Generic placeholder image

Current Psychiatry Research and Reviews


ISSN (Print): 2666-0822
ISSN (Online): 2666-0830

Systematic Review Article

Cognitive Behavioral Therapy Online for Adult Depression: A 10 Year Systematic Literature Review

Author(s): Vasileios Stavropoulos*, Sandra Cokorilo, Alexa Kambouropoulos, James Collard and Rapson Gomez

Volume 15, Issue 3, 2019

Page: [152 - 170] Pages: 19

DOI: 10.2174/1573400515666190628125914

Price: $65


Background: Acceptance, adherence and efficacy aspects of Cognitive Behavioural Therapy (CBT) online have invited significant interest, especially in the context of “stepped care” models, which advocate progressive stages of intervention in addressing depression. Objectives: The current work aspires to comprehensively identify critical factors linked to the applicability of online CBT, in order to inform clinical practices and future research targeting depressive behaviors in early and middle adulthood.

Methods: To serve these goals: a) the PRISMA systematic literature perspective is followed; b) a systematic search of online databases between 2008-2018 was undertaken and; c) a compositehybrid model, resulting from the integration of broadly adopted conceptualizations from the areas of psychological treatment and internet use behaviors, was combined with an interpretative phenomenological analysis perspective to organize the findings.

Results: In total, 28 studies were included in the present review. Factors defining the efficacy, adherence and acceptability of online CBT targeting depression (during early and middle adulthood) were classified into parameters related to the individual receiver, the context and the CBT activities involved.

Conclusion: Despite the cautiousness warranted by the limitations, as well as the diverge methodology of the reviewed studies, findings appear to favour the provision of brief, therapist supported, online CBT interventions, especially in addressing moderate depression during early and middle adulthood.

Keywords: Online CBT, depression, systematic literature review, PRISMA, effectiveness, depression.

Graphical Abstract
Fleming T, Bavin L, Lucassen M, Stasiak K, Hopkins S, Merry S. Beyond the trial: systematic review of real-world uptake and engagement with digital self-help interventions for depression, low mood, or anxiety. J Med Internet Res 2018; 20(6)e199
Nguyen MH, Smets EMA, Bol N, Loos EF, Van Weert JCM. How tailoring the mode of information presentation influences younger and older adults’ satisfaction with health websites. J Health Commun 2018; 23(2): 170-80.
Hannaford A, Lipshie-Williams M, Starrels JL, et al. The use of online posts to identify barriers to and facilitators of HIV pre-exposure prophylaxis (PrEP) among men who have sex with men: a comparison to a systematic review of the peer-reviewed literature. AIDS Behav 2018; 22(4): 1080-95.
Roddy MK, Georgia EJ, Doss BD. Couples with intimate partner violence seeking relationship help: associations and implications for self-help and online interventions. Fam Process 2018; 57(2): 293-307.
Orman J, O’Dea B. e-Therapy in primary care mental health. Aus J Gen Pract 2018; 47(4): 168-72.
Richards D. Features and benefits of online counselling: Trinity College online mental health community. Br J Guid Counc 2009; 37(3): 231-42.
van Straten A, Seekles W, van ’t Veer-Tazelaar NJ, Beekman AT, Cuijpers P. Stepped care for depression in primary care: what should be offered and how? Med J Aust 2010; 192(11)(Suppl.): S36-9.
Härter M, Heddaeus D, Steinmann M, et al. Collaborative and stepped care for depression: development of a model project within the Hamburg Network for Mental Health. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 58(4-5): 420-9.
Andersson G, Cuijpers P. Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cogn Behav Ther 2009; 38(4): 196-205.
Cuijpers P, Donker T, van Straten A, Li J, Andersson G. Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychol Med: J Res Psychiatr Allied Sci 2010; 40(12): 1943-57.
Johansson R, Andersson G. Internet-based psychological treatments for depression. Expert Rev Neurother 2012; 12(7): 861-9.
Williams AD, Andrews G. The effectiveness of internet cognitive behavioural therapy (iCBT) for depression in primary care: a quality assurance study. PLoS One 2013; 8(2)e57447
Belsky J. The differential susceptibility hypothesis: sensitivity to the environment for better and for worse. JAMA Pediatr 2016; 170(4): 321-2.
Douglas AC, Mills JE, Niang M, et al. Internet addiction: meta-synthesis of qualitative research for the decade 1996-2006. Comput Human Behav 2008; 24(6): 3027-44.
Stavropoulos V, Kuss D, Griffiths M, Motti-Stefanidi F. A longitudinal study of adolescent internet addiction: the role of conscientiousness and classroom hostility. J Adolesc Res 2016; 31(4): 442-73.
Monroe SM, Simons AD. Diathesis-stress theories in the context of life stress research: implications for the depressive disorders. Psychol Bull 1991; 110(3): 406.
Colodro-Conde L, Couvy-Duchesne B, Zhu G, et al. A direct test of the diathesis-stress model for depression. Mol Psychiatry 2018; 23(7): 1590.
Rozental A, Boettcher J, Andersson G, Schmidt B, Carlbring P. Negative effects of internet interventions: a qualitative content analysis of patients’ experiences with treatments delivered online. Cogn Behav Ther 2015; 44(3): 223-36.
Stavropoulos V, Griffiths MD, Burleigh TL, Kuss DJ, Doh YY, Gomez R. Flow on the internet: a longitudinal study of internet addiction symptoms during adolescence. Behav Inf Technol 2018; 37(2): 159-72.
Stavropoulos V, Burleigh TL, Beard CL, Gomez R, Griffiths MD. Being there: a preliminary study examining the role of presence in internet gaming disorder. Int J Ment Health Addict 2018; 17(4): 1-11.
Lépine JP, Briley M. The increasing burden of depression. Neuropsychiatr Dis Treat 2011; 7(Suppl. 1): 3-7.
Hunsaker A, Hargittai E. A review of internet use among older adults. New Media Soc 2018; 20(10): 3937-54.
Anderson EL, Steen E, Stavropoulos V. Internet use and problematic internet use: a systematic review of longitudinal research trends in adolescence and emergent adulthood. Int J Adolesc Youth 2017; 22(4): 430-54.
Mazur E, Signorella ML, Hough M. The Internet behavior of older adults in advanced methodologies and technologies in media and communications. In: Khosrow-Pour MDBA, Ed Advanced methodologies and technologies in media and communications. Pennsylvania: IGI Global 2019; pp. 405-16.
Besser A, Priel B. Interpersonal relatedness and self-definition in late adulthood depression: personality predispositions, and protective factors. Soc Behav Personal 2005; 33(4): 351-82.
King DA, Heisel MJ, Lyness JM. Assessment and psychological treatment of depression in older adults with terminal or life‐threatening illness. Clin Psychol Sci Pract 2005; 12(3): 339-53.
Alcaro A, Panksepp J. The seeking mind: primal neuro-affective substrates for appetitive incentive states and their pathological dynamics in addictions and depression. Neurosci Biobehav Rev 2011; 35(9): 1805-20.
Smith JA, Osborn M. Interpretative phenomenological analysis. In: Breakwell GM, Ed Doing social psychology research. Blackwell Publishing: Malden 2004; pp. 229-54.
Lüdtke T, Pult LK, Schröder J, Moritz S, Bücker L. A randomized controlled trial on a smartphone self-help application (be good to yourself) to reduce depressive symptoms. Psychiatry Res 2018; 269: 753-62.
Morgan C, Mason E, Newby JM, et al. The effectiveness of unguided internet cognitive behavioural therapy for mixed anxiety and depression. Internet Interv 2017; 10: 47-53.
Wagner B, Horn AB, Maercker A. Internet-based versus face-to-face cognitive-behavioral intervention for depression: a randomized controlled non-inferiority trial. J Affect Disord 2014; 152-154: 113-21.
Warmerdam L, van Straten A, Jongsma J, Twisk J, Cuijpers P. Online cognitive behavioral therapy and problem-solving therapy for depressive symptoms: exploring mechanisms of change. J Behav Ther Exp Psychiatry 2010; 41(1): 64-70.
Sethi S. Treating youth depression and anxiety: a randomised controlled trial: examining the efficacy of computerised versus face-to-face. Cognitive Behaviour Ther Aust Psychol 2013; 48(4): 249-57.
Fitzpatrick KK, Darcy A, Vierhile M. Delivering cognitive behavior therapy to young adults with symptoms of depression and anxiety using a fully automated conversational agent (woebot): a randomized controlled trial. JMIR Ment Health 2017; 6; 4(2): e19.
Titov N, Dear BF, Ali S, et al. Clinical and cost-effectiveness of therapist-guided internet-delivered cognitive behavior therapy for older adults with symptoms of depression: a randomized controlled trial. Behav Ther 2015; 46(2): 193-205.
Dear BF, Zou J, Titov N, et al. Internet-delivered cognitive behavioural therapy for depression: a feasibility open trial for older adults. Aust N Z J Psychiatry 2013; 47(2): 169-76.
Dear BF, Zou JB, Ali S, et al. Examining self-guided internet-delivered cognitive behavior therapy for older adults with symptoms of anxiety and depression: Two feasibility open trials. Internet Interv 2015; 2(1): 17-23.
Knowles SE, Lovell K, Bower P, Gilbody S, Littlewood E, Lester H. Patient experience of computerised therapy for depression in primary care. BMJ Open 2015; 5(11)e008581
Triandis HC. Individualism and collectivism. London: Routledge 2018.
Stavropoulos V, Beard C, Griffiths MD, Buleigh T, Gomez R, Pontes HM. Measurement invariance of the internet gaming disorder scale-short-form (IGDS9-SF) between Australia, the USA, and the UK. Int J Ment Health Addict 2018; 16(2): 377-92.
Duarté-Vélez Y, Bernal G, Bonilla K. Culturally adapted cognitive-behavior therapy: integrating sexual, spiritual, and family identities in an evidence-based treatment of a depressed Latino adolescent. J Clin Psychol 2010; 66(8): 895-906.
Choi I, Zou J, Titov N, et al. Culturally attuned Internet treatment for depression amongst Chinese Australians: a randomised controlled trial. J Affect Disord 2012; 136(3): 459-68.
Kayrouz R, Dear BF, Karin E, Fogliati VJ, Titov N. A pilot study of a clinician-guided internet-delivered cognitive behavioural therapy for anxiety and depression among Arabs in Australia, presented in both English and Arabic languages. Internet Interv 2016; 5: 5-11.
Kayrouz R, Dear BF, Johnston L, et al. A feasibility open trial of guided Internet-delivered cognitive behavioural therapy for anxiety and depression amongst Arab Australians. Internet Interv 2015; 2(1): 32-8.
Berry JW. Conceptual approaches to acculturation. Washington, DC: American Psychological Association 2003.
Berger T, Hämmerli K, Gubser N, Andersson G, Caspar F. Internet-based treatment of depression: a randomized controlled trial comparing guided with unguided self-help. Cogn Behav Ther 2011; 40(4): 251-66.
Moritz S, Schilling L, Hauschildt M, Schröder J, Treszl A. A randomized controlled trial of internet-based therapy in depression. Behav Res Ther 2012; 50(7-8): 513-21.
Sunderland M, Wong N, Hilvert-Bruce Z, Andrews G. Investigating trajectories of change in psychological distress amongst patients with depression and generalised anxiety disorder treated with internet cognitive behavioural therapy. Behav Res Ther 2012; 50(6): 374-80.
Donker T, Bennett K, Bennett A, et al. Internet-delivered interpersonal psychotherapy versus internet-delivered cognitive behavioral therapy for adults with depressive symptoms: randomized controlled noninferiority trial. J Med Internet Res 2013; 15(5)e82
Ruwaard J, Lange A, Schrieken B, Dolan CV, Emmelkamp P. The effectiveness of online cognitive behavioral treatment in routine clinical practice. PLoS One 2012; 7(7)e40089
Newby JM, Mackenzie A, Williams AD, et al. Internet cognitive behavioural therapy for mixed anxiety and depression: a randomized controlled trial and evidence of effectiveness in primary care. Psychol Med 2013; 43(12): 2635-48.
Watts S, Mackenzie A, Thomas C, et al. CBT for depression: a pilot RCT comparing mobile phone vs computer. BMC Psychiatry 2013; 13: 49.
Mullin A, Dear BF, Karin E, et al. The UniWellbeing course: a randomised controlled trial of a transdiagnostic internet delivered cognitive behavioural therapy (CBT) programme for university students with symptoms of anxiety and depression. Internet Interv 2015; 2(2): 128-36.
Titov N, Dear BF, Schwencke G, et al. Transdiagnostic internet treatment for anxiety and depression: a randomised controlled trial. Behav Res Ther 2011; 49(8): 441-52.
Dear BF, Titov N, Schwencke G, et al. An open trial of a brief transdiagnostic internet treatment for anxiety and depression. Behav Res Ther 2011; 49(12): 830-7.
Titov N, Andrews G, Davies M, McIntyre K, Robinson E, Solley K. Internet treatment for depression: a randomized controlled trial comparing clinician vs technician assistance. PLoS One 2010; 5(6)e10939
Titov N, Dear BF, Staples LG, et al. Disorder-specific versus transdiagnostic and clinician-guided versus self-guided treatment for major depressive disorder and comorbid anxiety disorders: a randomized controlled trial. J Anxiety Disord 2015; 35: 88-102.
Richards D, Timulak L, O’Brien E, et al. 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.

Rights & Permissions Print Export Cite as
© 2022 Bentham Science Publishers | Privacy Policy