The Efficacy and Effectiveness of Online CBT - Jeroen Ruwaard

2 Chapter 1. General Introductionpsychological, social, geographical, and systemic (Collins, Westra, Dozois, & Burns,2004). Internet applications have reduced or removed such barriers in many areasof life. Psychotherapeutic internet interventions may support public mental healthcarein a similar vein (F. Griffiths, Lindenmeyer, Powell, Lowe, & Thorogood, 2006;Emmelkamp, 2005).In the past decade, researchers have developed psychotherapeutic internet interventionsfor a wide variety of mental health disorders (Barak, Hen, Boniel-Nissim, &Shapira, 2008). These interventions vary in terms of the intended purpose (prevention,early intervention, treatment, aftercare), the electronic means that are used to deliverthe intervention (e-mail, e-chat, websites, video-conferencing, mobile applications),and in the level of professional support. In terms of the psychotherapeutic orientation,available interventions are surprisingly homogeneous: the vast majority of existinginternet interventions are based on Cognitive Behavioural Therapy (CBT).CBT is characterized by clear-cut therapeutic procedures, which are relatively easyto translate into an online format. In addition, there is general agreement on theeffectiveness of CBT (Butler, Chapman, Forman, & Beck, 2006). Meta-analyses suggestthat this effectiveness generalizes to internet interventions, although it should benoted that these meta-analyses also reveal significant heterogeneity in study outcomes(Cuijpers et al., 2009; Andersson & Cuijpers, 2009). There is growing consensus thatprofessional guidance is a critical determinant of the efficacy of online CBT (Palmqvist,Carlbring, & Andersson, 2007; Spek et al., 2007).1.1.1 Three types of online CBTSelf-help. Online self-help interventions do not include guidance from a mentalhealth professional. Such interventions allow large-scale, low-cost dissemination ofCBT. Online self-help appears to be effective for a variety of psychological symptoms,although its effects are statistically small and drop-out rates are very high (Kaltenthaleret al., 2006; Foroushani, Schneider, & Assareh, 2011; Spek et al., 2007; Andersson &Cuijpers, 2009). Even so, online self-help interventions are currently implemented inroutine practice for preventive purposes, based on the assumption that interventionswith small effects may have a noticeable impact if available to a large part of thepopulation.