Guided or Not, Internet-Based Cognitive Behavioral Therapy May Help With Depression

Guided, internet-based cognitive behavioral therapy (iCBT) may offer significant improvement in depression symptoms, and even non-guided options can be beneficial, according to a recent research review in JAMA Psychiatry.

Looking at 39 studies comprising nearly 10,000 patients, researchers compared the outcome of both guided and non-guided iCBT interventions for those with depression symptoms.

They found that patients with mild depression saw benefits from using CBT tools without direct therapeutic help, while guided options were more effective for those with moderate and severe depression. This highlights the advantages of personalized treatment, they concluded, particularly for depression.

Benefits of CBT

Sometimes called "talk therapy," CBT involves discussions with a mental health professional who is trained in the technique and can guide the conversation in a structured way.

One of the primary goals of CBT is more awareness around negative thought patterns, and it is often employed for building resistance, resolving relationship conflicts, managing emotions, and developing beneficial habits for dealing with stress.

According to the American Psychological Association (APA), this treatment has been shown to be effective for issues such as:

• Depression
• Anxiety disorders
• Alcohol and drug use problems
• Marital problems
• Eating disorders
• Severe mental illness

The APA adds that research studies suggest CBT can lead to significant improvement in functioning and quality of life, and may be as effective—and in some cases more effective—than other forms of psychological therapy or psychiatric medications.

Rise of Online Therapy

Online therapy has become more popular over the past year, according to Jennifer Gentile, PsyD, who treats some patients virtually using a telehealth app.

“We’ve all gotten used to doing more online, from grocery delivery to working to going to school, so this just makes sense,” she says. “For some people, Internet-based therapy is actually more comfortable and convenient. Because of that, it’s very possible this will continue to be an option for many people even when COVID is no longer an issue.”

Another major hurdle for many people is stigma in seeking out therapy options, but being able to access mental health resources from a computer or device may also remove some of that hesitation, she adds.

The shift to online therapy already was a growing trend before the stay-at-home orders of 2020, however. A study from 2014 in the Journal of Affective Disorders found that Internet-based interventions already were highlighted for their efficacy. In that research, for example, depressive symptoms remained low for those who had done online therapy, compared to a group that met in person.

Another study, published in the Canadian Medical Association Journal, found that online CBT, combined with clinical care, was effective in treating anxiety, depression, and emotional distress related to chronic illness.

Depression Awareness

For those who are contemplating using iCBT for mental health challenges, a first step might be recognizing potential signs of depression, suggests Scott Dehorty, LCSW-C, a Maryland-based psychotherapist. Although some people tend to think of sadness as the prevailing symptom, that’s not always the case, he says.

“Feeling really down isn’t all that common for someone with depression,” he states. “After all, that means you’re feeling something in a deep way. Depression is usually characterized more by indifference or numbness than sadness.”

He adds that the biggest symptoms tend to be:

• Absence of joy or pleasure, general feeling of indifference
• Exhaustion or fatigue that isn't lightened with rest or sleep
• Sudden mood changes unrelated or out of proportion to a situation
• Chronic pain, especially headaches or general ache
• Lower level of self-care like not showering, poor eating habits, being sedentary
• Feeling hopeless, distracted, helpless, or irritable

One bright spot, Dehorty says, is that depression is very treatable. Not only can iCBT and in-person CBT be helpful, but there are a range of other therapies that can also be utilized to address the issue.