Online cognitive behavioral therapy (CBT) life skills program for depression: pilot randomized controlled trial
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Abstract
Background: Depression is a common mental health problem with significant personal and social consequences. Studies have suggested that cognitive behavioral therapy (CBT) is an effective treatment for depression and anxiety when delivered one-to-one by an expert practitioner, but access to this talking therapy is often limited, and waiting lists can be long. However, a range of low-intensity interventions that can increase access to services are available including guided CBT self-help materials delivered via books, classes, and online packages. Objective: This project aimed to pilot a randomized controlled trial (RCT) of an online CBT-based life skills course with community-based individuals experiencing depression. Methods: Individuals with symptoms of depression were recruited directly from the community via newspaper advertisements. Participants were remotely randomized to receive either immediate access (IA) or delayed access (DA) to a research version of the Living Life to the Full online CBT-based life skills package (3rd edition) with telephone support provided by nonspecialist, charity-based workers while they used the online intervention. The primary end point was at 3 months postrandomization, at which point, the DA group were offered the intervention. Levels of depression, anxiety, social functioning, and satisfaction were assessed. Results: There were effective recruitment, randomization, and uptake, with 19 IA and 17 DA control participants entering the pilot study via newspaper advertisements and 13 of the 19 participants taking up the intervention. Overall, 72% (26/36) were not currently under the care of their general practitioner. The online package was acceptable to participants; the mean satisfaction score on the Client Satisfaction Questionnaire was 21 out of 32 (SD 8.89). At 3 months, data collection was achieved from 78% (28/36) of the participants. The efficacy and retention data were used for a power calculation indicating that 72 participants in total will be required for a future substantive RCT. Conclusions: The research design successfully tested the recruitment, data collection, and intervention delivery. The pilot study has provided data for the required sample size for the full RCT. Trial Registration: ISRCTN registry ISRCTN12890709; https://doi.org/10.1186/ISRCTN12890709 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-016-1336-y
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NICE guidelines recommend bibliotherapy at Step 2 of the stepped care model for individuals with mild to moderate depressive symptoms.
“According to the National Institute for Health and Care Excellence (NICE) guidelines, bibliotherapy is recommended at Step 2 of the stepped care model for individuals with mild to moderate depressive symptoms.”
From Recent developments in bibliotherapy for adolescent depression (2025) · cites this paper as [59]
The Introduction > Background (page unavailable) says NICE guidelines use a stepped-care model and place bibliotherapy among Step 2 low-intensity interventions. It does not specify that this recommendation is for individuals with mild to moderate depressive symptoms; it says treatment choice takes severity and other factors into account. (LLM, conf=0.83)
Experimental — accuracy not yet measuredBibliotherapy at Step 2 is typically implemented as CBT-informed self-help books and grouped with iCBT and group CBT as part of early psychological support strategies.
“It is typically implemented in the form of CBT-informed self-help books and is grouped with internet-based CBT (iCBT) and group CBT as part of early psychological support strategies (59).”
From Recent developments in bibliotherapy for adolescent depression (2025) · cites this paper as [59]
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Cites
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Self-citationLong-term effects of internet-supported cognitive behaviour therapy
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Cited by
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Recent developments in bibliotherapy for adolescent depression
Liao, F., Liang, J., Zhang, M., Liang, W., Zhang, C., & Yun, X. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1681462 · Cited by 4 · see citing works
- Authors
- Williams, C., McClay, C.-A., Martinez, R., Morrison, J., Haig, C., Jones, R., & Farrand, P.
- Affiliations
- University of Glasgow (GB)
- National Health Service (GB)
- University of Plymouth (GB)
- University of Exeter (GB)
- Corresponding author
- Williams, Christopher
- ORCID
- Venue
- JMIR Formative Research
- Publisher
- JMIR Publications Inc.
- Published
- 2022-02-17
- Volume
- 6
- Issue
- 2
- Pages
- e30489
- ISSN
- 2561-326X (ISSN-L)
- PMC
- PMC8895278
- OpenAlex
- W3214925962
- Cited by
- 3
- References
- 5
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 1
- FWCI
- 0.45
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Formative Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- 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
- depression, internet-based cognitive behavioral therapy, life skills training, telephone support, community-based recruitment, low-intensity intervention, access to mental health care, treatment acceptability, client satisfaction, social functioning, anxiety
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