Randomized Effectiveness Trial of an Internet, Pure Self-Help, Cognitive Behavioral Intervention for Depressive Symptoms in Young Adults

Clarke, Greg; Kelleher, Chris; Hornbrook, Matt; DeBar, Lynn; Dickerson, John; Gullion, Christina

doi:10.1080/16506070802675353

Cited by 154Digital Mental Health InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and Access

Randomized Effectiveness Trial of an Internet, Pure Self-Help, Cognitive Behavioral Intervention for Depressive Symptoms in Young Adults

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Clarke, Greg, Kelleher, Chris, Hornbrook, Matt, DeBar, Lynn, Dickerson, John, Gullion, Christina·2009·Cognitive Behaviour Therapy

DOI 10.1080/16506070802675353PMC PMC2829099

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Abstract

This study evaluated an Internet-delivered, cognitive behavioral skills training program versus a treatment-as-usual (TAU) control condition targeting depression symptoms in young adults aged 18 to 24 years. Potential participants were mailed a recruitment brochure; if interested, they accessed the study website to complete an online consent and baseline assessment. Intervention participants could access the website at their own pace and at any time. Reminder postcards were mailed periodically to encourage return use of the intervention. The pure self-help intervention was delivered without contact with a live therapist. The primary depression outcome measure was the Patient Health Questionnaire, administered at 0, 5, 10, 16, and 32 weeks after enrollment. A small but significant between-group effect was found from Week 0 to Week 32 for the entire sample (N = 160, d = .20, 95% confidence interval [CI] 0.00-0.50), with a moderate effect among women (n = 128, d .42, 95%C1 = 0.09-0.77). Greater depression reduction was associated with two measures of lower website usage, total minutes, and total number of page hits. Although intervention effects were modest, they were observed against a background of substantial TAU depression pharmacotherapy and psychosocial services. Highly disseminable, low-cost, and self-help interventions such as this have the potential to deliver a significant public health benefit.

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Specific daily tasks such as self-monitoring features (e.g. mood or symptom diary) or automated reminders are key elements for monitoring symptom improvement (Clarke et al., 2009; Wozney et al., 2017).
“Specific daily tasks such as self-monitoring features (e.g. mood or symptom diary) or automated reminders are key elements for monitoring symptom improvement and should therefore be included (Clarke et al., 2009; Wozney et al., 2017).”
From Involving patients' perspective in the development of an internet- and mobile-based CBT intervention for adolescents with chronic medical conditions: Findings from a qualitative study (2021) · cites this paper as Clarke et al., 2009
The Methods > Intervention passages describe daily mood ratings, activity tracking, and a feature for viewing depression scores over time, supporting the self-monitoring example. Methods > Assessment describes email reminders for study assessments, not automated intervention reminders for monitoring improvement. The paper does not establish that these features are key elements that should be included in interventions. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Overall 76% of the studies included in the review as a whole, and all but 4 studies included in the meta-analysis, had some risk of bias.
“Overall 76% of the studies included in the review as a whole, and all but 4 studies (43, 66, 68, 74) included in the meta-analysis had some risk of bias.”
From What Works and What Doesn’t Work? A Systematic Review of Digital Mental Health Interventions for Depression and Anxiety in Young People (2019) · cites this paper as [43]
The Results (Subject Flow) describe participants in a randomized trial, and the Discussion addresses limitations of that trial, not risk of bias across studies in a review. Searches for the 76% figure and for risk of bias among studies in a meta-analysis found no passage addressing either claim. (LLM, conf=0.77)
Experimental — accuracy not yet measured
Time spent online was not correlated to outcomes in studies that targeted depression and anxiety, but was correlated to outcomes in studies of infertility related distress and body dissatisfaction.
“Time spent online was not correlated to outcomes in studies that targeted depression [58] and anxiety [59], but was correlated to outcomes in studies of infertility related distress [60] and body dissatisfaction [61].”
From A Systematic Review of the Impact of Adherence on the Effectiveness of e-Therapies (2011) · cites this paper as [58]
The number of pages opened was negatively correlated to outcome in 1 study targeting depression but positively related to outcomes in 2 studies targeting body dissatisfaction.
“The number of pages opened was negatively correlated to outcome in 1 study targeting depression [58] but positively related to outcomes in 2 studies targeting body dissatisfaction [62,63].”
From A Systematic Review of the Impact of Adherence on the Effectiveness of e-Therapies (2011) · cites this paper as [58]
The lack of change in help-seeking in the RCTs may have been due to small sample sizes, an active comparison group, mild mental health problems rather than severe symptoms, or participants having previously sought help or being currently in treatment.
“The lack of change in these studies may have been due to small sample sizes, an active comparison group [52], mild mental health problems rather than severe symptoms [79], or the fact that participants had previously sought help or were currently in treatment [78].”
From Do online mental health services improve help-seeking for young people? A systematic review (2014) · cites this paper as [52]

The quasi-experimental study found a slight but significant increase in help-seeking [52,68,78,79].
“The quasi-experimental study found a slight but significant increase in help-seeking [52,68,78,79].”
From Do online mental health services improve help-seeking for young people? A systematic review (2014) · cites this paper as [52]
Seven studies [52,53,55,63,77-79] developed the intervention that they were evaluating, which may have led to a bias towards more favorable reporting.
“Seven studies [52,53,55,63,77-79] developed the intervention that they were evaluating, which may have led to a bias towards more favorable reporting.”
From Do online mental health services improve help-seeking for young people? A systematic review (2014) · cites this paper as [52]
The majority of studies reported small sample size as a limitation.
“small sample size [51,52,55,60,68,78,79]”
From Do online mental health services improve help-seeking for young people? A systematic review (2014) · cites this paper as [52]
No change in help-seeking was found in the three RCTs [52,78,79].
“No change in help-seeking was found in the three RCTs [52,78,79].”
From Do online mental health services improve help-seeking for young people? A systematic review (2014) · cites this paper as [52]
Studies by Isen and colleagues across several patient populations found an overall relationship between change in positive affect and change in health behavior.
“A series of studies by Isen and colleagues provided a self-affirmation, coping, and positive emotion intervention to several different patient populations and found an overall relationship between positive affect change and health behavior change[12,13,14,15].”
From An online positive affect skills intervention reduces depression in adults with type 2 diabetes (2014) · cites this paper as [12]
Previous studies of online intervention for depression in the community using a CBT protocol similar to the current study reported post-treatment effect sizes averaging 1.29 and follow-up effects averaging 1.42, based on samples ranging from 45 to 300.
“An analysis of a number of previous studies of an online intervention for depression in the community and that have used a CBT protocol similar to the intervention in the current study have reported post-treatment effect sizes averaging 1.29, and follow-up effects averaging 1.42, based on samples ranging from 45 – 300 [39,42-48].”
From Internet-delivered treatment: its potential as a low-intensity community intervention for adults with symptoms of depression: protocol for a randomized controlled trial (2014) · cites this paper as [43]
Skills trainings for various psychological problems have increasingly and successfully been offered as scalable online-based interventions.
“Given the rising cost pressure in the mental health domain, skills trainings for various psychological problems have increasingly and successfully been offered as scalable online-based interventions (e.g., Clarke et al., 2009; Rychtarik et al., 2015).”
From Smartphone-Based Emotion Recognition Skills Training for Alexithymia—A Randomized Controlled Pilot Study (2019) · cites this paper as Clarke et al., 2009

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Mindfulness online: an evaluation of the feasibility of a web-based mindfulness course for stress, anxiety and depression
Krusche, A., Cyhlarova, E., & Williams, J. M. G. (2013) · BMJ Open · doi:10.1136/bmjopen-2013-003498 · Cited by 192 · see citing works
Using technology to deliver mental health services to children and youth: a scoping review.
Boydell, K., Hodgins, M., Pignatiello, A., Teshima, J., Edwards, H. E., & Willis, D. (2014) · Europe PMC (PubMed Central) · Cited by 197 · see citing works
The Public Health Impact of Major Depression: A Call for Interdisciplinary Prevention Efforts
McLaughlin, K. A. (2011) · Prevention Science · doi:10.1007/s11121-011-0231-8 · Cited by 196 · see citing works
Treatment-as-usual (TAU) is anything but usual: a meta-analysis of CBT versus TAU for anxiety and depression
Watts, S. E., Turnell, A., Kladnitski, N., Newby, J. M., & Andrews, G. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.12.025 · Cited by 188 · see citing works
An online positive affect skills intervention reduces depression in adults with type 2 diabetes
Cohn, M. A., Pietrucha, M. E., Saslow, L. R., Hult, J. R., & Moskowitz, J. T. (2014) · The Journal of Positive Psychology · doi:10.1080/17439760.2014.920410 · Cited by 188 · see citing works
Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis
Karyotaki, E., Kemmeren, L., Riper, H., Twisk, J., Hoogendoorn, A., Kleiboer, A., Mira, A., Mackinnon, A., Meyer, B., Botella, C., et al. (2018) · Psychological Medicine · doi:10.1017/s0033291718000648 · Cited by 167 · see citing works
Guided self-help works: randomized waitlist controlled trial of pacifica, a mobile app integrating cognitive behavioral therapy and mindfulness for stress, anxiety, and depression
Moberg, C., Niles, A., & Beermann, D. (2019) · Journal of Medical Internet Research · doi:10.2196/12556 · Cited by 157 · see citing works
Internet-delivered psychotherapy for depression in adults
Titov, N. (2011) · Current Opinion in Psychiatry · doi:10.1097/yco.0b013e32833ed18f · Cited by 158 · see citing works
Internet and computer-based cognitive behavioral therapy for anxiety and depression in adolescents and young adults: systematic review and meta-analysis.
Christ, C., Schouten, M. J., Blankers, M., van Schaik, D. J., Beekman, A. T., Wisman, M. A., Stikkelbroek, Y. A., & Dekker, J. J. (2020) · Journal of Medical Internet Research · doi:10.2196/17831 · Cited by 148 · see citing works
The Clinical Effectiveness of Web-Based Cognitive Behavioral Therapy With Face-to-Face Therapist Support for Depressed Primary Care Patients: Randomized Controlled Trial
Høifødt, R. S., Lillevoll, K. R., Griffiths, K. M., Wilsgaard, T., Eisemann, M., Waterloo, K., & Kolstrup, N. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2714 · Cited by 154 · see citing works
“The adherence rate in the present study is comparable to that observed in other online guided interventions, in which adherence varied between 55% and 75% [13,14,23,30,99].”
Result
Online interventions for depression and anxiety – a systematic review
Saddichha, S., Al-Desouki, M., Lamia, A., Linden, I. A., & Krausz, M. (2014) · Health Psychology and Behavioral Medicine · doi:10.1080/21642850.2014.945934 · Cited by 133 · see citing works
“…guidance (Andersson et al., 2005; Andersson, Hesser, Veilord, et al., 2013; Bolier et al., 2013; Carlbring et al., 2013; Christensen et al., 2004; Clarke et al., 2009; Choi et al., 2012; De Graaf et al., 2009; Donker et al., 2013; Farrer, Christensen, Griffiths, &Mackinnon, 2011; Hollandare et…”
MethodResultInfluential
Internet-Based CBT for Depression with and without Telephone Tracking in a National Helpline: Randomised Controlled Trial
Farrer, L., Christensen, H., Griffiths, K. M., & Mackinnon, A. (2011) · PLoS ONE · doi:10.1371/journal.pone.0028099 · Cited by 140 · see citing works
A randomized controlled trial of internet-based therapy in depression
Moritz, S., Schilling, L., Hauschildt, M., Schröder, J., & Treszl, A. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.04.006 · Cited by 140 · see citing works
Cochrane Review: Psychological and educational interventions for preventing depression in children and adolescents
Merry, S., Hetrick, S. E., Cox, G., Brudevold‐Iversen, T., Bir, J. J., & McDowell, H. (2012) · Evidence-Based Child Health A Cochrane Review Journal · doi:10.1002/ebch.1867 · Cited by 129 · see citing works
Is computerised CBT really helpful for adult depression?-A meta-analytic re-evaluation of CCBT for adult depression in terms of clinical implementation and methodological validity
So, M., Yamaguchi, S., Hashimoto, S., Sado, M., Furukawa, T. A., & McCrone, P. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-113 · Cited by 129 · see citing works
“On the other hand, for the eight comparisons from seven trials with modern imputation techniques [38,39, 43-45,47,49], the SMD was −0.”
BackgroundMethodInfluential
Effectiveness of an app-based cognitive behavioral therapy program for postpartum depression in primary care: A randomized controlled trial
Jannati, N., Mazhari, S., Ahmadian, L., & Mirzaee, M. (2020) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2020.104145 · Cited by 124 · see citing works
Internet-delivered cognitive behavioural therapy in the treatment of psychiatric illness
Gratzer, D., & Khalid-Khan, F. (2015) · Canadian Medical Association Journal · doi:10.1503/cmaj.150007 · Cited by 111 · see citing works
Does online insomnia treatment reduce depressive symptoms? A randomized controlled trial in individuals with both insomnia and depressive symptoms
van der Zweerde, T., van Straten, A., Effting, M., Kyle, S. D., & Lancee, J. (2018) · Psychological Medicine · doi:10.1017/s0033291718001149 · Cited by 109 · see citing works
Mindfulness for pregnancy: a randomised controlled study of online mindfulness during pregnancy
Krusche, A., Dymond, M., Murphy, S. E., & Crane, C. (2018) · Midwifery · doi:10.1016/j.midw.2018.07.005 · Cited by 97 · see citing works
How do eHealth Programs for Adolescents With Depression Work? A Realist Review of Persuasive System Design Components in Internet-Based Psychological Therapies
Wozney, L., Huguet, A., Bennett, K., Radomski, A. D., Hartling, L., Dyson, M., McGrath, P. J., & Newton, A. S. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.7573 · Cited by 93 · see citing works
“A small but significant effect size favoring Mood Helper compared to the treatment as usual control condition was found, and researchers noted that participants using the website more intensely had higher average baseline depression scores [69].”
Influential
An Online Intervention for Co-Occurring Depression and Problematic Alcohol Use in Young People: Primary Outcomes From a Randomized Controlled Trial
Deady, M., Mills, K. L., Teesson, M., & Kay-Lambkin, F. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.5178 · Cited by 105 · see citing works
Evaluating the Efficacy of Internet-Delivered Cognitive Behavioral Therapy Blended With Synchronous Chat Sessions to Treat Adolescent Depression: Randomized Controlled Trial
Topooco, N., Byléhn, S., Nysäter, E. D., Holmlund, J., Lindegaard, J., Johansson, S., Åberg, L., Nordgren, L. B., Zetterqvist, M., & Andersson, G. (2019) · Journal of Medical Internet Research · doi:10.2196/13393 · Cited by 93 · see citing works
Web-Based Interventions for Youth Internalizing Problems: A Systematic Review
Reyes-Portillo, J. A., Mufson, L., Greenhill, L. L., Gould, M. S., Fisher, P. W., Tarlow, N., & Rynn, M. A. (2014) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2014.09.005 · Cited by 88 · see citing works
Development and pilot evaluation of an Internet-facilitated cognitive-behavioral intervention for maternal depression.
Sheeber, L. B., Seeley, J. R., Feil, E. G., Davis, B., Sorensen, E., Kosty, D. B., & Lewinsohn, P. M. (2012) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0028820 · Cited by 81 · see citing works
Artificial intelligence for psychotherapy: a review of the current state and future directions
Beg, M. J., Verma, M., M., V. C. K. M., & Verma, M. K. (2025) · Indian Journal of Psychological Medicine · doi:10.1177/02537176241260819 · Cited by 82 · see citing works
Adherence to e-mental health among youth: Considerations for intervention development and research design
Achilles, M. R., Anderson, M., Li, S., Subotic-Kerry, M., Parker, B., & O’Dea, B. (2020) · Digital Health · doi:10.1177/2055207620926064 · Cited by 77 · see citing works
The use of e‐health applications for anxiety and depression in young people: challenges and solutions
Christensen, H. M., Reynolds, J., & Griffiths, K. M. (2011) · Early Intervention in Psychiatry · doi:10.1111/j.1751-7893.2010.00242.x · Cited by 70 · see citing works
A qualitative exploration of Internet-based treatment for comorbid depression and alcohol misuse
Darvell, M. J., Kavanagh, D. J., & Connolly, J. M. (2015) · Internet Interventions · doi:10.1016/j.invent.2015.03.003 · Cited by 69 · see citing works
Effectiveness of a web-based solution-focused brief chat treatment for depressed adolescents and young adults: randomized controlled trial
Kramer, J., Conijn, B., Oijevaar, P., & Riper, H. (2014) · Journal of Medical Internet Research · doi:10.2196/jmir.3261 · Cited by 69 · see citing works
“But for progression of research, both studies with no-active control conditions and studies with active control conditions are necessary [13].”
It's time for disruptive innovation in psychotherapy
Simon, G. E., & Ludman, E. J. (2009) · The Lancet · doi:10.1016/s0140-6736(09)61415-x · Cited by 65 · see citing works
A systematic review and meta-analysis of Internet-based self-help interventions for mental health among adolescents and college students
Wang, Q., Zhang, W., & An, S.-B. (2023) · Internet Interventions · doi:10.1016/j.invent.2023.100690 · Cited by 51 · see citing works
Preliminary results from a randomized controlled study for an App-Based cognitive behavioral therapy program for depression and anxiety in cancer patients
Ham, K., Chin, S., Suh, Y. J., Rhee, M., Yu, E.-S., Lee, H. J., Kim, J.-H., Kim, S. W., Koh, S.-J., & Chung, K.-M. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.01592 · Cited by 61 · see citing works
Robot-Based Psychotherapy: Concepts Development, State of the Art, and New Directions
David, D. O., Matu, S. A., & David, D. (2014) · International Journal of Cognitive Therapy · doi:10.1521/ijct.2014.7.2.192 · Cited by 58 · see citing works
Use of a Fully Automated Internet-Based Cognitive Behavior Therapy Intervention in a Community Population of Adults With Depression Symptoms: Randomized Controlled Trial
Schure, M. B., Lindow, J. C., Greist, J. H., Nakonezny, P. A., Bailey, S. J., Bryan, W. L., & Byerly, M. (2019) · Journal of Medical Internet Research · doi:10.2196/14754 · Cited by 50 · see citing works
The impact of web-based approaches on psychosocial health in chronic physical and mental health conditions
Paul, C. L., Carey, M. L., Sanson-Fisher, R. W., Houlcroft, L. E., & Turon, H. E. (2013) · Health Education Research · doi:10.1093/her/cyt053 · Cited by 51 · see citing works
Strategies not accompanied by a mental health professional to address anxiety and depression in children and young people: a scoping review of range and a systematic review of effectiveness
Wolpert, M., Dalzell, K., Ullman, R., Garland, L., Cortina, M. A., Hayes, D., Patalay, P., & Law, D. (2018) · The Lancet Psychiatry · doi:10.1016/s2215-0366(18)30465-6 · Cited by 49 · see citing works
Toward the Design of Evidence-Based Mental Health Information Systems for People With Depression: A Systematic Literature Review and Meta-Analysis
Wahle, F., Bollhalder, L., Kowatsch, T., & Fleisch, E. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.7381 · Cited by 48 · see citing works
Effectiveness of Self-guided Tailored Implementation Strategies in Integrating and Embedding Internet-Based Cognitive Behavioral Therapy in Routine Mental Health Care: Results of a Multicenter Stepped-Wedge Cluster Randomized Trial
Vis, C., Schuurmans, J., Aouizerate, B., Craggs, M. A., Batterham, P. J., Bührmann, L., Calear, A. L., Pashoja, A. C., Christensen, H. M., Dozeman, E., et al. (2022) · Journal of Medical Internet Research · doi:10.2196/41532 · Cited by 42 · see citing works
Internet‐Based Psychotherapy for Adult Depression: What About the Mechanisms of Change?
Mogoaşe, C., Cobeanu, O., David, D., Giosan, C., & Szentágotai, A. (2016) · Journal of Clinical Psychology · doi:10.1002/jclp.22326 · Cited by 45 · see citing works
Effectiveness and cost-effectiveness of a guided Internet- and mobile-based intervention for the indicated prevention of major depression in patients with chronic back pain—study protocol of the PROD-BP multicenter pragmatic RCT
Sander, L., Paganini, S., Lin, J., Schlicker, S., Ebert, D. D., Buntrock, C., & Baumeister, H. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1193-6 · Cited by 44 · see citing works
Internet-Based Depression Prevention over the Life Course: A Call for Behavioral Vaccines
Voorhees, B. W. V., Mahoney, N., Mazo, R., Barrera, A. Z., Siemer, C. P., Gladstone, T. R. G., & Muñoz, R. F. (2011) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2010.11.002 · Cited by 42 · see citing works
Exploring the Role of Persuasive Design in Unguided Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety Among Adults: Systematic Review, Meta-analysis, and Meta-regression
McCall, H. C., Hadjistavropoulos, H. D., & Sundström, C. (2021) · Journal of Medical Internet Research · doi:10.2196/26939 · Cited by 39 · see citing works
Exploring the efficacy and acceptability of Internet-delivered cognitive behavioural therapy for young adults with anxiety and depression: An open trial
Johnston, L., Dear, B. F., Gandy, M., Fogliati, V. J., Kayrouz, R., Sheehan, J., Rapee, R. M., & Titov, N. (2014) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867414527524 · Cited by 36 · see citing works
Racial and ethnic differences in risk factors associated with suicidal behavior among young adults in the USA
Lorenzo‐Luaces, L., & Phillips, J. A. (2013) · Ethnicity and Health · doi:10.1080/13557858.2013.846299 · Cited by 36 · see citing works
Internet-delivered treatment: its potential as a low-intensity community intervention for adults with symptoms of depression: protocol for a randomized controlled trial
Richards, D., Timulak, L., Doherty, G., Sharry, J., Colla, A., Joyce, C., & Hayes, C. (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-147 · Cited by 35 · see citing works
The MARIGOLD study: Feasibility and enhancement of an online intervention to improve emotion regulation in people with elevated depressive symptoms
Addington, E. L., Cheung, E. O., Bassett, S. M., Kwok, I., Schuette, S., Shiu, E. W., Yang, D., Cohn, M., Leykin, Y., Saslow, L. R., et al. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.07.049 · Cited by 36 · see citing works
Internet-based cognitive behavior therapy for depression, social anxiety disorder, and panic disorder: Effectiveness and predictors of response in a teaching clinic
Niles, A. N., Axelsson, E., Andersson, E., Hedman‐Lagerlöf, E., Carlbring, P., Andersson, G., Johansson, R., Widén, S., Driessen, J., Santoft, F., et al. (2020) · Behaviour Research and Therapy · doi:10.1016/j.brat.2020.103767 · Cited by 35 · see citing works
Predictors of Response to Web-Based Cognitive Behavioral Therapy With High-Intensity Face-to-Face Therapist Guidance for Depression: A Bayesian Analysis
Høifødt, R. S., Mittner, M., Lillevoll, K. R., Katla, S. K., Kolstrup, N., Eisemann, M. R., Friborg, O., & Waterloo, K. K. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.4351 · Cited by 33 · see citing works
A CBT-based mobile intervention as an adjunct treatment for adolescents with symptoms of depression: a virtual randomized controlled feasibility trial
Kulikov, V. N., Crosthwaite, P. C., Hall, S. A., Flannery, J., Strauss, G., Vierra, E., Koepsell, X., Lake, J. I., & Padmanabhan, A. (2023) · Frontiers in Digital Health · doi:10.3389/fdgth.2023.1062471 · Cited by 33 · see citing works
Heterogeneity of Treatment Effects in Internet- and Mobile-Based Interventions for Depression
Terhorst, Y., Kaiser, T., Brakemeier, E., Moshe, I., Philippi, P., Cuijpers, P. J., Baumeister, H., & Sander, L. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.23241 · Cited by 32 · see citing works
Analysis of syntax and word use to predict successful participation in guided self-help for anxiety and depression.
Zinken, J., Zinken, K., Wilson, J., Butler, L., & Skinner, T. (2010) · Psychiatry Research · doi:10.1016/j.psychres.2010.04.011 · Cited by 31 · see citing works
Smartphone-Based Emotion Recognition Skills Training for Alexithymia—A Randomized Controlled Pilot Study
Lukas, C. A., Trevisi Fuentes, H., & Berking, M. (2019) · Internet Interventions · doi:10.1016/j.invent.2019.100250 · Cited by 27 · see citing works
Involving patients' perspective in the development of an internet- and mobile-based CBT intervention for adolescents with chronic medical conditions: Findings from a qualitative study
Geirhos, A., Lunkenheimer, F., Holl, R. W., Minden, K., Schmitt, A., Temming, S., Baumeister, H., & Domhardt, M. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100383 · Cited by 23 · see citing works
“mood or symptom diary) or automated reminders are key elements for monitoring symptom improvement and should therefore be included (Clarke et al., 2009; Wozney et al., 2017).”
Background
The Acceptability of E-mental Health Services for Children, Adolescents, and Young Adults: A Systematic Search and Review
Struthers, A., Charette, C., Bapuji, S. B., Winters, S., Ye, X., Metge, C., Kreindler, S., Raynard, M., Lemaire, J., Synyshyn, M., et al. (2015) · Canadian Journal of Community Mental Health · doi:10.7870/cjcmh-2015-006 · Cited by 27 · see citing works
Relationship Between Patient Engagement and Depressive Symptoms Among People Living With HIV in a Mobile Health Intervention: Secondary Analysis of a Randomized Controlled Trial
Zeng, Y., Guo, Y., Li, L., Hong, Y. A., Li, Y., Zhu, M., Zeng, C., Zhang, H., Cai, W., Liu, C., et al. (2020) · JMIR mhealth and uhealth · doi:10.2196/20847 · Cited by 25 · see citing works
Systematic review of the information and communication technology features of web- and mobile-based psychoeducational interventions for depression
Zhao, D., Lustria, M. L. A., & Hendrickse, J. (2017) · Patient Education and Counseling · doi:10.1016/j.pec.2017.01.004 · Cited by 24 · see citing works
Supported Internet-Delivered Cognitive Behavior Treatment for Adults with Severe Depressive Symptoms: A Secondary Analysis
Richards, D., Duffy, D. J., Burke, J., Anderson, M., Connell, S., & Timulák, L. (2018) · JMIR Mental Health · doi:10.2196/10204 · Cited by 23 · see citing works
Feasibility and Acceptability of an Online Positive Affect Intervention for Those Living with Comorbid HIV Depression
Bassett, S. M., Cohn, M., Cotten, P. D., Kwok, I., & Moskowitz, J. T. (2019) · AIDS and Behavior · doi:10.1007/s10461-019-02412-z · Cited by 23 · see citing works
Facilitator Contact, Discussion Boards, and Virtual Badges as Adherence Enhancements to a Web-Based, Self-guided, Positive Psychological Intervention for Depression: Randomized Controlled Trial
Moskowitz, J. T., Addington, E. L., Shiu, E. W., Bassett, S. M., Schuette, S., Kwok, I., Freedman, M. E., Leykin, Y., Saslow, L. R., Cohn, M., et al. (2021) · Journal of Medical Internet Research · doi:10.2196/25922 · Cited by 21 · see citing works
Mobile applications for mental health self-care: A scoping review
Ahmed, A., Ali, N., Giannicchi, A., Abd-Alrazaq, A. A., Ahmed, M. A., Aziz, S., & Househ, M. S. (2021) · Computer Methods and Programs in Biomedicine Update · doi:10.1016/j.cmpbup.2021.100041 · Cited by 22 · see citing works
Race, Ethnicity, and Other Cultural Background Factors in Trials of Internet-Based Cognitive Behavioral Therapy for Depression: Systematic Review
Jesús-Romero, R. D., Holder-Dixon, A. R., Buss, J. F., & Lorenzo-Luaces, L. (2023) · Journal of Medical Internet Research · doi:10.2196/50780 · Cited by 36 · see citing works
‘Pesky gNATs’: investigating the feasibility of a novel computerized CBT intervention for adolescents with anxiety and/or depression in a Tier 3 CAMHS setting
Chapman, R., Loades, M., O'Reilly, G., Coyle, D., Patterson, M., & Salkovskis, P. (2016) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x16000222 · Cited by 21 · see citing works
Appropriate Use and Operationalization of Adherence to Digital Cognitive Behavioral Therapy for Depression and Anxiety in Youth: Systematic Review
Li, S. H., Achilles, M. R., Werner‐Seidler, A., Beames, J. R., Subotic-Kerry, M., & O’Dea, B. (2022) · JMIR Mental Health · doi:10.2196/37640 · Cited by 20 · see citing works
An Unguided, Computerized Cognitive Behavioral Therapy Intervention (TreadWill) in a Lower Middle-Income Country: Pragmatic Randomized Controlled Trial
Ghosh, A., Cherian, R. J., Wagle, S., Sharma, P., Kannan, K. R., Bajpai, A., & Gupta, N. (2023) · Journal of Medical Internet Research · doi:10.2196/41005 · Cited by 23 · see citing works
Pilot Randomized Control Trial of an App-Based CBT Program for Reducing Anxiety in Individuals with ASD without Intellectual Disability
Yang, Y. J., & Chung, K. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-022-05617-9 · Cited by 19 · see citing works
Time-Dependent Changes in Depressive Symptoms Among Control Participants in Digital-Based Psychological Intervention Studies: Meta-analysis of Randomized Controlled Trials
Tong, A. C. Y., Ho, F. S., Chu, O. H., & Mak, W. W. S. (2023) · Journal of Medical Internet Research · doi:10.2196/39029 · Cited by 19 · see citing works
Evaluation of a computerized cognitive behavioural therapy programme, <i>MindWise (2.0)</i> , for adults with mild‐to‐moderate depression and anxiety
Collins, S., Byrne, M., Hawe, J., & O'Reilly, G. (2018) · British Journal of Clinical Psychology · doi:10.1111/bjc.12165 · Cited by 15 · see citing works
Digital Mental Health Interventions for the Prevention and Treatment of Social Anxiety Disorder in Children, Adolescents, and Young Adults: Systematic Review and Meta-Analysis of Randomized Controlled Trials
Walder, N., Frey, A., Berger, T., & Schmidt, S. J. (2025) · Journal of Medical Internet Research · doi:10.2196/67067 · Cited by 28 · see citing works
Effectiveness of internet-based self-help interventions for depression in adolescents and young adults: a systematic review and meta-analysis
Ma, Q., Shi, Y., Zhao, W. G., Zhang, H., Tan, D., Ji, C., & Liu, L. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-06046-x · Cited by 15 · see citing works
Balancing Ethics and Opportunities: The Role of AI in Psychotherapy and Counselling
Bloch‐Atefi, A. (2025) · Psychotherapy and Counselling Journal of Australia · doi:10.59158/001c.129884 · Cited by 15 · see citing works
Client Contact in Self-Help Therapy for Anxiety and Depression: Necessary But Can Take a Variety of Forms Beside Therapist Contact
Talbot, F. (2012) · Behaviour Change · doi:10.1017/bec.2012.4 · Cited by 15 · see citing works
Psicoterapia vía Internet: aplicación de un programa de intervención cognitivo-conductual para pacientes con depresión
Flores Plata, L. A., Cárdenas López, G., Durán Baca, X., & De la Rosa Gómez, A. (2014) · Psicología Iberoamericana · doi:10.48102/pi.v22i1.139 · Cited by 14 · see citing works
Engagement With a Mobile Phone–Based Life Skills Intervention for Adolescents and Its Association With Participant Characteristics and Outcomes: Tree-Based Analysis
Castro, R. P., Haug, S., Debelak, R., Jakob, R., Kowatsch, T., & Schaub, M. P. (2021) · Journal of Medical Internet Research · doi:10.2196/28638 · Cited by 14 · see citing works
Out & Online; effectiveness of a tailored online multi-symptom mental health and wellbeing program for same-sex attracted young adults: study protocol for a randomised controlled trial
Abbott, J.-A., Klein, B., McLaren, S., Austin, D., Molloy, M., Meyer, D., & McLeod, B. (2014) · Trials · doi:10.1186/1745-6215-15-504 · Cited by 15 · see citing works
Effectiveness and moderators of individual cognitive behavioral therapy versus treatment as usual in clinically depressed adolescents: a randomized controlled trial
Stikkelbroek, Y. A. J., Vink, G., Nauta, M. H., Bottelier, M. A., Vet, L. J. J., Lont, C., van Baar, A. L., & Bodden, D. H. M. (2020) · Scientific Reports · doi:10.1038/s41598-020-71160-1 · Cited by 14 · see citing works
The Effectiveness of Internet-Based Cognitive Behavioral Therapy for the Treatment of Depression in a Large Real-World Primary Care Practice: A Randomized Trial
Stuart, R., Fischer, H. J., Leitzke, A., Becker, D., Saheba, N., & Coleman, K. J. (2022) · The Permanente Journal · doi:10.7812/tpp/21.183 · Cited by 13 · see citing works
Are Digitally Delivered Psychological Interventions for Depression the Way Forward? A Review
Stefanopoulou, E., Lewis, D., Taylor, M., Broscombe, J., Ahmad, J., & Larkin, J. (2018) · Psychiatric Quarterly · doi:10.1007/s11126-018-9576-5 · Cited by 11 · see citing works
Understanding the role of adjunctive nonpharmacological therapies in management of the multiple pathways to depression
Velehorschi, C., Bleau, P., Vermani, M., Furtado, M., & Klassen, L. J. (2014) · Psychiatry Research · doi:10.1016/s0165-1781(14)70004-6 · Cited by 11 · see citing works

A randomized controlled trial of an internet-delivered treatment: Its potential as a low-intensity community intervention for adults with symptoms of depression
Richards, D., Timulak, L., O'Brien, E., Hayes, C., Vigano, N., Sharry, J., & Doherty, G. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.10.005 · Cited by 109 · see citing works
Evaluating the effectiveness and efficacy of unguided internet-based self-help intervention for the prevention of depression: A randomized controlled trial.
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Internet-based self-help for depression: randomised controlled trial
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Self-citation
Effects of a Psychological Internet Intervention in the Treatment of Mild to Moderate Depressive Symptoms: Results of the EVIDENT Study, a Randomized Controlled Trial
Klein, J. P., Berger, T., Schröder, J., Späth, C., Meyer, B., Caspar, F., Lutz, W., Arndt, A., Greiner, W., Gräfe, V., et al. (2016) · doi:10.7892/boris.85270

Authors: Clarke, G., Kelleher, C., Hornbrook, M., DeBar, L., Dickerson, J., & Gullion, C.
Affiliations: Kaiser Permanente (US)
ORCID: DeBar, Lynn
Dickerson, John
Venue: Cognitive Behaviour Therapy
Publisher: Informa UK Limited
Published: 2009-05-13
Volume: 38
Issue: 4
Pages: 222-234
ISSN: 1650-6073 (ISSN-L)
1651-2316
DOI: 10.1080/16506070802675353
PMC: PMC2829099
OpenAlex: W2017824397
Cited by: 154
References: 47
Citations by year: 2026: 5 · 2025: 11 · 2024: 7 · 2023: 8 · 2022: 9 · 2021: 10 · 2020: 6 · 2019: 9 · 2018: 8 · 2017: 8 · 2016: 7 · 2015: 11 · 2014: 19 · 2013: 9 · 2012: 9
FWCI: 10.41
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Cognitive Behaviour Therapy (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Mental Health (R24MH061422)
Topics: Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords: online intervention, cognitive behavioral therapy, self-help, depression, young adults, depressive symptoms, medication adherence, website usage, gender differences, dissemination, low-cost interventions
MeSH terms: Depressive Disorder, Female, Humans, Male, Patient Acceptance of Health Care, Self-Help Groups, Cognitive Behavioral Therapy, Internet, Young Adult

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Randomized Effectiveness Trial of an Internet, Pure Self-Help, Cognitive Behavioral Intervention for Depressive Symptoms in Young Adults

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