The Effectiveness and Acceptability of Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety in Routine Clinical Care

Abstract: Evidence-based psychological interventions delivered via the internet and mobile technologies (Digital Mental Health) hold the promise of reducing barriers to care, including difficulties accessing treatment because of distance, cost, work and family commitments, and limited provider capacity. Such barriers represent a particular challenge for individuals with depression and anxiety, that tend to co-occur and to recur following treatment cessation, and which are among the most common and burdensome illnesses worldwide. Numerous randomized controlled trials have shown that internet-delivered cognitive behavioral therapy (ICBT) for depression and anxiety is highly effective in reducing the severity and impact of symptoms and improving overall functioning when compared to no-treatment in individuals recruited online. However, important knowledge gaps remain about the acceptability and effectiveness of ICBT when delivered in routine psychiatric care settings. Bridging these knowledge gaps is especially important now as ICBT is being disseminated at a rapid pace in Sweden. The current program of research was carried out with the purpose of investigating the usefulness, acceptability, and effectiveness of ICBT when delivered in a routine psychiatric care setting to adults. Study I was a naturalistic evaluation of the sustained effectiveness of treatment for depression in a psychiatric out-patient setting and examination of psychosocial and clinical predictors of symptom recurrence and relapse to a depression diagnosis. Study II was a randomized waitlist-controlled trial evaluating the acceptability and effectiveness of an 8-week ICBT program for depression delivered in a routine psychiatric setting. Study III was a qualitative study that sought to identify why patients with mixed symptoms of generalized anxiety disorder (GAD) and depression had non-adhered to an ICBT program for GAD. Overall, the findings indicate that ICBT for depression delivered in a routine outpatient psychiatric care setting is acceptable and effective in reducing depressive symptoms as well as mitigating anxiety. However, the study also highlights challenges related to treatment adherence and the need for more effective interventions to prevent relapse and recurrence in psychiatric depression treatment. Further research and improvements in ICBT delivery are warranted to address these issues and enhance mental health care outcomes in such settings.