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Cited by 747Digital Mental Health InterventionsImpact of Technology on AdolescentsMental Health Research Topics

Internet-delivered psychological treatments: from innovation to implementation

Open access
Andersson, Gerhard, Titov, Nickolai, Dear, Blake F., Rozental, Alexander, Carlbring, Per·2019·World Psychiatry
DOI 10.1002/wps.20610PMC PMC6313242
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Abstract

Internet interventions, and in particular Internet-delivered cognitive behaviour therapy (ICBT), have existed for at least 20 years. Here we review the treatment approach and the evidence base, arguing that ICBT can be viewed as a vehicle for innovation. ICBT has been developed and tested for several psychiatric and somatic conditions, and direct comparative studies suggest that therapist-guided ICBT is more effective than a waiting list for anxiety disorders and depression, and tends to be as effective as face-to-face CBT. Studies on the possible harmful effects of ICBT are also reviewed: a significant minority of people do experience negative effects, although rates of deterioration appear similar to those reported for face-to-face treatments and lower than for control conditions. We further review studies on change mechanisms and conclude that few, if any, consistent moderators and mediators of change have been identified. A recent trend to focus on knowledge acquisition is considered, and a discussion on the possibilities and hurdles of implementing ICBT is presented. The latter includes findings suggesting that attitudes toward ICBT may not be as positive as when using modern information technology as an adjunct to face-to-face therapy (i.e., blended treatment). Finally, we discuss future directions, including the role played by technology and machine learning, blended treatment, adaptation of treatment for minorities and non-Western settings, other therapeutic approaches than ICBT (including Internet-delivered psychodynamic and interpersonal psychotherapy as well as acceptance and commitment therapy), emerging regulations, and the importance of reporting failed trials. © 2019 World Psychiatric Association

Integrity signals

Registry

Crossref · 10.1002/wps.20610

Cites

116 of 116 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

49 of 85 cited sources checked · 36 supported · 0 flagged · accuracy not yet measured

  • Findingcitation

    Therapist-guided ICBT is more effective than a waiting list for depression.

    “direct comparative studies suggest that therapist-guided ICBT is more effective than a waiting list for anxiety disorders and depression”
    • Also stated in: § EVIDENCE BASE TO DATE · plain
      “Andrews et al 61 found an Hedges' g for ICBT or cCBT compared to care as usual, waiting list, infor mation control, psychological placebo or pill placebo of 0.67 (95% CI: 0.51 to 0.81), based on 32 studies.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [61] 61. Andrews G, Basu A, Cuijpers P et al. Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: an updated metaanalysis. J Anxiety Disord 2018;55:708. source
  • Findingcitation

    Some studies show that self-guided treatments can produce clinically significant improvements.

    “some studies in which administra tive contact is included tend to show that selfguided treat ments can also produce clinically significant improvements 27,28 .”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [27] 27. Dear BF, Staples LG, Terides MD et al. Transdiagnostic versus disorder specific and clinicianguided versus selfguided internetdelivered treat ment for generalized anxiety disorder and comorbid disorders: a ran domized controlled trial. J Anxiety Disord 2015;36:6377. source
    • cites [28] 28. Titov N, Dear BF, Staples LG et al. Disorderspecific versus transdiagnostic and clinicianguided versus selfguided treatment for major depressive disorder and comorbid anxiety disorders: a randomized controlled trial. J Anxiety Disord 2015;35:88102. source
  • Findingcitation

    ICBT or cCBT was superior to control conditions for social anxiety disorder (Hedges' g=0.92, 95% CI 0.76 to 1.08; 11 studies).

    “0.92 (95% CI: 0.76 to 1.08; 11 studies) for social anxiety disorder”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [61] 61. Andrews G, Basu A, Cuijpers P et al. Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: an updated metaanalysis. J Anxiety Disord 2018;55:708. source
  • Findingcitation

    Guided ICBT programs tend to be more effective than self-guided ICBT.

    “overall, guided ICBT programs tend to be more effective than selfguided ICBT 26”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [26] 26. Baumeister H, Reichler L, Munzinger M et al. The impact of guidance on Internetbased mental health interventions -a systematic review. Internet Interv 2014;1:20515. source
  • Findingcitation

    Affirming responses to client emails can be associated with better outcomes in ICBT for depression.

    “affirming responses to client emails can be associated with better outcomes in ICBT for depression”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [33] 33. Holländare F, Gustafsson SA, Berglind M et al. Therapist behaviours in internetbased cognitive behaviour therapy (ICBT) for depressive symp toms. Internet Interv 2016;3:17. source
  • Classified as probably not a substantial claim. 14
  • May combine two claims. 28
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Internet interventions, and in particular Internet-delivered cognitive behaviour therapy (ICBT), have existed for at least 20 years.

    “Internet interventions, and in particular Internet-delivered cognitive behaviour therapy (ICBT), have existed for at least 20 years.”
    • Also stated in: § IMPLEMENTATION · plain
      “ICBT and Internet interventions at large have been around for about 20 years 3”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [3] 3. Andersson G. Internet interventions: past, present and future. Internet Interv 2018;12:1818. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Researchers in this field often start by conducting a randomized controlled trial, sometimes referred to as a 'pilot RCT', but not necessarily having smaller samples than older psychotherapy trials, which were often underpowered.

    “Researchers in this field often start by conducting a ran domized controlled trial (RCT), sometimes referred to as a”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [43] 43. Lundgren JG, Dahlström Ö, Andersson G et al. The effect of guided webbased cognitive behavioral therapy on patients with depressive symptoms and heart failure: a pilot randomized controlled trial. J Med Internet Res 2016;18: e194. source

      The Methods (Recruitment Procedure and Inclusion; page unavailable) describe randomizing 50 patients, and the paper identifies itself as a pilot randomized controlled trial. The paper does not establish that researchers often begin with pilot RCTs or compare their sample sizes with older psychotherapy trials. The Discussion (Principal Findings; page unavailable) calls this study itself underpowered, not older trials generally. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [44] 44. Cuijpers P, Cristea IA, Karyotaki E et al. How effective are cognitive behav ior therapies for major depression and anxiety disorders? A metaanalytic update of the evidence. World Psychiatry 2016;15:24558. source

      The Identification and selection of studies section describes randomized psychotherapy trials, and the introduction notes small studies and lower quality among older trials. Neither passage addresses whether researchers often begin with a ‘pilot RCT’ or whether such trials have sample sizes comparable to older, underpowered psychotherapy trials. Searches for pilot trials, sample size, and statistical power did not establish those points. (LLM, conf=0.72)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    Participants in guided ICBT completed on average 80.8% of their treatment, which did not differ significantly from participants in face-to-face CBT (83.9%, p=0.59).

    “participants in guided ICBT completed on average 80.8% of their treatment, which did not differ significantly from participants in facetoface CBT (83.9%, p=0.59).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [76] 76. van Ballegooijen W, Cuijpers P, van Straten A et al. Adherence to Internet based and facetoface cognitive behavioural therapy for depression: a metaanalysis. PLoS One 2014;9:e100674. source

  • May combine two claims.

    Findingcitation

    Self-guided ICBT was significantly more effective than control conditions on depressive symptoms severity (g=0.27) and treatment response (odds ratio=1.95, 95% CI 1.52 to 2.50).

    “Self guided ICBT was significantly more effective than control con ditions on depressive symptoms severity (g=0.27) and treat ment response (odds ratio=1.95,95% CI: 1.52 to 2.50).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [65] 65. Karyotaki E, Riper H, Twisk J et al. Efficacy of selfguided internetbased cognitive behavioral therapy in the treatment of depressive symptoms: a metaanalysis of individual participant data. JAMA Psychiatry 2017;74: 3519. source

  • May combine two claims.

    Findingcitation

    Improvements in knowledge occur following ICBT for social anxiety disorder, eating disorders, and adolescents with depression.

    “Studies have investigated whether ICBT influences knowledge acquisition in social anxiety disorder 30 , eating dis orders 92 and, most recently, adolescents with depression 93 .The studies show that improvements in knowledge occur following ICBT.”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [30] 30. Andersson G, Carlbring P, Furmark T, on behalf of the SOFIE Research Group. Therapist experience and knowledge acquisition in Internet delivered CBT for social anxiety disorder: a randomized controlled trial. PLoS One 2012;7:e37411. source
    • cites [92] 92. Strandskov WS, Ghaderi A, Andersson H et al. Effects of tailored and ACT Influenced Internetbased CBT for eating disorders and the relation be tween knowledge acquisition and outcome: a randomized controlled trial. Behav Ther 2017;48:62437. source
    • cites [93] 93. Berg M, Rozental A, Johansson S et al. The role of knowledge in Internet based cognitive behavioural therapy for adolescent depression: results from a randomised controlled study. Internet Interv (in press).

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    The Interapy program from the Netherlands started in the 1990s and subsequently published effectiveness data on adult patients with symptoms of depression, panic disorder, PTSD or burnout.

    “Another early example was the Interapy program from the Netherlands, which started in the 1990s and subsequently pub lished effectiveness data on adult patients with symptoms of depression, panic disorder, PTSD or burnout 97 .”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [97] 97. Ruwaard J, Lange A, Schrieken B et al. The effectiveness of online cognitive behavioral treatment in routine clinical practice. PLoS One 2012;7:e40089. source

      The Abstract (Participants & Setting) reports effectiveness data from 1,500 adult patients treated for depression, panic disorder, posttraumatic stress, or burnout at a Dutch online clinic. However, the Discussion (Clinical Utility) says the Interapy clinic was founded in 2001, not in the 1990s. (LLM, conf=0.91)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In the European stakeholder survey, for severe depression, 1.9% would recommend ICBT only and 27% blended treatment.

    “The same discrepancy was found for severe depression, with 1.9% recommending ICBT and 27% blended treatments.”
    Quote in the paperSubstantial claim1 of 1 sources checked

  • May combine two claims.

    Premisecitation

    In the European stakeholder survey, for moderate depression, 15.7% would recommend ICBT only and 57.2% blended treatment.

    “For example, for mild depression, 46.5% would recommend ICBT only and 69.8% blended treatment, but for moderate depression the cor responding figures were 15.7% and 57.2%, a marked difference.”
    Quote in the paperSubstantial claim1 of 1 sources checked

  • May combine two claims.

    Premisecitation

    In the European stakeholder survey, for mild depression, 46.5% would recommend ICBT only and 69.8% blended treatment.

    “For example, for mild depression, 46.5% would recommend ICBT only and 69.8% blended treatment, but for moderate depression the cor responding figures were 15.7% and 57.2%, a marked difference.”
    Quote in the paperSubstantial claim1 of 1 sources checked

  • May combine two claims.

    Findingreasoning

    Recruitment in online studies is usually much faster than in ordinary clinical trials, in part because it is not geographically confined.

    “recruitment is usually much faster than in ordinary clinical trials, in part because it is not geographically confined.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    High alliance ratings have been reported in ICBT, suggesting that clients do develop a relationship with their online therapist.

    “Overall, high alliance ratings have been reported, suggesting that clients do develop a relationship with their online therapist.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    The actual time devoted to each client in online treatment research is much less than in face-to-face treatment research, with an average of 10 min per client per week versus the traditional 45 min weekly sessions.

    “the actual time devoted to each client is much less than in faceto face treatment research, with an average of 10 min per client and week versus the traditional 45 min weekly sessions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    A common problem when reviewing the literature on Internet interventions is the use of different terms to describe the interventions, referred to as 'terminology chaos'.

    “This has been referred to as”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [58] 58. Barak A. Concepts, definitions, and applications: the terminology cha os of Internetsupported psychotherapeutic interventions. Presented at the 6th Meeting of the International Society for Research on Internet Interventions, Chicago, May 2013.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Findingnone given

    There are now as many as 300 controlled trials of Internet interventions (including unpublished studies), for different disorders and target populations, and the number continues to increase.

    “There are now as many as 300 controlled trials of Internet interventions (includ ing unpublished studies), for different disorders and target populations, and the number continues to increase.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Negative effects are increasingly documented in association with controlled trials of ICBT, but there are also separate reports of negative effects.

    “Negative effects are increasingly docu mented in association with controlled trials of ICBT, but there are also separate reports of negative effects.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    There are no consistent predictors or change mechanisms reported in Internet interventions research.

    “there are no consistent predictors or change mechanisms reported in Internet interventions research.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [82] 82. Kazdin AE. Understanding how and why psychotherapy leads to change. Psychother Res 2009;19:41828. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Implementation efforts for ICBT have rarely been well documented from an implementation science perspective.

    “Moreover, these efforts have rarely been well docu mented from an implementation science perspective.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Implementation efforts for ICBT have rarely been well documented from an implementation science perspective.

  • May combine two claims.

    Findingcitation

    The tinnitus clinic in Uppsala, Sweden, began delivering CBT for tinnitus via the Internet by the end of 1999 and published effectiveness data early on.

    “One early application in general health care was the tinnitus clinic in Uppsala, Sweden, which began delivering CBT for tinnitus via the Internet by the end of 1999, and published effectiveness data early on 96 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [96] 96. KaldoSandström V, Larsen HC, Andersson G. Internetbased cognitive behavioral selfhelp treatment of tinnitus: clinical effectiveness and pre dictors of outcome. Am J Audiol 2004;13:18592.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Moodgym from Australia is an early example with published data from community users.

    “The publicly available Moodgym from Australia is another early example with published data from community users 98 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [98] 98. Christensen H, Griffiths K, Groves C et al. Free range users and one hit wonders: community users of an Internetbased cognitive behaviour therapy program. Aust N Z J Psychiatry 2006;40:5962. source

  • May combine two claims.

    Findingnone given

    Methods for exploring negative effects are still limited, and relatively little is known about the causes of negative effects observed during Internet interventions.

    “our methods for exploring negative effects are still limited and, for example, relatively little is known about the causes (e.g., the intervention itself, factors outside of the intervention) of the negative effects observed during Internet interventions.”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingcitation

    Long-term effects of ICBT are likely sustained over time; pre-to-follow-up effect size g=1.52 in 14 trials with average follow-up of three years.

    “The pre to follow up effect size was g=1.52.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [77] 77. Andersson G, Rozental A, Shafran R et al. Longterm effects of Internet supported cognitive behavior therapy. Expert Rev Neurother 2018;18:218. source

  • May combine two claims.

    Findingcitation

    Being in a relationship, being older, and having at least a university degree were associated with lower odds of deterioration, but only in patients assigned to the treatment condition.

    “Being in a relationship, being older and having at least a university degree were associated with lower odds of deteriora tion, but only in patients assigned to the treatment condition.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [79] 79. Rozental A, Magnusson K, Boettcher J et al. For better or worse: an indi vidual patient data metaanalysis of deterioration among participants receiv ing Internetbased cognitive behavior therapy. J Consult Clin Psychol 2017; 85:16077. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Internet therapy is more effective when the treatment is user friendly and not overly technically advanced, and a clear deadline is provided for the duration of the treatment.

    “it has been reported that Internet therapy is more effective when the treatment is user friendly and not overly technically ad vanced, and a clear deadline is provided for the duration of the treatment 89 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [89] 89. Andersson G, Carlbring P, Berger T et al. What makes Internet therapy work? Cogn Behav Ther 2009;38:5560. source

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    ICBT can be viewed as a vehicle for innovation.

    “arguing that ICBT can be viewed as a vehicle for innovation.”
    • Also stated in: § INNOVATION · plain
      “even current Internet interventions research can be viewed as an engine for innova tion, with treatments being developed and tested directly for Internet delivery instead of first being tested as a facetoface treatment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    One advantage of conducting studies online is lower costs and shorter study periods.

    “one advantage of conducting studies online is lower costs and shorter study periods.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Psychotherapy research has suffered from high costs involved with running controlled trials.

  • May combine two claims.

    Interpretationown data

    Therapist-supported ICBT is more efficacious than control conditions for anxiety disorders, and not significantly different from face-to-face CBT, although further evidence of better quality is needed.

    “Overall, these data seem to suggest that therapistsupported ICBT is more efficacious than control conditions for anxiety disorders, and not significantly different from facetoface CBT, although further evidence of a better quality is needed.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The use of factorial designs is likely to speed up the development of new interventions and treatment components.

    “The use of factorial designs is likely to speed up the development of new interventions and treatment components.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    There is no need for a therapy room in online treatment research, and clients do not need to wait to the same extent as in a face-to-face study.

    “There is no need for a therapy room, and clients do not need to wait to the same extent as in a facetoface study.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationnone given

    Online treatment research offers the possibility to repeat a lesson/module and faster access to support if needed.

    “Further advantages are the possibility to repeat a lesson/module and the faster ac cess to support if needed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    ICBT and other forms of Internet interventions can serve as vehicles for innovation, which may subsequently inform face-to-face treatments.

    “They can also serve as vehicles for innovation, which may subsequently inform facetoface treatments.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The benefit of Internet interventions is likely to be that they provide an opportunity to care for people who cannot or do not want to access face-to-face care, rather than for people presenting for and wanting face-to-face care.

    “Nevertheless, the benefit of Internet interventions is likely to be that they provide an opportunity to care for people who cannot or do not want to access faceto face care, rather than for people presenting for and wanting facetoface care.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Interpretationnone given

    Even if ICBT is gradually being implemented, the process is slow and needs to be better documented.

    “Even if ICBT is gradually being implemented, the process is slow and needs to be better documented.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: In most cases, implementation of ICBT has been handled by specialist and centralized clinics rather than widescale dissemination across a whole country with several clinics involved.

  • May combine two claims.

    Interpretationcitation

    Published data suggest that ICBT can work in regular settings, even as a stepped care approach.

    “While still being at an early stage, published data clearly sug gest that ICBT can work in regular settings, even as a stepped care approach 101 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [101] source

  • Classified as probably not a substantial claim.

    Interpretationnone given

    ICBT and other forms of Internet interventions hold promise as a way to increase access to evidence-based psychological treatment.

    “ICBT and other forms of Internet interventions hold promise as a way to increase access to evidencebased psychological treatment.”
    Quote in the paperSubstantial claim
34 of 34

  • The paper relies on this without support.

    Psychotherapy research has suffered from high costs involved with running controlled trials.

    “Psychotherapy research has most likely suffered from the high costs involved with running controlled trials”

  • The paper relies on this without support.

    Implementation efforts for ICBT and Internet interventions have had mixed success.

    “implementation efforts have had mixed success.”

  • The paper relies on this without support.

    Implementation efforts for ICBT have rarely been well documented from an implementation science perspective.

    “these efforts have rarely been well docu mented from an implementation science perspective.”

  • The paper relies on this without support.

    Clinicians may not know what ICBT is.

    “Given the observation that clinicians may not know what ICBT is, there is also a role for education in order to facilitate dissemination 104 .”

  • The paper relies on this without support.

    In most cases, implementation of ICBT has been handled by specialist and centralized clinics rather than widescale dissemination across a whole country with several clinics involved.

    “However, in most cases, the implementation has been handled by specialist and centralized clinics as op posed to widescale dissemination across a whole country with several clinics involved.”
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • ICBT efficacy is equivalent to face-to-face CBT while overcoming several implementation challenges of traditional CBT delivery.

    “The efficacy of ICBT shows equivalence with face-to-face CBT while also overcoming several of the implementation challenges of traditional CBT delivery modalities (Andersson et al., 2014; Andersson et al., 2019; Andrews et al., 2018).”

    From Guided internet-based LGBTQ-affirmative cognitive-behavioral therapy: A randomized controlled trial among sexual minority men in China (2024) · cites this paper as Andersson et al., 2019

    The EVIDENCE BASE TO DATE section reports that guided ICBT tends to have effects equivalent to face-to-face CBT, but the claim omits the guided-treatment qualifier and states equivalence more definitively. The INNOVATION section describes advantages over face-to-face delivery, including less therapist time, no need for a therapy room, and less waiting. Page numbers were not available in our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • There is usually no correlation between alliance and outcome in ICBT treatments, even though alliance estimates are generally high.

    “There is usually no correlation, even though the alliance estimates are generally high in ICBT treatments (Andersson et al., 2019).”

    From Effectiveness of and processes related to internet-delivered acceptance and commitment therapy for adolescents with anxiety disorders: a randomized controlled trial (2023) · cites this paper as Andersson et al., 2019

    The TREATMENT APPROACH passage reports generally high alliance ratings in ICBT, but says findings on alliance and outcome are mixed: some studies find a small, statistically significant association, while others find none. The MECHANISMS OF CHANGE AND PREDICTORS OF OUTCOME section likewise calls the results inconsistent, rather than establishing that there is usually no correlation. Page numbers were not provided in our copy. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • IMIs are similarly effective as face-to-face counseling in the treatment of mental disorders and mental health promotion and prevention; they are low-threshold, can reach students who would otherwise not receive care, and have the potential to be cost-effective.

    “IMIs are similarly effective as face-to-face counseling in the treatment of mental disorders (69) and mental health promotion (64) and prevention (66); they are low-threshold, can reach students (with mental disorders, no intention of seeking help, and no treatment experience) who would otherwise not receive care, and have the potential to be cost-effective (68).”

    From Mental health services for German university students: acceptance of intervention targets and preference for delivery modes (2024) · cites this paper as [66]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • The deterioration rate in individuals who did not accept or adhere to CBT is 17.4%.

    “The recovery (25.0%) and deterioration (17.4%) rates in individuals who did not accept or adhere to the CBT were approximated from the outcome findings of the waiting list group reported by a health technology assessment study (including 7 systematic reviews of i-CBT for mild-to-moderate anxiety (n = 6) and depression (n = 1)) [20] and a review of internet-delivered psychological intervention [21]”

    From Cost-effectiveness of internet-supported cognitive behavioral therapy for university students with anxiety symptoms: A Markov-model analysis (2022) · cites this paper as [21]

    The HARMFUL EFFECTS section reports a 17.4% deterioration rate in control conditions across 29 ICBT trials. It does not identify those participants as people who did not accept or adhere to CBT, nor does it say all control conditions were waiting lists. The cited figure supports the approximation, but not that description of the group. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • The reasons that patients were not well informed about CCBT could be because their GPs were ill-informed, unaware, and/or sceptical about the programme.

    “The reasons that patients were not well informed about CCBT could be because their GPs were ill-informed, unaware, and/or sceptical about the programme (Andersson et al ., 2019; Breedvelt et al ., 2019; Du et al ., 2013).”

    From A qualitative study of patients’ experiences and acceptance of computerised cognitive behavioural therapy in primary care, Scotland (2021) · cites this paper as Andersson et al., 2019

    The Implementation section says clinicians may not know what ICBT is and identifies negative clinician attitudes as a potential obstacle. It does not specifically identify GPs or say that their lack of awareness or scepticism caused patients to be poorly informed about CCBT. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Krotoski A, 2013, Untangling the web. What the internet is doing to you

Cited by

Sorted by citations

Related

Authors
Andersson, G., Titov, N., Dear, B. F., Rozental, A., & Carlbring, P.
Affiliations
  • Linköping University (SE)
  • Macquarie University (AU)
  • Karolinska Institutet (SE)
  • Stockholm University (SE)
ORCID
Venue
World Psychiatry
Publisher
Wiley
Published
2019-01-02
Volume
18
Issue
1
Pages
20-28
ISSN
  • 1723-8617 (ISSN-L)
  • 2051-5545
DOI
10.1002/wps.20610
PMC
PMC6313242
OpenAlex
W2906905981
Cited by
747
References
116
Citations by year
2026: 74 · 2025: 96 · 2024: 122 · 2023: 94 · 2022: 96 · 2021: 98 · 2020: 79 · 2019: 21 · 2017: 1
FWCI
47.69
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • World Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (submittedVersion)
  • PubMed Central (submittedVersion)
  • University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, other-oa)
Funders
Linköpings Universitet
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
Keywords
internet-based cognitive behavioral therapy, online intervention, anxiety disorders, depression, treatment effectiveness, adverse effects, mechanisms of change, mediators and moderators

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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