, 223–233 (2013). https://doi.org/10.1007/s10879-013-9237-9
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DOI: https://doi.org/10.1007/s10879-013-9237-9