A qualitative study of university students' experience of Internet‐based CBT for depression
Abstract
Internet‐based treatments for depression have the potential to promote the mental health of university students. Yet, little is known about students' experiences of Internet‐based mental health interventions (also known as e‐interventions) and the acceptability of this mode of treatment in low‐resource settings. Our aims were to investigate South African university students' experiences of using a brief semi‐guided Internet‐based cognitive behavioural therapy (iCBT) for depression and document the acceptability of this mode of psychotherapy. Data were collected via in‐depth semi‐structured interviews with students ( n = 9) who had moderate to moderately severe symptoms of depression (as assessed by the PHQ‐9) and had used a 7 session guided skills‐based iCBT intervention. Data were analysed inductively using thematic analysis, with the aid of Atlas‐ti software. Participants found the anonymity, privacy and accessibility of iCBT appealing, believing this facilitated use of the intervention and overcame stigma associated with accessing traditional campus counselling services. The intervention was helpful and facilitated self‐disclosure, emotional expression, self‐awareness and skill acquisition. However, students also reported disappointment with the lack of human contact and immediate responsiveness, articulating an expectation that the e‐intervention would mimic face‐to‐face psychotherapy. Moves to incorporate iCBT into student counselling should take account of and manage students' expectations about the ability of e‐interventions to mimic traditional therapy and/or incorporate more opportunities for human interaction.
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This study is the first to investigate factors related to the use (and nonuse) of an app within a bCBT program among students.
“Although there are some qualitative studies covering health care providers’ [40] and patients’ experiences with bCBT [41] as well as with stand-alone iCBT [54], this study is, to our knowledge, the first to investigate factors related to the use (and nonuse) of an app within a bCBT program among students.”
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BackgroundUsing rich data to inform student mental health practice and policy
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Dropout and completion in iCBT for university students: Insights from a thematic analysis
Koelen, J. A., de Koning, L., Nottage, M., Klein, A. M., der Heijde, C. M. V., Vonk, P., & Wiers, R. W. H. J. (2025) · Internet Interventions · doi:10.1016/j.invent.2025.100831 · Cited by 11 · see citing works
Jackson, H. M., Gulliver, A., Hasking, P. A., Leach, L., Batterham, P. J., Calear, A. L., & Farrer, L. M. (2024) · Digital Health · doi:10.1177/20552076241277175 · Cited by 10 · see citing works
“21,27,37 However, our study is the fi rst to con fi rm these fi ndings among a university student sample using a brief video-based intervention.”
Hunt, X., Jivan, D. C., Naslund, J. A., Breet, E., & Bantjes, J. R. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.39 · Cited by 10 · see citing works
“This highlights the need to develop marketing messages that are better tailored to the target population of students, as well as to manage students’ expectations when recruiting them to digital interventions, a point that has been made by other authors (Gericke et al., 2021).”
ResultSelf-citationLambert, J. D., Loades, M. E., Marshall, N., Higson‐Sweeney, N., Chan, S. W. Y., Mahmud, A., Pile, V., Maity, A., Adam, H., Sung, B., et al. (2025) · Journal of Medical Internet Research · doi:10.2196/58164 · Cited by 9 · see citing works
“Digital interventions (eg, online CBT) are one way of overcoming barriers students may experience in accessing mental health support by addressing concerns regarding anonymity, privacy, accessibility, and stigma [20].”
Børtveit, L., Nordgreen, T., & Nordahl-Hansen, A. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1236895 · Cited by 9 · see citing works
“…the responsibility for their own treatment, is that the patients after completion of the treatment would have gained new skills and be more empowered to handle future depressive episodes (Lillevoll et al., 2013; Berg et al., 2020; Gericke et al., 2021; Lindegaard et al., 2021; Eilert et al., 2022).”
BackgroundFacilitating Thought Progression to Reduce Depressive Symptoms: Randomized Controlled Trial
Yatziv, S.-L., Pedrelli, P., Baror, S., DeCaro, S. A., Shachar, N., Sofer, B., Hull, S., Curtiss, J. E., & Bar, M. (2024) · Journal of Medical Internet Research · doi:10.2196/56201 · Cited by 6 · see citing works
“However, while the CBT intervention aims at teaching strategies to change the content of thought [65,66], the FTP-based approach focuses on changing the structure and pattern of thoughts by having patients engage in cognitive exercises that are independent from thought content.”
Bantjes, J. R., Kessler, M., Hunt, X., Kessler, R. C., & Stein, D. J. (2023) · South African Medical Journal · doi:10.7196/samj.2023.v113i4.16753 · Cited by 6 · see citing works
“[38] There is also evidence that some students in SA find digital mental health interventions acceptable and satisfying,[39] suggesting that digital technologies could be an effective way to deliver suicide prevention interventions to SA students, although more research is needed to verify whether these findings are g…”
BackgroundSelf-citationRaeber, F., Haldemann, M. I., Ray, S., Huber, J. P., Firima, E., Fernández, L. G., Amstutz, A., Gerber, F., Labhardt, N. D., & Belus, J. M. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1241403 · Cited by 5 · see citing works
Ncheka, J. M., Menon, J. A., Davies, E. B., Paul, R., Mwaba, S. O. C., Mudenda, J., Wharrad, H. J., Tak, H., & Glazebrook, C. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05542-4 · Cited by 5 · see citing works
“Findings from a qualitative study suggested that an in-house developed, supported iCBT intervention was perceived to help develop skills to manage depression by facilitating self-reflection and was less stigmatizing to access than face-to-face therapy [18].”
BackgroundÖzer, Ö., & Köksal, B. (2023) · OSMANGAZİ JOURNAL OF MEDICINE · doi:10.20515/otd.1309551 · Cited by 5 · see citing works
Köksal, B., & Topkaya, N. (2025) · Current Psychology · doi:10.1007/s12144-025-07905-w · Cited by 3 · see citing works
“Additionally, difficulties with self-assessment, reading long texts, and maintaining concentration align with prior find - ings that students struggle with cognitive effort-intensive tasks (Gericke et al., 2021 ).”
Sutikno, T. (2023) · doi:10.31219/osf.io/5mjae · Cited by 3 · see citing works
Internet-Based Cognitive-Behavior Interventions for University Students: a Systematic Review
Ledur, B., Schmitt, M., Rossa, I., & Andretta, I. (2023) · Trends in Psychology · doi:10.1007/s43076-023-00310-x · Cited by 2 · see citing works
“Asynchronous interventions would have higher adhesion when they involve interpersonal interaction (Gericke et al., 2021).”
University student experiences of digital mental health packages
Barnwell, A. M., & Patton, R. (2025) · Journal of Further and Higher Education · doi:10.1080/0309877x.2025.2451693 · Cited by 2 · see citing works
“In one qualitative study, exploring students’ use of cCBT for depression, students valued anonymity, self-disclosure and skills acquisition (Gericke et al. 2021).”
Eylem, Ö., Poulter, S., Ashcroft, K., Robinson, T., Mane, P., Islam, M., Condell, J. V., & Leavey, G. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-083554 · Cited by 2 · see citing works
“31 However, other RCTs investigating the same intervention reported promising results in terms of the feasibility, acceptability and potential effectiveness of ICare Prevent among students with anxiety and/or depression in Germany 32 33 South Africa 34 and Indonesia.”
BackgroundEylem-van Bergeijk, O., Robinson, T., Manktelow, M., Olympios, M., Poulter, S., Mane, P., Panagioti, M., Condell, J., & Leavey, G. (2025) · JMIR mHealth and uHealth · doi:10.2196/70691 · Cited by 2 · see citing works
“Known common human-related barriers include disappointment with the lack of human contact, the expectation that the intervention would mimic face-to-face psychotherapy, busy schedules, differing support needs, forgetfulness, and privacy concerns [33,34].”
InfluentialRahmania, F. A., & Kumolohadi, R. A. R. (2023) · Gadjah Mada Journal of Professional Psychology (GamaJPP) · doi:10.22146/gamajpp.88247 · Cited by 1 · see citing works
Jackson, H. M., Batterham, P. J., Calear, A. L., Ohan, J. L., & Farrer, L. M. (2024) · JMIR Mental Health · doi:10.2196/53794 · Cited by 1 · see citing works
“These findings are consistent with past research on the co-design and evaluation of DMHIs among young people, which found that this group has a preference for practical and easy to use information and an aversion to text-heavy content [72-74].”
ResultSprague, S., Gallant, J. L., Fleming, N., Bzovsky, S., MacRae, S., Lyons, M., Prieto, J. M. D. M., Johal, H. S., McKay, P., Busse, J. W., et al. (2025) · PLoS ONE · doi:10.1371/journal.pone.0317485 · Cited by 1 · see citing works
Uchechukwu, L., Hardman, M. P., Hadley, I. M., Gornik, M. E., Petty, S. K., Pryor, T. A. M., Alcolado, G. M., Furer, P., & Reynolds, K. (2025) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-025-07270-3 · Cited by 1 · see citing works
“In this study and other online CBT studies participants have expressed appreciation for the strategies provided and how they plan to use them in the future [66].”
Auyeung, L., Mak, W. W. S., & Tsang, E. Z. (2025) · Computers in Human Behavior Reports · doi:10.1016/j.chbr.2025.100880 · Cited by 1 · see citing works
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Brain Insights and Resolution of Youth Depression through Neurotechnology
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“This is relevant since qualitative studies of adverse effects of ICBT have found that many patients find the format stressful because of time demands (Gericke et al., 2021; Rozental et al., 2015).”
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- Authors
- Gericke, F., Ebert, D. D., Breet, E., Auerbach, R. P., & Bantjes, J.
- Affiliations
- Stellenbosch University (ZA)
- Technical University of Munich (DE)
- Columbia University (US)
- Corresponding author
- Bantjes, Jason
- Venue
- Counselling and Psychotherapy Research
- Publisher
- Wiley
- Published
- 2021-08-17
- Volume
- 21
- Issue
- 4
- Pages
- 792-804
- ISSN
- 1473-3145 (ISSN-L)
- 1746-1405
- OpenAlex
- W3194053877
- Cited by
- 57
- References
- 80
- Citations by year
- 2026: 6 · 2025: 12 · 2024: 12 · 2023: 20 · 2022: 6 · 2021: 1
- FWCI
- 8.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Counselling and Psychotherapy Research (publishedVersion)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- internet-based cognitive behavioral therapy, depression, university students, student counseling, stigma, self-disclosure, resource-limited settings, South Africa
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