Novel delivery of therapist-led online CBT helps people with depression, major trial finds

A new way of delivering therapist-led online cognitive behavioural therapy (CBT) can reduce symptoms of depression and improve function, according to new University of Bristol-led research published in The Lancet Primary Care.

Depression affects millions of people and can have a major impact on daily life, relationships and work. Although CBT is an effective treatment, many people face barriers to accessing it, including long waiting lists and difficulties attending in-person appointments due to work commitments, caring responsibilities, living in more remote areas, or social anxiety.

Delivering CBT online using instant messaging is known to be effective, but therapy delivered by instant messaging alone does not support the practice of CBT outside the therapy session. The research aimed to find out whether integrating interactive online materials might improve engagement with therapy and increase access.

The INTERACT (Integrated therapist and online Cognitive Behavioural Therapy for depression in primary care) study tested a new form of therapy called ‘integrated CBT’. It combined one-to-one CBT delivered by instant messaging with an accredited CBT therapist, with worksheets and information that could be accessed, both during and between sessions, through a secure digital platform.

The National Institute for Health and Care Research (NIHR)-funded trial involved 451 adults with depression recruited from 67 GP practices across England. Half were offered integrated CBT using the online therapy platform in addition to their usual care, while the other half continued to receive usual care from their GP.

Integrated CBT consisted of nine to twelve therapist-led sessions tailored to each person’s needs. Therapists worked with patients using written conversations in real time through the online platform and shared resources for patients to use during and between sessions to help them develop skills in managing negative thoughts and changing unhelpful behaviours.

After six months, people who received integrated CBT reported significantly fewer symptoms of depression than those receiving usual care alone. Those in the intervention group had a depression score that was, on average, 4.4 points lower than those in the usual care group. This difference was likely to be clinically important. The benefits were seen across a large and diverse group of patients recruited from routine primary care settings. Improvements were maintained over 12 months.

The findings suggest that this novel approach to delivering therapist-led online CBT could help increase access to evidence-based treatment for depression, particularly for people who cannot easily attend traditional in-person appointments. It may also help services offer more flexible ways of delivering mental health support.

Debbie Tallon, INTERACT Programme Manager and Senior Clinical Trials Manager at Bristol Medical School and lead author, said:

“Depression is common, but many people face practical barriers to accessing psychological therapies. Our findings show that therapist-led CBT delivered using an online therapy platform which provides access to resources for patients to use within and between sessions can be an effective treatment option, giving people greater flexibility in how they receive care while maintaining the benefits of working with a qualified therapist.”

Nicola Wiles, Professor of Epidemiology at the Centre for Academic Mental Health and Centre for Academic Primary Care at the University of Bristol, and senior author, said:

“CBT is an effective treatment for depression, but demand for psychological therapies continues to outstrip capacity. Our study shows that integrating therapist support with online CBT materials can achieve meaningful improvements in depression symptoms and could become an important part of how NHS services meet growing need.”

Professor Olivia Wu, NIHR Programme Director of Programme Grants for Applied Research (PGfAR), said:

“These findings highlight how integrated, therapist-led digital CBT can deliver clinically meaningful and sustained improvements for people living with depression, offering an evidence-based option for those who struggle to access care in person. As the NHS looks to expand community-based, digital-first services, this trial shows what interventions like this can achieve for patients.”

The INTERACT study was an eight-year programme of research led by the University of Bristol in collaboration with the Universities of Glasgow, York, Hull York Medical School, University College Dublin, and University College London.