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Cited by 48Digital Mental Health InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesTelemedicine and Telehealth Implementation

Predictors of adherence and outcome in internet-based cognitive behavior therapy delivered in a telephone counseling setting

Open access
Farrer, Louise M., Griffiths, Kathleen M., Christensen, Helen, Mackinnon, Andrew J., Batterham, Philip J.·2014·Cognitive Therapy and Research
DOI 10.1007/s10608-013-9589-1
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Verified 2026-10-10 · 1 reference not checked yet

AI snapshot

Written from the paper’s full text.

TL;DR

This secondary analysis of an RCT with callers to a national telephone counseling service examined predictors of adherence and outcome in a 6-week online psychoeducation/CBT intervention for depression. Lower baseline depression predicted greater adherence, while low and moderate motivation predicted better depression outcomes than high motivation; adherence was not associated with outcome.

Key findings

  • Among 83 participants assigned to Web only or Web with tracking, only about 16% completed all 6 weeks; mean weeks completed was 2.5 (SD = 2.28). In the adjusted model, lower baseline depression was associated with greater adherence (Beta = −.27, p = .043); univariate predictors included more education (Beta = .25, p = .000), higher motivation (Beta = .29, p = .03), and younger age (Beta = −.18, p = .04), with pre-intervention depression approaching significance (p = .052).
  • No significant three-way interactions were found between measurement occasion, condition (web CBT vs. tracking only/control), and sex, age, education, relationship status, employment status, or adherence for depression outcome (e.g., adherence: F(3,83.4) = 1.06, p = .37, n = 153).
  • A significant measurement occasion × motivation interaction was found for depression symptoms (F(3,38.3) = 2.85, p = .0499, n = 50); quadratic motivation was also significant (linear F(3,36.9) = 3.44, p = .027; quadratic F(3,43.2) = 4.88, p = .005). At 6 months, low motivation (t = −2.09, p = .043) and moderate motivation (t = −2.49, p = .017) had lower depressive symptoms than high motivation; at 12 months, moderate motivation had lower depressive symptoms than high motivation (t = −2.44, p = .019).
  • Dropout predictors included Internet plus tracking condition post-intervention (OR 6.46, p = .002) and at 12 months (OR 3.70, p = .01); fewer completed MoodGYM modules post-intervention (OR .49, p < .001), at 6 months (OR .56, p < .001), and at 12 months (OR .66, p = .001); higher pre-intervention psychological distress (OR 1.10, p = .04) and lower pre-intervention anxiety (OR .93, p = .03) predicted dropout at 12 months.

Methods

  • Randomized controlled trial with four conditions: Web only (n = 38), Web with tracking (n = 45), Tracking only (n = 37), and Control (n = 35). Current adherence analyses included the Web only and Web with tracking conditions (n = 83); outcome analyses compared the two web-CBT groups with tracking/control groups (n = 155).
  • Participants were callers to Lifeline’s 24-hour counseling service, recruited by telephone counselors in four major Australian cities; eligibility included English speaking, Internet access at least 30 minutes per week, age 18+, and K10 score ≥22. The intervention was 6 weeks of online psychoeducation (BluePages in week 1) and CBT (MoodGYM weeks 2–6); Web with tracking also received weekly 10-minute counselor calls.
  • Measures included demographics, CES-D depression severity, and the NML-P motivation scale (administered only to web conditions; 51 completed it, internal consistency = .66). Analyses used logistic regression for dropout, linear regression with robust standard errors for adherence, and mixed models repeated measures ANOVA for outcome, with measurement occasion as a within-groups factor and intervention condition as a between-groups factor.

Limitations

  • Stated: within-trial attrition was high (107 [69%] completed post-intervention, 92 [59%] at 6 months, 57 [37%] at 12 months), and the small sample—especially the adherence subgroup—means both significant and null findings are uncertain and may be underpowered; replication in a larger sample is required.
  • Stated: the objective adherence measure provided little information about engagement with intervention content; motivation was not assessed in the control and tracking-only conditions, so conclusions about motivation and outcome should be cautious; only a small number of possible predictors were examined.
  • Evident from the text: the helpline-recruited sample may be unique and not broadly generalizable; education level was high/restricted; dropout-reason data were obtained from only 10 participants (21.3%); and the NML-P had internal consistency of .66 in this sample.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1007/s10608-013-9589-1

Cites

53 of 54 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 51 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    At 12 months, depression symptoms were significantly lower in the moderate motivation group compared with the high motivation group (t = -2.44, p = .019).

    “At 12 months, depression symptoms were significantly lower in the moderate motivation group, compared with the high motivation group (t = -2.44,p = .019).”
    • Also stated in: § Abstract · plain
      “At 12 month follow-up, those with moderate levels of motivation had lower depressive symptoms than those with high motivation.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Missingness in the data is either completely at random (MCAR) or at random conditional on observed data (MAR).
  • Findingown data

    No significant effects were found for the three-way interactions between measurement occasion, condition and sex, age, level of education, relationship status, employment status, or adherence.

    “No significant effects were found for the three-way interactions between measurement occasion, condition (web CBT conditions vs. tracking only/control conditions) and any of the following predictors, including: sex (F(3,88.9)= .67,p = .58,n = 153); age (F(3, 82.4) = 1.62, p = .19,n = 153); level of education (F(3,86.5)= .31,p = .82,n = 148); relationship status (F(3,83.4)= .33,p = .81,n = 153);”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Missingness in the data is either completely at random (MCAR) or at random conditional on observed data (MAR).
  • Findingown data

    Post-intervention, depression symptoms did not differ significantly between participants with different levels of motivation.

    “Post-intervention, depression symptoms did not differ significantly between participants with different levels of motivation.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Missingness in the data is either completely at random (MCAR) or at random conditional on observed data (MAR).
  • Findingown data

    Higher motivation was linked to greater adherence.

    “although our results found that higher motivation was linked to greater adherence”
    Quote in the paperSubstantial claim
  • Findingown data

    Pre-intervention depression approached significance as a predictor of adherence (p = .052).

    “Pre-intervention depression approached significance as a predictor of adherence (p = .052).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 23
  • Classified as probably not a substantial claim. 22
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    Individuals with high levels of motivation had poorer outcomes compared to those with low and moderate levels of motivation at 6 month follow-up and those with moderate levels of motivation at 12 month follow-up.

    “Individuals with high levels of motivation had poorer outcomes compared to those with low and moderate levels of motivation at 6 month follow-up and those with moderate levels of motivation at 12 month follow-up.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The odds of dropout were greater for participants in the Internet plus tracking condition, relative to participants in the control condition post-intervention (OR 6.46, p = .002) and at 12 month follow-up (OR 3.70, p = .01).

    “The odds of dropout (failure to complete an outcome assessment) were greater for participants in the Internet plus tracking condition, relative to participants in the control condition post-intervention (OR 6.46, p = .002)and at 12 month follow-up (OR 3.70, p = .01).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Both linear and quadratic motivation terms were significant, and the addition of the quadratic effect explained significantly greater variance in the depression outcome (χ2(4) = 12.02, p = .007).

    “When the model was re-estimated using both linear and quadratic motivation terms, both were significant (linear F(3,36.9)= 3.44, p = .027;quadratic F(3,43.2) = 4.88, p = .005).Based on change in -2 log likelihood, the addition of the quadratic effect explained significantly greater variance in the depression outcome (χ 2 (4) = 12.02, p = .007).”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Missingness in the data is either completely at random (MCAR) or at random conditional on observed data (MAR).

  • May combine two claims.

    Findingown data

    Those who completed fewer MoodGYM modules had greater odds of dropout post-intervention (OR .49, p < .001), at 6 month follow-up (OR .56, p < .001) and at 12 month follow-up (OR .66, p = .001).

    “Those who completed fewer MoodGYM modules also had greater odds of dropout post-intervention (OR .49,p <.001), at 6 month follow-up (OR .56,p <.001) and at 12 month follow-up (OR .66,p = .001).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Relationship status, sex of the participant and employment status were unrelated to adherence.

    “Relationship status, sex of the participant and employment status were unrelated to adherence.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Those with higher levels of pre-intervention psychological distress (OR 1.10, p = .04) and those with lower pre-intervention anxiety symptoms (OR .93, p = .03) were more likely to dropout at 12 months.

    “In addition, those with higher levels of pre-intervention psychological distress (OR 1.10, p = .04),and those with lower pre-intervention anxiety symptoms (OR .93,p = .03)were more likely to dropout at 12 months.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    At 6 month follow-up, depression symptoms were lower for both the low motivation group (t = -2.09, p = .043) and the moderate motivation group (t = -2.49, p = .017), compared with the high motivation group.

    “At 6 month follow-up, depression symptoms were lower for both the low motivation (t = -2.09,p = .043)and moderate motivation groups (t = -2.49,p = .017),compared with the high motivation group, based on estimates obtained from the fixed effects model.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Missingness in the data is either completely at random (MCAR) or at random conditional on observed data (MAR).

  • May combine two claims.

    Findingown data

    The most commonly cited reasons for dropout were lack of time (n = 5), feeling too depressed (n = 5), slow or unreliable Internet connection (n = 4), the intervention contained too much text (n = 4), or CBT was too complicated to understand (n = 4).

    “The most commonly cited reasons were: lack of time (n = 5), feeling too depressed (n = 5), slow or unreliable Internet connection (n = 4), the intervention contained too much text (n = 4) or CBT was too complicated to understand (n = 4).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Internet-delivered interventions are effective in the treatment of depression and other mental disorders.

    “Internet-delivered interventions are effective in the treatment of depression and other mental disorders (Andersson & Cuijpers, 2009;Andrews, Cuijpers, Craske, McEvoy, & Titov, 2010;Griffiths, Farrer, & Christensen, 2010).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Andersson & Cuijpers, 2009 source

      Not checked in the free run.

    • cites Andrews, Cuijpers, Craske, McEvoy, & Titov, 2010 source

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    • cites Griffiths, Farrer, & Christensen, 2010

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  • May combine two claims.

    Premisecitation

    Higher educational attainment and being married or in a partnered relationship appear to be associated with better adherence to online interventions.

    “Two of the more consistent findings are that higher educational attainment and being married or in a partnered relationship appear to be associated with better adherence to online interventions.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Lange et al., 2003

      Not checked in the free run.

    • cites Spek, Nyklicek, Cuijpers, & Pop, 2008 source

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    • cites Batterham, Neil, Bennett, Griffiths, & Christensen, 2008

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  • May combine two claims.

    Premisecitation

    Premature dropout from face-to-face treatment appears to prolong depressive episodes and increase the likelihood of symptom relapse.

    “Premature dropout from face-to-face treatment appears to prolong depressive episodes and increase the likelihood of symptom relapse (Pekarik, 1985(Pekarik, , 1986)).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Pekarik, 1985

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    • cites Pekarik, 1986

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

    Premisenone given

    The relationship between employment status and adherence to online treatments has not yet been investigated.

    “The relationship between employment status and adherence to online treatments has not yet been investigated.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Several factors have been found to be associated with treatment adherence and outcome in relation to face-to-face treatment, including demographic characteristics, clinical characteristics, and motivational factors.

    “Several factors have been found to be associated with treatment adherence and outcome in relation to face-to-face treatment, including demographic characteristics (e.g., age, sex, educational level, employment status, and relationship status), clinical characteristics (e.g., severity of symptoms, chronicity or stability of symptoms, complexity of diagnostic presentation), and motivational factors”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Arnow et al., 2007 source

      Not checked in the free run.

    • cites Hillis, Alexander, & Eagles, 1993

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    • cites Last, Thase, Hersen, Bellack, & Himmelhoch, 1985

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    The study was a randomized controlled trial with four conditions.

    “The study was a randomized controlled trial with four conditions: (a) Web only: online psychoeducation and CBT (n = 38), (b) Web with tracking: online psychoeducation and CBT, plus weekly telephone tracking (n = 45), (c) Tracking only: weekly telephone tracking only (n = 37), (d) Control: no online psychoeducation and CBT or telephone tracking (n = 35).”
    Quote in the paperSubstantial claim

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

    Study design and conductreasoning

    Several significant findings from the univariate analyses should be interpreted with caution, given the small sample size and propensity for type 1 error when multiple tests are conducted.

    “Several significant findings emerged from the univariate analyses.These should be interpreted with caution, given the small sample size and propensity for type 1 error when multiple tests are conducted.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    One study found that response to treatment was superior for females and those with higher levels of education.

    “However, one study found that response to treatment was superior for females and those with higher levels of education (Spek et al., 2008).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Spek et al., 2008 source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    The most consistent findings are that higher educational attainment and being in a married/partnered relationship are predictive of better adherence, and that baseline depression symptom severity is largely unrelated to adherence.

    “The most consistent findings are that higher educational attainment and being in a married/partnered relationship are predictive of better adherence, and that baseline depression symptom severity is largely unrelated to adherence.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    107 (69%) participants completed the post-intervention survey, 92 (59%) completed the 6 month follow-up survey and 57 (37%) completed the 12 month follow-up survey.

    “107 (69%) participants completed the post-intervention survey, 92 (59%) completed the 6 month follow-up survey and 57 (37%) completed the 12 month follow-up survey.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    One study reported greater adherence among individuals with higher baseline depression symptom severity.

    “However, one study reported greater adherence among individuals with higher baseline depression symptom severity (Batterham et al., 2008).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Batterham et al., 2008

      Not checked in the free run.

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

    Study design and conductcitation

    Depression symptom severity was measured using the 16-item Centre for Epidemiologic Studies Depression Scale (CES-D), which is widely used and has strong reliability and validity.

    “Depression symptom severity was measured using the 16-item Centre for Epidemiologic Studies Depression Scale (CES-D) (Radloff, 1977).The scale is widely used and has strong reliability and validity (Husaini, Neff, Harrington, Hughes, & Stone, 1980;Knight, Williams, McGee, & Olaman, 1997;Radloff, 1977;Roberts, 1980;Roberts & Vernon, 1983;Ross & Mirowsky, 1984).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Radloff, 1977 source

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    • cites Husaini, Neff, Harrington, Hughes, & Stone, 1980

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    • cites Knight, Williams, McGee, & Olaman, 1997

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

    Premisecitation

    Andersson and colleagues found that depression symptom severity at baseline was significantly positively correlated with depression symptom severity at 6 month follow-up.

    “However, Andersson and colleagues found that depression symptom severity at baseline was significantly positively correlated with depression symptom severity at 6 month follow-up (Andersson et al., 2004).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Andersson et al., 2004

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Baseline depression appears to be associated with treatment outcome, whereas age, sex, and education level do not.

    “On the other hand, baseline depression appears to be associated with treatment outcome, whereas age, sex, and education level do not.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    There is contradictory evidence regarding the effect of relationship status on response to online CBT, with one study reporting better outcomes among married individuals and another reporting better outcomes among those who were separated, widowed or divorced.

    “There is a small amount of contradictory evidence regarding the effect of relationship status on response to online CBT, with one study reporting better outcomes among married individuals (Spek et al., 2008), and another study reporting better outcomes among those who were separated, widowed or divorced (Button et al., 2012).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Spek et al., 2008 source

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    • cites Button et al., 2012

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  • May combine two claims.

    Interpretationown data

    The findings suggest that lower pre-intervention depression symptoms may positively influence adherence to online treatment for depression, while low and moderate levels of motivation appear to be optimal for treatment outcome.

    “The findings suggest that lower pre-intervention depression symptoms may positively influence adherence to online treatment for depression, while low and moderate levels of motivation appear to be optimal for treatment outcome.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Treatment expectations were positively related to outcome in one study, but no association was found in another.

    “However only one of the studies found that treatment expectations were positively related to outcome (de Graaf et al., 2009), with the second reporting no association (Cavanagh et al., 2009).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites de Graaf et al., 2009 source

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    • cites Cavanagh et al., 2009 source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

    Study design and conductown data

    In the current sample, internal consistency for the NML-P scale was 0.66 (N = 45).

    “In the current sample, internal consistency for the scale was 0.66 (N = 45).”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Studies of face-to-face treatments suggest that a relationship exists between dropout and lower income and lower socioeconomic status.

    “Studies of face-to-face treatments suggest that a relationship exists between dropout and lower income and lower socioeconomic status (Arnow et al., 2007;Wierzbicki & Pekarik, 1993).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Arnow et al., 2007 source

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    • cites Wierzbicki & Pekarik, 1993 source

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  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    A higher number of logins, greater total time spent using the treatment and greater use of an online mood diary were predictive of better outcome at 3 months postintervention.

    “One study reported that a higher number of logins, greater total time spent using the treatment and greater use of an online mood diary were predictive of better outcome at 3 months postintervention (de Graaf et al., 2009).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites de Graaf et al., 2009 source

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

    Study design and conductcitation

    The NML-P is a recently developed scale, and its test-retest reliability and validity have yet to be extensively evaluated.

    “However, given that the NML-P is a recently developed scale, test-retest reliability and validity have yet to be extensively evaluated.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Allart-van Dam et al., 2004

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  • Classified as probably not a substantial claim.

    Premisecitation

    Other studies report an association between positive expectations for treatment and better treatment response.

    “other studies that report an association between positive expectations for treatment and better treatment response (de Haan et al., 1997;Keijsers, Hoogduin, & Schaap, 1994;Keithly, Samples, & Strupp, 1980;Sotsky et al., 1991;Weinberger & Eig, 1999).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites de Haan et al., 1997 source

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    • cites Keijsers, Hoogduin, & Schaap, 1994

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    • cites Keithly, Samples, & Strupp, 1980

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

    Premisecitation

    Age, sex and education level are not associated with response to treatment, either in terms of reduced post-treatment symptom severity or pre-to posttreatment symptom change.

    “Results from several studies suggest that age, sex and education level are not associated with response to treatment, either in terms of reduced post-treatment symptom severity (Clarke et al., 2002;de Graaf, Hollon, & Huibers, 2010) or pre-to posttreatment symptom change (Andersson, Bergström, Hollandare, Ekselius, & Carlbring, 2004;Button, Wiles, Lewis, Peters, & Kessler, 2012;de Graaf et al., 2”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Clarke et al., 2002 source

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    • cites de Graaf, Hollon, & Huibers, 2010 source

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    • cites Andersson, Bergström, Hollandare, Ekselius, & Carlbring, 2004

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

    Premisecitation

    Another study reported that unemployment was linked to worse outcome following online CBT (de Graaf et al., 2010).

    “contrasts with the findings of another which reported that unemployment was linked to worse outcome following online CBT (de Graaf et al., 2010).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites de Graaf et al., 2010 source

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

    Study design and conductreasoning

    This study examined only a small number of the many possible predictors of adherence and outcome.

    “This study also examined only a small number of the many possible predictors of adherence and outcome.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The finding that sex was unrelated to outcome adds weight to the findings that online CBT is equally effective for men and women.

    “This result adds weight to the findings of the small complement of existing online depression studies that have demonstrated that online CBT is equally effective for men and women”
    Quote in the paperSubstantial claim

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

    Premisecitation

    The lack of association between employment status and outcome is consistent with one study of online CBT for depression (Warmerdam et al., 2008).

    “The lack of association found between employment status and outcome is consistent with one study of online CBT for depression (Warmerdam et al., 2008)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Warmerdam et al., 2008 source

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

    Study design and conductnone given

    Ethics approval for the trial was granted by The Australian National University Human Research Ethics Committee (Protocol no. 2007/12).

    “Ethics approval for the trial was granted by The Australian National University Human Research Ethics Committee (Protocol no.2007/12).”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    Informed written consent was obtained from participants.

    “Informed written consent was obtained from participants”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Participants were randomly allocated to one of the four trial conditions.

    “participants were randomly allocated to one of the four trial conditions.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    de Graaf and colleagues (2009) reported that better treatment outcome was associated with greater number of logins, greater total time spent using the intervention, and greater compliance with homework exercises.

    “de Graaf and colleagues (2009) who reported that better treatment outcome was associated with greater number of logins, greater total time spent using the intervention, and greater compliance with homework exercises.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites de Graaf et al., 2009 source

      Not checked in the free run.

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

    Premisecitation

    Existing online depression studies have demonstrated that online CBT is equally effective for men and women.

    “the small complement of existing online depression studies that have demonstrated that online CBT is equally effective for men and women (Andersson et al., 2004;Clarke et al., 2002;de Graaf et al., 2010).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Andersson et al., 2004

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    • cites Clarke et al., 2002 source

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    • cites de Graaf et al., 2010 source

      Not checked in the free run.

40 of 40

  • The paper relies on this without support.

    Many users of Internet-based interventions do not complete the intervention in its entirety, and not all who complete Internet programs benefit from treatment.

    “Many users of Internet-based interventions do not complete the intervention in its entirety, and not all who complete Internet programs benefit from treatment.”

  • The authors state this as an assumption.

    Missingness in the data is either completely at random (MCAR) or at random conditional on observed data (MAR).

    “Mixed modelling allows the use of all available data for each participant to yield unbiased estimates of effects under the assumption that missingness is either completely at random (MCAR) or at random conditional on observed data (MAR) (Hamer & Simpson, 2009).”

  • The authors state this as an assumption.

    Greater treatment adherence results in improved outcomes.

    “It is generally assumed that greater treatment adherence results in improved outcomes.”
3 of 3

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?

  • The study found no evidence for many previously identified predictive factors for adherence including baseline symptom levels, gender, age, or education.

    “In contrast to previous studies on adherence in depression and anxiety interventions, we found no evidence for many of the previously identified predictive factors for adherence including baseline symptom levels, gender, age, or education (Christensen et al., 2009; Farrer et al., 2014; Karyotaki et al., 2015; Beatty et al., 2017).”

    From Predictors of acceptability and engagement in a self-guided online program for depression and anxiety (2021) · cites this paper as Farrer et al., 2014

    In “Predictors of adherence to the intervention” (page unavailable), age and education predicted adherence in univariate analyses, although neither remained significant when the predictors were modeled together. The paper also found that lower baseline depression significantly predicted better adherence in the combined model, contrary to the claim that it found no evidence for baseline symptom levels. The Discussion (page unavailable) reports no association between sex and adherence. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • The education of users is consistent with the proposed type of interventions, which require reading, writing, and computer skills.

    “This is consistent with the proposed type of interventions, which require reading, writing, and computer skills (Farrer et al., 2014).”

    From Online and Mobile Interventions for Problem Gambling, Alcohol, and Drugs: A Systematic Review (2017) · cites this paper as Farrer et al., 2014

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • ConsistentF(3, 88.9) = 0.67reported p = .58 · recomputed p = .573

    “F(3,88.9)= .67,p = .58”

  • ConsistentF(3, 82.4) = 1.62reported p = .19 · recomputed p = .191

    “F(3, 82.4) = 1.62, p = .19”

  • ConsistentF(3, 86.5) = 0.31reported p = .82 · recomputed p = .818

    “F(3,86.5)= .31,p = .82”

  • ConsistentF(3, 83.4) = 0.33reported p = .81 · recomputed p = .804

    “F(3,83.4)= .33,p = .81”

  • ConsistentF(3, 88.9) = 0.74reported p = .53 · recomputed p = .531

    “F(3,88.9)= .74,p = .53”

  • ConsistentF(3, 83.4) = 1.06reported p = .37 · recomputed p = .371

    “F(3,83.4)= 1.06, p = .37”

  • ConsistentF(3, 38.3) = 2.85reported p = .0499 · recomputed p = .050

    “F(3,38.3)= 2.85, p = .0499”

  • ConsistentF(3, 36.9) = 3.44reported p = .027 · recomputed p = .026

    “F(3,36.9)= 3.44, p = .027”

  • ConsistentF(3, 43.2) = 4.88reported p = .005 · recomputed p = .005

    “F(3,43.2) = 4.88, p = .005”

9 of 9

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Motivation scores differ between the text and Table 1

    Major

    For the 51 participants who completed the motivation survey, the text reports a mean of 54.5 and SD of 15.94, whereas Table 1 reports a mean of 55.7 and SD of 16.6.

  • Participant restriction conflicts with the outcome analysis

    Minor

    The Participants section says only the two web-intervention groups were analyzed, but the paper also reports an outcome analysis comparing them with the tracking-only and control groups.

2 of 2

Cites

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Authors
Farrer, L. M., Griffiths, K. M., Christensen, H., Mackinnon, A. J., & Batterham, P. J.
Affiliations
  • Australian National University (AU)
  • Black Dog Institute (AU)
  • The University of Melbourne (AU)
Corresponding author
Farrer, Louise M.
ORCID
Venue
Cognitive Therapy and Research
Publisher
Springer Science and Business Media LLC
Published
2013-10-27
Volume
38
Issue
3
Pages
358-367
ISSN
  • 0147-5916 (ISSN-L)
  • 1573-2819
DOI
10.1007/s10608-013-9589-1
OpenAlex
W2017400726
Cited by
47
References
54
Citations by year
2025: 1 · 2024: 1 · 2023: 8 · 2022: 6 · 2021: 6 · 2020: 4 · 2019: 2 · 2018: 1 · 2017: 7 · 2016: 8 · 2015: 3
FWCI
5.17
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Cognitive Therapy and Research (publishedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion)
  • ANU Open Research (Australian National University) (submittedVersion)
Funders
  • Medical Research Council
  • Australian Research Council (LP0667970)
  • National Health and Medical Research Council (1035262, 525413, 525411)
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
Keywords
internet-based cognitive behavioral therapy, medication adherence, depression, predictors of treatment outcome, motivation, baseline depression severity, online psychoeducation, treatment discontinuation, predictors of adherence

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 2026-10-10.

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

Statistics and arithmetic are recomputed, not judged.

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