The DOI matches its Crossref record; 22 of the 22 references it cites were found in a registry or an index.
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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“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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”
In the citing paper
“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]
In the citing paper
“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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Integrating the Digital and the Traditional to Deliver Therapy for Depression
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“It is of note, however, that baseline symptom severity in CoBalT was similar to other RCTs of depression in the UK (Chalder et al., 2012; Kessler et al., 2009; Lewis et al., 2011; Wiles et al., 2012).”
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“Methods Data This study follows a trial of online CBT for primary care clients diagnosed with depression.(30,31) This study utilises typed transcripts of online CBT sessions from 183 client-therapist dyads.”
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“Kessler et al. (2009) found that greater symptom severity predicted greater symptom reduction, which has also been observed both in subsequent studies that have not excluded people with severe symptoms (e.g., Hadjistavropoulos, Pugh, Hesser, & Andersson, 2016) and in studies that have (e.g.,…”
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“…to be a representative population for addressing both hypotheses: the mean BDI scores are similar to those seen in other UK depression in primary care trials (Kessler et al., 2009; Ward et al., 2000), and the response to antidepressants is similar to the US study STAR*D (Trivedi et al., 2006).”
ResultSelf-citationVitale, E., Genovese, V. V., & Allenet, B. (2021) · Education thérapeutique du patient - Therapeutic patient education · doi:10.1051/tpe/2021007 · Cited by 7
Tallon, D., Thomas, L., Brabyn, S., Ching, B. C. F., Hahn, J. S., Jude, B., Logan, M. X., Burrage, A., Fox, F. E., Gilbody, S. M., et al. (2023) · Trials · doi:10.1186/s13063-023-07396-9 · Cited by 8
“The second target is based on data from our previous CBT trials [2, 8] in which 9–13% of those randomised to receive the intervention did not attend any sessions and a further 3–7% of participants only attended one session with a therapist, giving an overall percentage of 12–19% attending fewer than two sessions.”
BackgroundMethodResultInfluentialSelf-citationMedical Family Therapy in Family Medicine
Hodgson, J. L., Trump, L. J., Wilson, G., & Garcia‐Huidobro, D. (2018) · Focused issues in family therapy · doi:10.1007/978-3-319-68834-3_2 · Cited by 6
Using technology to understand how therapist variables are associated with clinical outcomes in IAPT
Bateup, S., Palmer, C. R., & Catarino, A. (2020) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x20000252 · Cited by 7
“The clinical efficacy of IECBT has been demonstrated by Kessler et al .”
Psychiatric Disorders - New Frontiers in Affective Disorders
Schoepf, D. (2013) · InTech eBooks · doi:10.5772/2039 · Cited by 6
Internetbasierte psychologische Behandlungen bei Depressionen und Angststörungen
Moritz, S., Berger, T., & Klein, J. P. (2014) · Nervenheilkunde · doi:10.1055/s-0038-1633387 · Cited by 5
“Ein Beispiel hierfür ist eine in The Lancet veröffentlichte kontrolliert randomisierten Studie, in welcher depressive Patienten in Hausarztpraxen rekrutiert und zufällig zwei Bedingungen zuteilt wurden: treatment as usual (TAU) vom Hausarzt oder TAU + ChatTherapie (61).”
BackgroundJoyce, N. (2012) · OhioLink ETD Center (Ohio Library and Information Network) · Cited by 5
Internet-Interventionen in der Psychotherapie
Berger, T., Bur, O. T., & Krieger, T. (2020) · Fortschritte der Neurologie · Psychiatrie · doi:10.1055/a-1165-7496 · Cited by 5
Hanlon, I., Hewitt, C., Evans, S., Taylor, J., Selinger, C., & Mikocka-Walus, A. (2022) · Journal of Health Psychology · doi:10.1177/1359105320945001 · Cited by 4
Rapport Building in Written Crisis Services: Qualitative Content Analysis
Schwab‐Reese, L. M., Short, C., Jacobs, L., & Fingerman, M. (2024) · Journal of Medical Internet Research · doi:10.2196/42049 · Cited by 5
“One randomized controlled trial of a chat-based cognitive behavioral therapy demonstrated reduced depression symptoms after 10 sessions [25].”
BackgroundCarey, M., Kerr‐Gaffney, J., Strawbridge, R., Hieronymus, F., McCutcheon, R. A., Young, A. H., & Jauhar, S. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.04.070 · Cited by 5
Soria-Saucedo, R., Eisen, S. V., Cabral, H., & Kazis, L. E. (2016) · Journal of Pharmaceutical Health Services Research · doi:10.1111/jphs.12122 · Cited by 4
The Internet and CBT: A New Clinical Application of an Effective Therapy
Gratzer, D., Khalid-Khan, F., & Balasingham, S. (2018) · InTech eBooks · doi:10.5772/intechopen.72146 · Cited by 6
“Therefore, many primary care physicians and psychiatrists do not offer CBT [7].”
BackgroundDie therapeutische Beziehung in internetbasierten Behandlungsansätzen
Berger, T. (2017) · Springer eBooks · doi:10.1007/978-3-662-54310-8_9 · Cited by 4
Critical Concerns When Incorporating Telepractice in Outpatient Settings and Private Practice
Palomares, R. S., Bufka, L. F., & Baker, D. C. (2015) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2015.0013 · Cited by 4
“…health interventions specific to some services, disorders, and populations of adults (Ruskin et al. 2004; Fortney et al. 2007; O’Reilly et al. 2007; Kessler et al. 2009; Richardson et al. 2009; Morland et al. 2010; Hilty et al. 2013), and, to a lesser extent, children and adolescents (Nelson et…”
Caractéristiques et évidences empiriques des traitements psychologiques basés sur Internet
Hohl, É., Berger, T., Bergström, J., Andersson, G., & Caspar, F. (2010) · Journal de Thérapie Comportementale et Cognitive · doi:10.1016/j.jtcc.2010.04.002 · Cited by 4
Explorations in Designing Virtual Environments for Remote Counselling
Cao, J., Gao, W., Pai, Y. S., Hoermann, S., Li, C., Baghaei, N., & Billinghurst, M. (2024) · IEEE International Symposium on Mixed and Augmented Reality Adjunct (ISMAR-Adjunct) · doi:10.1109/ismar-adjunct64951.2024.00070 · Cited by 4
“For example, Pedram et al.[23] introduced VRchat as a remote counselling tool, where therapist and client experience a shared virtual environment.”
Owusu, J. T., Wang, P., Wickham, R. E., Smith, S. F., Lee, J. L., Chen, C., & Lungu, A. (2022) · JMIR Formative Research · doi:10.2196/44138 · Cited by 3
“Text-based care has the added benefit of potentially allowing for more discretion and greater convenience [20], in addition to possibly allowing for more internal reflection than face-to-face sessions [20,21].”
Sogomonjan, M., Kerikmäe, T., Ööpik, P., & Ross, P. (2019) · Cogent Psychology · doi:10.1080/23311908.2019.1637623 · Cited by 3
“Studies on Internet-delivered cognitive behavioral therapy (iCBT) have been demonstrated to be an effective and efficient method of mental health care delivery under strictly controlled conditions where patients were allowed to take additional medication (Berger et al., 2017; Newby et al., 2013; Bergstrom et al., 2010…”
MethodMeier, J. V., Noel, J. A., & Kaspar, K. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1234167 · Cited by 4
“VPT showed robust clinical efficacy in multiple studies and meta-analyses (Barak et al., 2008; Kessler et al., 2009; Bower et al., 2013; Karyotaki et al., 2017; Carlbring et al., 2018; Morriss et al., 2019; Giovanetti et al., 2022) as well as similar levels in diagnosis, emergency treatment,…”
BackgroundBjornstad, G. J., Sonthalia, S., Rouse, B., Freeman, L., Hessami, N., Dunne, J. H., & Axford, N. (2024) · Campbell Systematic Reviews · doi:10.1002/cl2.1376 · Cited by 3
Patients' and Therapists' Views of Integrated Online CBT for Depression
Fox, F. E., Wiles, N., Kessler, D. A., Tallon, D., Thomas, L., Williams, C. J., Shafran, R., Lanham, P., & Turner, K. M. (2024) · Health Expectations · doi:10.1111/hex.70002 · Cited by 3
“Programmes where therapists deliver CBT sessions via real ‐ time instant messaging can be as effective as in ‐ person CBT [10, 11], and trials evaluating a blended model of online self ‐ guided CBT with some therapist input have shown it to be effective in treating major depressive disorder [7].”
BackgroundSelf-citationInternet- und mobilbasierte Interventionen zur Prävention und Behandlung psychischer Störungen
Ebert, D. D., Zarski, A., Berking, M., & Baumeister, H. (2016) · Springer eBooks · doi:10.1007/978-3-662-49504-9_20 · Cited by 4
Conducting Performance Evaluation of an e-Health Platform
Lo, O., Fan, L., Buchanan, W. J., & Thüemmler, C. (2013) · Advances in business information systems and analytics book series · doi:10.4018/978-1-4666-4062-7.ch016 · Cited by 4
“Research conducted by Cobb et al. (2005) present a live clinical trial of an e-Health system that provides support for patients wishing to quit smoking whilst Kessler et al. (2009) present a system for the delivery of psychotherapy via the internet.”
BackgroundNovas abordagens terapêuticas - terapias on-line *
Crestana, T. (2015) · Cited by 3
How mobile health applications can help treat depression
Rosenfeld, A., Pendse, S. R., & Nugent, N. R. (2017) · The Brown University Child and Adolescent Behavior Letter · doi:10.1002/cbl.30236 · Cited by 3
Internet-Interventionen in der Psychotherapie
Berger, T., Bur, O. T., & Krieger, T. (2019) · PSYCH up2date · doi:10.1055/a-0847-9263 · Cited by 4
“Ein anderes Beispiel ist eine randomisierte kontrollierte Studie, in welcher in Großbritannien eine Chat-Therapie bei depressiven Patientinnen und Patienten mit einer Treatment-as-usual-Kontrollgruppe verglichen wurde [15].”
BackgroundLan, J., Qin, Z., Niu, H., & Wang, J. (2025) · Cognitive Therapy and Research · doi:10.1007/s10608-025-10678-y · Cited by 3
Mohr, D. C., Burns, M. N., Schueller, S. M., Clarke, G. N., & Klinkman, M. S. (2013) · Cited by 2
Depression roundtable: Is there a role for BoNT?
Kels, L. H. (2023) · Toxicon · doi:10.1016/j.toxicon.2023.107148 · Cited by 2
Metadata
- 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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