Internet-delivered cognitive behavioural therapy (CBT) combined with clinical care has been shown to benefit people with depression, anxiety and emotional distress from illness, according to an evidence-based review in CMAJ (Canadian Medical Association Journal).

"In the age of Google, this psychological intervention is empowering, clinically efficient and consistent with the way that, increasingly, patients interact with health care," write Dr. David Gratzer, attending psychiatrist, and Faiza Khalid-Khan, social worker and Director of Mental Health, The Scarborough Hospital, Toronto, Ontario.

The review looks at recent, high quality studies and the growing body of literature on smartphone and tablet applications for mental illness. Some studies showed that patients who used Internet-delivered CBT had better outcomes than placebo controls and equal or better outcomes than those with traditional in-person cognitive behaviour therapy. These outcomes were seen in patients with depression, as well as those with physical illnesses such as cancer and multiple sclerosis.

"There is as much evidence for cognitive behavioural therapy as there is for medications to treat mild and moderate depression, as well as evidence that they have a synergistic effect," says Dr. Gratzer. "In other words, for the hundreds of thousands of Canadians struggling with depression, Internet-assisted cognitive behavioural therapy offers a cost-effective and empowering way of accessing an important treatment."

Patients may participate in online therapy whenever and wherever they like, which provides the anonymity that may help depressed or shy patients who are reluctant to speak to a health care professional.

"[Internet-delivered] CBT has two principal advantages: patient empowerment and increased clinical efficiency," write the authors. "It allows clinicians to treat more patients effectively in less time. Even with intermittent therapist support, it is less time-consuming and requires fewer resources overall than traditional CBT."

However, this therapy is not recommended for people with severe mental illness.

Potential disadvantages to Internet-delivered CBT include the lack of a real human relationship, which prevents direct patient monitoring and the ability to tailor the therapy to the patient's progress; low adherence by patients and lack of home access to the Internet.

"There are compelling data to support the integration of Internet-delivered CBT into clinical psychiatric care. These data indicate that this form of CBT offers numerous benefits to both the patient and the practitioner. It allows treatment of patients with many different psychiatric conditions, at lower cost than traditional CBT," the authors conclude.

They note that more research is needed to determine the ideal demographic for this therapy and that there are challenges in integrating it into clinical practice.