Internet-Delivered Cognitive Behavior Therapy as a Prequel to Face-To-Face Therapy for Depression and Anxiety: A Naturalistic Observation
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a stepped care model treating individuals with depression and anxiety disorders. Internet-delivered cognitive behavioural therapy (iCBT) is routinely offered to individuals with mild to moderate symptoms, but its applicability to individuals with severe clinical symptoms and requiring a high-intensity intervention is relatively unknown. The current study sought to investigate the potential impacts of using iCBT as a prequel for patients requiring high-intensity treatment (HIT; face-to-face) for depression and anxiety in IAPT. Methods: The study utilised an open study design. 124 participants who were on a waiting list for high-intensity, face-to-face psychological treatment, were offered iCBT. Psychometric data on symptoms of depression, anxiety and functioning were collected from participants before starting and on finishing iCBT and at the point of service exit. Therapeutic alliance data was collected from patients and clinicians during treatment. Patient pathway data, such as number of treatment sessions and time in treatment, was also collected and incorporated into the analysis. Results: Significant reductions across primary outcome measures of depression and anxiety, as well as improved functioning, were observed from baseline to iCBT treatment exit, and from iCBT exit to service exit. Analysis of the therapeutic alliance data for patients and clinicians illustrated differences in outcome for those who dropped out and those who completed treatment. Discussion: This study illustrates the potential for using iCBT as a prequel to high intensity therapy for depre¬ssion and anxiety disorders and is the first of its kind to do so within IAPT stepped-care. The results show that iCBT is a valuable option reducing waiting times and enhancing clinical efficiency. The study contributes to the well-established evidence on online psychological treatments worldwide, but further clinical and service development research is necessary to scale these treatments appropriately.
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Digital mental health treatments have begun to be integrated into health care systems in Europe and Australia.
“Although DMHTs have begun to be integrated into health care systems in Europe and Australia (16–20), they have not been well integrated into the U.S. health care system.”
From Banbury forum consensus statement on the path forward for digital mental health treatment (2021) · cites this paper as [19]
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References 73 · Cited by 49
Research works printed but not linked: 4
- [13]National Institute for Health and Care Excellence The treatment and management of depression in adults. London, UK: NICE (2009). 35977056
- [37]Richards D Duffy D Burke J Anderson M Connell S Timulak L Supported internet-delivered cognitive behavior treatment for adults with severe depressive symptoms: a secondary analysis. JMIR Ment Heal (2018) 5(4): e10204. 10.2196/10204 PMC6231851 30279154 · DOI
- [41]Richards D Timulak L O’Brien E Hayes C Vigano N Sharry J A randomized controlled trial of an internet-delivered treatment: its potential as a low-intensity community intervention for adults with symptoms of depression. Behav Res Ther (2015) 75: 20– 31. 10.1016/j.brat.2015.10.005 26523885 · DOI · Paper page
- [72]Richards D Murphy T Viganó N Timulak L Doherty G Sharry J Acceptability, satisfaction and perceived efficacy of “Space from Depression” an internet-delivered treatment for depression. Internet Interv (2016) 5: 12– 22. 10.1016/j.invent.2016.06.007 30135802 PMC6096253 · DOI · Paper page
- Authors
- Duffy, D., Enrique, A., Connell, S., Connolly, C., & Richards, D.
- Affiliations
- Trinity College Dublin (IE)
- SilverCloud (Ireland) (IE)
- Corresponding author
- Duffy, Daniel
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2020-01-09
- Volume
- 10
- Pages
- 902-902
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC6962244
- OpenAlex
- W2999681456
- Cited by
- 49
- References
- 73
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 12 · 2023: 12 · 2022: 9 · 2021: 5 · 2020: 4
- FWCI
- 6.78
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Arrow@dit (Dublin Institute of Technology) (submittedVersion, cc-by-nc-sa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Trinity's Access to Research Output (TARA) (Trinity College Dublin) (submittedVersion)
- Lenus, The Irish Health Repository (Dr Steevens Hospital Library) (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 › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- internet-based cognitive behavioral therapy, depression, anxiety disorders, stepped care, waiting lists, therapeutic relationship, treatment discontinuation, clinical efficiency, waiting time
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