Cited by 112Digital Mental Health InterventionsHealth Literacy and Information AccessibilityMobile Health and mHealth Applications

The Science of Internet Interventions

Ritterband, Lee M., Tate, Deborah F.·2009·Annals of Behavioral Medicine

Abstract

Over the past decade, there has been an explosion in research focused on the development and evaluation of health-based treatment and prevention programs delivered via the Internet. A plethora of terms have been used to both categorize the related field (e.g., e-therapy, online treatment, Internet therapy, and interactive health communication), as well as the specific applications (e.g., web-based programs, Internet applications, and web systems). The programs or “Internet interventions,” as they are more apt to be called, typically target behavioral or mental health problems. Prior to these Internet-based programs, computer-based applications to change behavior or treat mental disorders had been created and tested intermittently during the previous two decades as computers were popularized. The breadth of literature on these systems, particularly those that utilize the Internet, has become quite substantive [1]. Outcome trials of Internet interventions have consistently demonstrated greater symptom improvements or changes in behavior compared with controls, and for some problems, outcomes from Internet interventions rival those seen in face-to-face interventions. Hundreds of peer-reviewed papers have now been published in this area, most since the year 2000. There is already quite a number of review articles focused specifically on Internet intervention research. Some of these reviews are now older, highlighting early, but important findings in the field [2]; some are systematic and fairly detailed [3]; and some are large scale, comprehensive reviews [1, 4]. There are many reviews focused on specific areas, such as pediatrics [5]; physical activity [6]; obesity [7]; alcohol and tobacco use [8, 9]; cardiac disease [10]; depression and anxiety [11]; and traumatic stress [12]. There are also a surprising number of published meta-analyses for such a young field [13–15]. The conclusion drawn from most reviews and meta-analyses is that Internet interventions yield positive treatment outcomes, symptom reduction, and improved quality of life.

AI snapshot

Written from the paper’s full text.

TL;DR

This editorial introduces a special series arguing that Internet interventions have established efficacy but lack a sufficient scientific foundation. It summarizes five contributions on definitions, a behavior-change model, methodology, cost-effectiveness, and commentary.

Key findings

  • Outcome trials of Internet interventions have consistently demonstrated greater symptom improvements or behavior changes compared with controls, and for some problems outcomes rival face-to-face interventions; hundreds of peer-reviewed papers have been published, most since 2000.
  • Despite many reviews and meta-analyses concluding positive treatment outcomes, symptom reduction, and improved quality of life, there is “remarkably little literature on the underlying science of the field.”
  • Barak et al. organize programs into four primary categories: web-based interventions, online counseling and therapy, Internet-operated therapeutic software, and other online activities; Ritterband et al. propose a nine-step behavior-change model.
  • Danaher and Seeley review methodological approaches and call for more innovative designs; Tate et al. review cost and cost-effectiveness analyses and note that few studies provide cost data; Glasgow’s commentary highlights scalability, reach, and health disparity.

Methods

  • Design: editorial/introduction to a special series in *Annals of Behavioral Medicine*; not an empirical study.
  • Data or sample: narrative overview of five special-series articles—Barak et al., Ritterband et al., Danaher and Seeley, Tate et al., and a commentary by Glasgow.
  • Main analysis: descriptive synthesis of each article’s focus and implications; no primary data collection or statistical analysis is reported.

Limitations

  • Stated: the Ritterband model is a simplification that will evolve, with components possibly added or removed and further elements requiring testing; cost savings are often assumed based on fully automated systems, while few studies provide cost data; requiring outcomes similar to face-to-face care may be unnecessarily stringent.
  • Evident: as an editorial, it presents no original empirical data, systematic review methods, or quantitative synthesis, so its conclusions rely on cited literature and the special-series papers.

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

Integrity signals

Registry

Crossref · 10.1007/s12160-009-9132-5

Cites

23 of 23 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 8 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    For some problems, outcomes from Internet interventions rival those seen in face-to-face interventions.

    “for some problems, outcomes from Internet interventions rival those seen in face-to-face interventions.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1] Marks IM, Cavanagh K, Gega L. Hands-on help: computer-aided psychotherapy. Hove, England, and New York: Psychology; 2007. source

      Not checked in the free run.

    • cites [4] Murray E, Burns J, See TS, Lai R, Nazareth I (2005) Interactive health communication applications for people with chronic disease. Cochrane Database Syst Rev. (4):CD004274 source

      Not checked in the free run.

  • Premisecitation

    Outcome trials of Internet interventions have consistently demonstrated greater symptom improvements or changes in behavior compared with controls.

    “Outcome trials of Internet interventions have consistently demonstrated greater symptom improvements or changes in behavior compared with controls,”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1] Marks IM, Cavanagh K, Gega L. Hands-on help: computer-aided psychotherapy. Hove, England, and New York: Psychology; 2007. source

      Not checked in the free run.

    • cites [4] Murray E, Burns J, See TS, Lai R, Nazareth I (2005) Interactive health communication applications for people with chronic disease. Cochrane Database Syst Rev. (4):CD004274 source

      Not checked in the free run.

  • Interpretationreasoning

    Internet interventions can provide an option to those who cannot or choose not to seek face-to-face treatment.

    “Internet interventions can provide an option to those who cannot or choose not to seek face-to-face treatment.”
    Quote in the paperSubstantial claim
  • Premisecitation

    Few studies provide any cost data for Internet interventions.

    “However, while cost is an often cited reason for examining Internet interventions, few studies provide any cost data [3].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] Griffiths F, Lindenmeyer A, Powell J, Lowe P, Thorogood M. Why are health care interventions delivered over the Internet? A systematic review of the published literature. J Med Internet Res. 2006; 8: e11. source

      Not checked in the free run.

  • May combine two claims. 3
  • Classified as probably not a substantial claim. 16
  • May combine two claims.

    Premisecitation

    The conclusion drawn from most reviews and meta-analyses is that Internet interventions yield positive treatment outcomes, symptom reduction, and improved quality of life.

    “The conclusion drawn from most reviews and metaanalyses is that Internet interventions yield positive treatment outcomes, symptom reduction, and improved quality of life.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [13] Wantland D, Portillo C, Holzemer W, Laughter R, McGhee E. The effectiveness of web-based vs. non-web-based interventions: a meta-analysis of behavioral change outcomes. J Med Internet Res. 2004; 6: e40. source

      Not checked in the free run.

    • cites [14] Spek V, Cuijpers P, Nyklicek I, Riper H, Keyzer J, Pop V. Internet-based cogntive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med. 2007; 37: 319-328. source

      Not checked in the free run.

    • cites [15] Barak A, Hen L, Boniel-Nissim M, Shapira N. A comprehensive review and a meta-analysis of the effectiveness of Internet-based psychotherapeutic interventions. J Tech Hum Serv. 2008; 26: 109-160. source

      Not checked in the free run.

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

    Interpretationreasoning

    Grounding Internet interventions in a theoretical framework will further establish them as viable, scientifically-based prevention and treatment programs.

    “Grounding these interventions in a theoretical framework will further establish Internet interventions as viable, scientifically-based prevention, and treatment programs.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Little attention has been paid in the literature to the theoretical underpinnings of Internet interventions.
  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Internet interventions may enhance the ability of health care providers to better utilize their time and possibly reallocate valuable face-to-face time to those who require a more intensive intervention.

    “They may also enhance the ability of health care providers to better utilize their time and possibly reallocate valuable face-toface time to those who require a more intensive intervention by allowing the clinical needs of some patients to be addressed through the use of Internet interventions.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim.

    Interpretationnone given

    Many Internet treatments can be used as additive or adjunctive components of traditional treatment, supplementing material, skills, or time that clinicians may not have.

    “Many of these treatments can be used as additive or adjunctive components of traditional treatment, supplementing material, skills, or time that clinicians may not have.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim.

    Premisenone given

    There are many forms of treatment offered via the Internet, including programs that incorporate substantial human involvement.

    “However, there are many forms of treatment offered via the Internet, including programs that incorporate substantial human involvement.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    The potential for widescale dissemination of Internet interventions is significant.

    “In addition, the potential for widescale dissemination is significant.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Individuals who would otherwise be unable or unwilling to receive care might have access to Internet prevention or treatment options, particularly those in rural areas.

    “Individuals, who would otherwise be unable or unwilling to receive care, might have access to Internet prevention or treatment options, particularly those in rural areas.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Internet interventions offer advantages from an intervention delivery perspective, including the ability to provide treatments in a standardized manner with fidelity across a variety of settings.

    “They also offer many advantages from an intervention delivery perspective including the ability to provide treatments in a standardized manner with fidelity across a variety of settings.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Internet interventions lower many of the barriers that patients face when accessing traditional forms of care, including difficulties in finding a skilled clinician, inconvenience of scheduling, missing work/school, travel, expense, and others.

    “These interventions lower many of the barriers that patients face when accessing traditional forms of care, including the difficulties in finding a skilled clinician for a specific disorder, inconvenience of scheduling face-to-face appointments, missing work/school, travel to and from a clinician's office, expense, and many others.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    The assumption that Internet interventions cost less than traditional services is typically based on comparisons to fully automated systems, where ongoing maintenance costs are considered to be minimal per user.

    “While it may seem obvious that Internet interventions cost less than traditional services, this assumption is typically based on comparisons to fully automated systems, where ongoing maintenance costs are considered to be minimal per user.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    There is an unprecedented opportunity for comprehensive evidence-based treatments to be more widely disseminated via the Internet, reaching patients at doctors' offices, school, work, and home.

    “There is an unprecedented opportunity for comprehensive evidencebased treatments to be more widely disseminated via the Internet, reaching patients at doctors' offices, school, work, and home.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Interpretationreasoning

    Internet interventions promise an efficacious, scalable, and cost-effective prevention and treatment option, with significant potential for public health impact.

    “Internet interventions, clearly, promise an efficacious, scalable, and cost-effective prevention and treatment option, with significant potential for public health impact.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Internet interventions have the potential to reach large numbers of people all over the world with enormous cost savings.
    • The authors state this as an assumption: Internet interventions cost less than traditional services.
  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Internet interventions can be used as part of a stepped-care model.

    “They can be used as part of a stepped-care model.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Without a scientific underpinning, the field of Internet interventions may flounder.

    “However, without a scientific underpinning, the field may flounder.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: There is remarkably little literature on the underlying science of Internet interventions.
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisereasoning

    Some of the main advantages to developing Internet interventions relate to scalability and expense.

    “Some of the main advantages to developing Internet interventions relate to scalability and expense.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Without unifying definitions, it is difficult to ensure that reviews and meta-analyses include the relevant and appropriate studies, potentially impacting the generalizations drawn from these reviews.

    “Without unifying definitions, it is difficult to ensure that reviews and meta-analyses include the relevant and appropriate studies, potentially impacting the generalizations that are drawn from these reviews.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim.

    Interpretationreasoning

    If designed and used correctly, Internet interventions can become a powerful tool in helping reduce health disparities, particularly among the geographically isolated.

    “If designed and used correctly, Internet interventions can become a powerful tool in helping reduce health disparities, particularly among the geographically isolated.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The outcome literature has helped establish Internet interventions as a viable and important prevention and treatment option.

    “While the outcome literature has helped establish Internet interventions as a viable and important prevention and treatment option”
    Quote in the paperNot a substantial claim
18 of 18
  • The paper relies on this without support.

    There is remarkably little literature on the underlying science of Internet interventions.

    “However, despite considerable attention devoted to Internet intervention research, there is remarkably little literature on the underlying science of the field.”
  • The paper relies on this without support.

    Little attention has been paid in the literature to the theoretical underpinnings of Internet interventions.

    “In addition to definitions, little attention has been paid in the literature to the theoretical underpinnings of Internet interventions.”
  • The paper relies on this without support.

    Behavior change and symptom improvement are typically assumed to be achieved through the same means as more traditional intervention approaches such as face-to-face treatment.

    “Behavior change and symptom improvement are typically assumed to be achieved through the same means as more traditional intervention approaches such as face-to-face treatment.”
  • The paper relies on this without support.

    The feasibility of Internet interventions is now well-established.

    “The feasibility of Internet interventions is now wellestablished.”
  • The paper relies on this without support.

    Internet interventions have the potential to reach large numbers of people all over the world with enormous cost savings.

    “Internet interventions have the potential to reach large numbers of people all over the world with enormous cost savings.”
  • The authors state this as an assumption.

    Internet interventions cost less than traditional services.

    “While it may seem obvious that Internet interventions cost less than traditional services, this assumption is typically based on comparisons to fully automated systems, where ongoing maintenance costs are considered to be minimal per user.”
6 of 6

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?

  • There have been calls to develop a more scientific approach to the design and evaluation of Web-based interventions, including the analysis of engagement.

    “As the corpus of research studies grows, there have been calls to develop a more scientific approach to the design and evaluation of Web-based interventions: a methodology that includes the analysis of engagement.”
  • Adapting empirically supported treatments into online delivery platforms makes them more accessible, particularly to those living in remote areas, with outcomes often rivaling those for in-clinic treatment.

    “However, one increasingly used approach to overcoming these obstacles has been to adapt empirically supported treatments into online delivery platforms that make them more accessible, particularly to those living in remote areas,29,43,47 with outcomes often rivaling those for in-clinic treatment.10,14”

Cites

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Authors
Ritterband, L. M., & Tate, D. F.
Affiliations
  • University of Virginia Health System (US)
  • University of North Carolina at Chapel Hill (US)
Corresponding author
Ritterband, Lee M.
Venue
Annals of Behavioral Medicine
Published
2009-08
Volume
38
Issue
1
Pages
1-3
ISSN
  • 0742-5554 (ISSN-L)
  • 0883-6612
  • 1532-4796
OpenAlex
W1991503422
Cited by
111
References
23
Citations by year
2026: 1 · 2025: 1 · 2024: 3 · 2023: 2 · 2022: 1 · 2021: 2 · 2020: 4 · 2019: 9 · 2018: 10 · 2017: 11 · 2016: 10 · 2015: 10 · 2014: 10 · 2013: 13 · 2012: 7
FWCI
9.41
Type
journal article
Language
en
Open access
closed
Locations
  • Annals of Behavioral Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Keywords
online intervention, e-therapy, online therapy, behavioral health, psychotherapy, prevention programs, treatment outcomes, meta-analysis
MeSH terms
Humans, Psychotherapy, Therapy, Computer-Assisted, Internet, Evidence-Based Practice

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