Cognitive behavioural therapy: Online just as good as in-person delivery

A retrospective cohort study has shown that short first-line treatments with therapist-guided, internet-delivered cognitive behavioural therapy (CBT) yield comparable outcomes as face-to-face CBT.

Researchers linked full archived CBT (therapist-guided internet-delivered [iCBT] and face-to-face [fCBT]) cohort registries with multiple Finnish social and healthcare registries. Both CBT protocols were provided to individuals with depression without acute suicide or substance-misuse risk, with fCBT delivered in a single region and iCBT delivered nationwide and excluded people with treatment-interfering psychotic, neurological, or personality disorders, chronic or bipolar depression, or those under 16 years of age.

The primary outcome was the difference in during-treatment symptom reductions between fCBT and therapist-guided iCBT (calculated as the causal average treatment effect), with symptoms measured using the Patient Health Questionnaire-9 (PHQ-9).

A total of 32,343 registered therapies were identified. Out of these, 388 people were included from the fCBT registry and 5,446 people from the iCBT registry, with a total of 5,834 participants included for analysis. The mean age of the sample was 35 years, and 70 percent were female.

The resulting ATE estimate showed that the PHQ-9 score in the iCBT group was lower by 0.745 points (95 percent confidence interval, 0.156–1.334) than in the fCBT group. Sensitivity analyses yielded consistent estimates.