Internet-delivered cognitive behavioural therapy in the treatment of psychiatric illness

The implementation of Internet-delivered CBT also poses several clinical challenges. The first is that of blending this form of CBT with other therapies, such as pharmacotherapy or in-person support. Further studies are needed to identify the most effective combination of Internet-delivered CBT and other treatments. The second challenge relates to clinical implementation. The number of physicians available for guided Internet-delivered CBT is limited. However, a recent RCT on generalized anxiety disorder compared the efficacy of guidance by clinicians and nonpsychologist technicians.69 Patients were divided into three groups: clinician-guided Internet-delivered CBT, technician-guided Internet-delivered CBT and waitlisted controls. The two Internet-delivered CBT groups had access to the Worry program (six modules, 10 weeks) and were evaluated before and immediately after treatment and at threemonth follow-up. The technician-guided and clinician-guided Internet-delivered CBT groups were similar in terms of adherence (80% v. 74%) and outcomes (Penn State Worry Questionnaire pre-treatment to follow-up effect size 0.97 v. 1.42; Generalized Anxiety Disorder Seven-Item effect size 1.61 v. 1.48). These data showed that a modestly trained individual with no prior counselling qualifications could guide Internet-delivered CBT, with adherence and outcomes similar to those achieved with clinician guidance, indicating that well-trained assistants may be used to supplement clinicians. The third challenge is scale-up. Several large-scale government rollouts have supported Internet-delivered CBT as a feasible national health care option. The e-Mental Health Alliance in Australia has outlined its own challenges for scaling up Internet-delivered CBT, specifically increasing awareness of available services and optimizing the programs to increase adherence and maximize outcomes.42 These factors should be considered in future large-scale investigations. Internet-delivered CBT for anxiety has been evaluated in numerous RCTs and has thus been the subject of several meta-analyses. A 2009 meta-analysis evaluated 19 Internet- or computer-based CBT trials (n = 1167) for depression and anxiety.8 The length of treatment and post-treatment evaluation times varied among the studies included. The measures evaluated also differed substantially, but could be broadly classified into five categories: depression, anxiety, general distress, dysfunctional thinking, and functioning or quality of