Does iCBT work? | Medical News Bulletin

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Looking for information on iCBT? You are in the right place!

Scenario: You’ve been given a referral for internet-based cognitive behavioural therapy instead of an in-person appointment with a therapist and you have questions. We get it! It’s not what you were expecting and you might be feeling unsure if it works or cautious about what happens next. 

We are here to walk you through the evidence that shows iCBT is effective in treating mild to moderate depression, symptoms of anxiety and more. Make informed decisions about your care, knowledge is power!

In this article we will explain:

What is Cognitive Behavioural Therapy?

Cognitive Behavioural Therapy (CBT) is a personalized, goal-oriented, structured, hands-on therapy approach where the therapist and patient work together to identify and adjust unhelpful thinking or behavioural patterns. Dr. Aaron Becks  developed CBT in the 1960s, with the core idea being that the way people interpret situations influences how they feel and act. He theorized that changing unhelpful patterns of thinking and behaviour can lead to improvements in mood and day-to-day life. Extensive research shows that CBT is effective for a variety of medical conditions such as pain, depression, schizophrenia, anxiety, eating disorders, substance abuse, attention deficit hyperactivity disorder (ADHD) and bipolar disorder.1

What Is internet-based Cognitive Behavioural Therapy (iCBT)?

Internet-based cognitive behavioural therapy (iCBT) is CBT delivered through an online platform rather than through traditional in-person therapy sessions. The therapeutic model does not change and the principles and goals of CBT are the same. Instead of meeting a therapist weekly in an office, people trying iCBT typically use:

  • A secure website or application
  • Structured lessons or modules released over time
  • Written explanations, videos or interactive content
  • Exercises and homework tasks
  • Tools for tracking mood, sleep or any associated symptoms

Some iCBT programs include regular support from a trained therapist, while others are fully self-guided. Sometimes, people mistakenly assume that iCBT is ‘just an app’ or ‘self-help’. In fact, iCBT programs are thoughtfully developed by clinical researchers and use the same principles as face-to-face CBT.

Who is iCBT for?

iCBT is for everybody, but some people might find it especially helpful:

People With Mild to Moderate Depression

One of the largest bodies of evidence for iCBT comes from studies of people with mild to moderate depressive symptoms. In a 2024 meta-analysis of 124 randomized controlled trials, both guided and unguided iCBT were associated with significant improvements in depressive symptoms compared with control conditions.2 This review, published in the well respected medical journal Clinical Psychology Review, reanalysed the data from trials with a combined number of more than 45,000 participants between 2004 and 2024. The researchers found that for mild to moderate depression, iCBT was consistently superior to treatment as usual or no therapy. People who used iCBT were more likely to feel better a year later. They also had a lower chance of relapse than people who didn’t have therapy and their odds of ‘remission’ or no longer meeting the criteria for depression were very good. The team also found that iCBT for people with mild to moderate depression was just as good as in person CBT. This means that iCBT is a useful option that works for adults experiencing depressive symptoms that interfere with daily life but are not severe enough to need urgent crisis intervention or intensive psychiatric care.

Adults With Anxiety Disorders

iCBT can help people with anxiety disorders, including generalized anxiety disorder (GAD), panic disorder and social anxiety. In multiple randomized controlled trials, adults receiving guided iCBT showed significant reductions in anxiety symptoms compared with people on waiting lists or usual care and improvements have been reported for conditions like generalized and social anxiety.3 Importantly, in the 2024 Clinical Psychology Review article, the authors concluded that iCBT actually works better than face-to-face CBT!2 

People Who Can’t Go to Medical Office Appointments

If your living situation means you need help to leave home or you don’t have access to transport to get to an in-person appointment, iCBT can be a lifeline. Compared to people on waiting lists for face-to-face treatment, people who use iCBT show significant improvements in their symptoms of depression, insomnia, obsessive-compulsive disorder, eating disorders and anxiety disorders. Studies that focused on older adults living in care homes and unable to travel to appointments showed that iCBT helped residents suffering with a range of disorders. In particular, studies have shown iCBT helps to reduce depressive symptoms in older adults living in institutional settings, with a large proportion of participants completing the program and reporting satisfaction with the lessons.4 

Where is the therapist?

There are two types of iCBT: guided iCBT and unguided AKA self-guided iCBT. Guided iCBT provides online CBT content plus regular support from a trained therapist or professional. You will get assistance through secure messages, brief phone calls or scheduled video interactions.

In unguided or self-guided iCBT, users work through CBT modules entirely on their own, with no ongoing therapist or support. The content is usually self-paced and feedback comes from the program itself rather than from a human.

Blended iCBT combines online CBT modules with periodic face-to-face or direct live sessions with a therapist. This can involve online homework reinforced by in-person sessions or in-person therapy supplemented with digital tools.5 Blended iCBT is especially useful for patients who need both the structured flexibility of online learning and the personal interaction that only an in-person session can provide. 

Is guided iCBT better than self-guided iCBT?

Here’s where things get interesting. Remember how iCBT works better than face-to-face CBT for some anxiety disorders? Researchers have also thoroughly compared whether iCBT needs to be guided for it to work. It turns out that a lot of the time there isn’t much difference between guided and self guided iCBT either! 

It’s tempting to think that guided iCBT must be better than unguided because we are used to the idea that the therapist is helping us. Clinical research, however, shows that for mild to moderate depression, unguided iCBT is just as good as guided iCBT. Don’t take our word for it; let’s have a look at an example from the research.

A large systematic review of 39 studies, consisting of 9,751 participants found that guided iCBT tended to produce better treatment outcomes than fully self-guided versions, especially for people with moderate or more severe symptoms of depression.6 The differences between the two, however, were very small. 

The team measured outcomes using the Patient Health Questionnaire –9 (PHQ-9). This is the standard test that doctors use to diagnose and measure symptoms of depression. The researchers used scores taken before and after the iCBT treatments to test how much the therapy helped patients. On average, the difference in PHQ-9 scores between guided programs and unguided programs was less than one point, and after six months the difference in outcomes between guided and unguided iCBT was unmeasurable. This tells us that both guided and unguided iCBT help people with depression to feel better. Guided and unguided iCBT gave very similar results for people who went in with a PHQ-9 score between five and nine, neither one was better than the other. For people who started off with a PHQ-9 score of nine or more, guided therapy worked a little better. This makes sense because very depressed people might need a bit more help to get going.6

Why am I being offered iCBT rather than in person CBT?

  1. It works!

Multiple clinical trials and large research reviews show that iCBT significantly improves symptoms of depression and anxiety when compared with treatment as usual or waiting lists. In many cases, it is as effective or more effective than face-to-face CBT.6,7

  1. It Saves you Time and Money

In-person CBT is expensive, hard to schedule around work commitments and often has long waiting lists. If you are living in an area with few qualified CBT therapists or if you have a job that makes it hard for you to make regular appointments during the day, iCBT can be a lifeline. In some cases, as with anxiety disorders, iCBT can be more effective than face-to-face appointments. Think about it, how much extra stress does it add trying to make it out of work on time for a session? Research comparing iCBT directly with traditional CBT for specific conditions (like health anxiety) found that iCBT achieved similar benefits while needing less therapeutic time, which can reduce waiting times and bills, where applicable, for patients.7 

  1. You Can Personalize It to Your Needs.

iCBT programs can be guided or unguided with research suggesting that guided formats tend to work better for people with moderate to severe symptoms of depression and unguided versions still help those with milder concerns. This flexibility allows you and your therapist to choose the approach that fits your situation.2,6,7

Is iCBT safe?

Cyber Safety

When you start an iCBT program, it’s understandable to wonder how your information will be handled and whether the online format is safe. Privacy and safety are important parts of responsible iCBT delivery and because iCBT is delivered online, protecting your personal information, such as your login details, responses to questions and progress data is a top priority. Just as in other secure online systems (like banking or telehealth platforms), iCBT programs use secure data storage and encryption to keep your information private. This also reduces the risk of unauthorized access and this level of data protection is essential before a program is offered to the public.8 

Research on digital mental health tools further highlights privacy and data protection among the main ethical and legal factors that developers and clinicians consider when designing these interventions. This includes ensuring that systems are compliant with relevant data protection standards and any personal data you provide is used solely for your care.9 

Psychological Safety

Studies examining the safety of digital mental health interventions including iCBT have found that most programs actively monitor for adverse events (such as symptom worsening or emotional distress) during and after treatment. Thirteen randomized controlled trials consisting 3805 participants were analysed. Researchers found that symptom deterioration is rare and often lower in iCBT than in control conditions, suggesting that iCBT does not increase the risk of harm for most users.10 

In addition, systematic reviews of digital mental health interventions encourage consistent safety monitoring and reporting so that therapists and patients can be confident the benefits outweigh any risks. This includes having pathways for users to seek help if symptoms worsen or if they experience distress while using the program.11 iCBT programs that include therapist or coach support incorporate an extra layer of safety and oversight. Trained professionals are available to clarify difficult parts of the program and if they notice signs of worsening symptoms, they recommend further care where necessary.11

How does iCBT work?

If iCBT has been recommended for you, it is natural to wonder what actually happens inside the program and how it is meant to help. A good way to understand this is to look at what happens when iCBT is tested in real clinical studies, where it is used by people with the same kinds of difficulties that bring many patients to treatment.

A randomized controlled trial (RCT), which was carried out in two Chinese hospitals between August and December 2021, showed that an iCBT program for people with depression significantly reduced symptoms compared with a control group. The program consisted of 84 participants who were diagnosed with major depressive disorder. They were divided into two groups, with 40 participants engaged in iCBT, while 44 proceeded with their usual treatment. The iCBT was delivered through a WeChat mini program known as Morning Mood and comprised seven modules that were designed to teach CBT skills, while general support from health practitioners was made available. Seventy-eight percent of the iCBT group completed the modules and the study showed that an iCBT program for people with depression significantly reduced symptoms compared with a control group who did not receive the intervention.12

Using the study as a framework, here is how iCBT works:

  1. You Complete Structured Lessons Online

Once you begin, you may access a series of modules on a secure digital platform. Think of each module as a weekly lesson that teaches specific skills and these lessons are designed to be easy to follow as they build on one another.

Some typical topics may include:

  • Understanding how thoughts, feelings and behaviours are connected
  • Recognizing unhelpful thinking patterns
  • Practising techniques to challenge and reframe those thoughts
  • Learning new behaviours that support better mental health

During the clinical trial, participants worked through seven weekly modules that taught exactly these kinds of CBT skills – just like you would learn in in-person therapy.

  1. You Practise Skills in Everyday Life

You may be asked to do practical exercises between lessons, which are similar to ‘homework’ in traditional CBT. These exercises might include:

  • Keeping a mood diary
  • Writing down stressful thoughts and examining whether they’re accurate
  • Scheduling activities that bring you joy or a sense of accomplishment.
  • Trying small behavioural changes that gradually reduce anxiety or improve mood

These real-world exercises help you to implement what you’re learning and make changes in how you think and act.

  1. You May Receive Support Along the Way

Many iCBT programs include some form of support from a trained helper. This is not the same as traditional therapy with long sessions; support from the helper is usually brief and focused on helping you stay on track. It might be in the form of:

  • Short messages through the platform
  • Encouragement to complete modules
  • Answers to questions about how the program works

In the clinical trial mentioned earlier, participants received supportive contact from trained staff who encouraged them to continue and helped to answer questions. This kind of guidance doesn’t replace therapy but it does encourage most people stay engaged and complete the program.

  1. You Track Your Progress

iCBT platforms typically include tools that assist you in monitoring your symptoms from week to week. This could be through simple questionnaires about your mood, stress or sleep.

Tracking your progress helps in two ways:

  • It shows you how your symptoms are changing over time
  • It gives you feedback about which strategies are working best for you.

In the research study, participants completed symptom questionnaires before and after the program. The changes in answers over time allowed researchers to confirm that people who used iCBT had meaningful improvements in depression and anxiety scores compared with those who didn’t get therapy.

  1. You Learn to Apply Skills Long-Term

One of the goals of iCBT is to help you keep using these skills even after the program ends. Just like in face-to-face CBT, the work you do online aims to give you tools you can apply for life and not just temporary relief.

This includes:

  • Recognizing early signs of mood changes
  • Using problem-solving techniques when stress increases
  • Applying cognitive strategies in real situations

Final Thoughts

Internet-based cognitive behavioural therapy (iCBT) represents a modern way of delivering one of the most widely researched and trusted psychological treatments. Rather than replacing CBT, it brings the same structured techniques into an online format that you can access from home and at your own pace. Research over the past two decades has shown that iCBT is not an experimental or inferior option. For many people with depression, anxiety and similar conditions, guided iCBT produces results comparable to traditional face-to-face therapy. It has been tested in large randomized controlled trials, reviewed in meta-analyses and adopted by health systems around the world because it works and because it improves access to care.

References

  1. Chand, S. P., Kuckel, D. P., & Huecker, M. R. (2023). Cognitive behavior therapy. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470241/
  2. Zainal NH, Soh CP, Doren NV, Benjet C. Do the effects of internet-delivered cognitive-behavioural therapy (iCBT) last after a year and beyond? A meta-analysis of 154 randomized controlled trials (RCTs). Clin Psychol Rev. 2024;114:102518. doi:10.1016/j.cpr.2024.102518
  3. Health Quality Ontario. (2019). Internet-delivered cognitive behavioural therapy for major depression and anxiety disorders: A health technology assessment. Ontario Health Technology Assessment Series, 19(6), 1–199. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6394534/
  4. Kong, F., Yu, L., Hou, Y., Zhu, L., Zhou, J., Huang, L., Lv, Y., Wang, L., Zhang, L., Yang, Y., & Ying, Y. (2024). Efficacy of internet-based cognitive behavioral therapy for subthreshold depression among older adults in institutional long-term care settings: Pragmatic randomized controlled trial. Journal of Medical Internet Research, 26, e40187. https://doi.org/10.2196/40187
  5. Mathiasen, K., Andersen, T. E., Lichtenstein, M. B., Ehlers, L. H., Riper, H., Kleiboer, A., & Roessler, K. K. (2022). The clinical effectiveness of blended cognitive behavioral therapy compared with face-to-face cognitive behavioral therapy for adult depression: Randomized controlled noninferiority trial. Journal of Medical Internet Research, 24(9), e36577. https://doi.org/10.2196/36577
  6. Karyotaki, E., Efthimiou, O., Miguel, C., Bermpohl, F. M. G., Furukawa, T. A., Cuijpers, P., et al. (2021). Internet-based cognitive behavioral therapy for depression: A systematic review and individual patient data network meta-analysis. JAMA Psychiatry, 78(4), 361–371. https://doi.org/10.1001/jamapsychiatry.2020.4364
  7. Axelsson, E., Andersson, E., Ljótsson, B., Björkander, D., Hedman-Lagerlöf, M., & Hedman-Lagerlöf, E. (2020). Effect of internet vs face-to-face cognitive behavior therapy for health anxiety: A randomized noninferiority clinical trial. JAMA Psychiatry, 77(9), 915–924. https://doi.org/10.1001/jamapsychiatry.2020.0940
  8. Young, C., Sinclair, A., Black, C., et al. (2019). Internet-delivered cognitive behavioural therapy for post-traumatic stress disorder: A health technology assessment. Canadian Agency for Drugs and Technologies in Health. https://www.ncbi.nlm.nih.gov/books/NBK554851/
  9. Hall, C. L., Gómez Bergin, A. D., & Rennick-Egglestone, S. (2024). Research into digital health intervention for mental health: 25-year retrospective on the ethical and legal challenges. Journal of Medical Internet Research, 26, e58939. https://doi.org/10.2196/58939
  10. Karyotaki, E., Kemmeren, L., Riper, H., Twisk, J., Hoogendoorn, A., Kleiboer, A., Mira, A., Mackinnon, A., Meyer, B., Botella, C., et al. (2018). Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis. Psychological Medicine, 48(15), 2456–2466. https://doi.org/10.1017/S0033291718000648
  11. Taher, R., Hsu, C. W., Hampshire, C., Fialho, C., Heaysman, C., Stahl, D., Shergill, S., & Yiend, J. (2023). The safety of digital mental health interventions: Systematic review and recommendations. JMIR Mental Health, 10, e47433. https://doi.org/10.2196/47433
  12. Lin, Z., Cheng, L., Han, X., Wang, H., Liao, Y., Guo, L., Shi, J., Fan, B., Teopiz, K. M., Jawad, M. Y., Zhang, H., Chen, Y., Lu, C., & McIntyre, R. S. (2023). The effect of internet-based cognitive behavioral therapy on major depressive disorder: Randomized controlled trial. Journal of Medical Internet Research, 25, e42786. https://doi.org/10.2196/42786