Therapist-delivered internet psychotherapy for depression in primary care: a randomised controlled trial
Abstract
Background Despite strong evidence for its effectiveness, cognitive-behavioural therapy (CBT) remains difficult to access. Computerised programs have been developed to improve accessibility, but whether these interventions are responsive to individual needs is unknown. We investigated the effectiveness of CBT delivered online in real time by a therapist for patients with depression in primary care.Methods In this multicentre, randomised controlled trial, 297 individuals with a score of 14 or more on the Beck depression inventory (BDI) and a confirmed diagnosis of depression were recruited from 55 general practices in Bristol, London, and Warwickshire, UK. Participants were randomly assigned, by a computer-generated code, to online CBT in addition to usual care (intervention; n=149) or to usual care from their general practitioner while on an 8-month waiting list for online CBT (control; n=148). Participants, researchers involved in recruitment, and therapists were masked in advance to allocation. The primary outcome was recovery from depression (BDI score <10) at 4 months. Analysis was by intention to treat. This trial is registered, number ISRCTN 45444578.Findings 113 participants in the intervention group and 97 in the control group completed 4-month follow-up. 43 (38%) patients recovered from depression (BDI score <10) in the intervention group versus 23 (24%) in the control group at 4 months (odds ratio 2.39, 95% CI 1.23-4.67; p=0.011), and 46 (42%) versus 26 (26%) at 8 months (2.07, 1.11-3.87; p=0.023).Interpretation CBT seems to be effective when delivered online in real time by a therapist, with benefits maintained over 8 months. This method of delivery could broaden access to CBT.Funding BUPA Foundation.
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Most internet treatment applications do not require the work to be performed at a particular time, which is an advantage for patients and clinicians.
“while internet treatment can be presented in real time [35], most treatment applications will not require that the work is performed at a particular time, and this is an advantage for both patients and clinicians.”
From The promise and pitfalls of the internet for cognitive behavioral therapy (2010) · cites this paper as [35]
Psychotherapy delivered via instant messaging is effective and yields reasonable effect sizes.
“Psychotherapy has also been provided effectively and with reasonable effect sizes via instant messaging (12).”
From Behavioral Intervention Technologies: Evidence review and recommendations for future research in mental health (2013) · cites this paper as [12]
Internet-enabled CBT has been shown to be clinically effective for the treatment of depression.
“Internet-enabled CBT has been shown to be clinically effective for the treatment of depression16 and is currently deployed within IAPT.”
From Quantifying the association between psychotherapy content and clinical outcomes using deep learning (2020) · cites this paper as [16]
Ten therapist-delivered sessions of CBT over the internet were effective in reducing depression at 4 and 8 months.
“Ten therapist-delivered sessions of CBT over the internet were effective in reducing depression at 4 and 8 months (equivalent to our short-term measures).71”
The attrition rates in this study were equal or lower compared with several similar studies on guided Web-based interventions for depression with long-term follow-up assessments.
“The attrition rates in this study were equal or lower compared with several similar studies on guided Web-based interventions for depression with long-term follow-up assessments [67,73,74].”
From Long-Term Results of a Web-Based Guided Self-Help Intervention for Employees With Depressive Symptoms: Randomized Controlled Trial (2014) · cites this paper as [73]
There are important differences between the therapist-supported intervention in the study by Kessler et al. [28] and the nonguided intervention in the study by de Graaf et al. [19].
“However, despite similar delivery context and study design, there are important differences between the therapist-supported intervention in the study by Kessler et al. [28] and the nonguided intervention in the study by de Graaf et al. [19].”
From Internet-based psychological treatments for depression (2012) · cites this paper as [28]
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Self-citation
- Authors
- Kessler, D., Lewis, G., Kaur, S., Wiles, N., King, M., Weich, S., Sharp, D. J., Araya, R., Hollinghurst, S., & Peters, T. J.
- Affiliations
- National Institute for Health and Care Research (GB)
- University of Bristol (GB)
- The Royal Free Hospital (GB)
- University of Warwick (GB)
- Corresponding author
- Kessler, David
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2009-08
- Volume
- 374
- Issue
- 9690
- Pages
- 628-634
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2130951278
- Cited by
- 387
- References
- 22
- Citations by year
- 2026: 9 · 2025: 7 · 2024: 12 · 2023: 10 · 2022: 12 · 2021: 19 · 2020: 30 · 2019: 23 · 2018: 26 · 2017: 29 · 2016: 33 · 2015: 28 · 2014: 41 · 2013: 35 · 2012: 27
- FWCI
- 28.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Bristol Research (University of Bristol) (submittedVersion)
- Explore Bristol Research (submittedVersion)
- Funders
- National Institute for Health and Care Research (CL-2007-25-001)
- Bupa Foundation
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- online therapy, cognitive behavioral therapy, depression, primary care, access to mental health care, recovery from depression
- MeSH terms
- Adult, Antidepressive Agents, Depressive Disorder, England, Female, Follow-Up Studies, Health Services Accessibility, Humans, Male, Psychiatric Status Rating Scales, Severity of Illness Index, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Effect Modifier, Epidemiologic, Linear Models, Logistic Models, Treatment Outcome, Internet, International Classification of Diseases
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