About 85% of patients with depression have significant anxiety.

Depression and anxiety.

Treatment programs have been studied in patients with mild-to-moderate, moderate-to-severe and severe depression.

iCBT may be particularly useful for patients in rural and remote locations and for patients with mobility issues.

Precautions

CBT may not be suitable for patients with additional disorders or conditions such as borderline personality disorder, antisocial personality disorder or substance dependence.

Practitioners should assess a patient’s risk of self-harm or suicide before recommending iCBT. More immediate and direct means of assistance may be necessary for some patients.

Practitioners should alert patients to report a lack of improvement or worsening of anxiety or depression.

CCBT or iCBT programs engage patients in structured programs of care. The content is similar to and based on therapist-provided CBT programs.

Programs vary in style, degree of complexity, content and involvement by clinician.

Tips and challenges

Internet intervention may offer help for many individuals without access to effective treatments.

Slow or unreliable internet access may limit availability of some programs. For these patients, access to programs could be offered in the general practice.

Bibliotherapy for depression on HANDI is an alternative for patients without internet access.

Training

Each site offers clinician access and guidance.

There are several different iCBT programs available at no or low-to-moderate cost:

• The Australian National University (ANU) has a tool that rates various depression-related websites (some also cover anxiety). MoodGYM (see Consumer resources) has been developed by the ANU.
• Mindhealthconnect offers information about and access to online programs.
• eMHPrac provides has a list of programs, apps and services to support the management of mild-to-moderate depression and anxiety.

More information on specific sites is provided in the Consumer resources section.

MoodGYM (used in the Christensen trial) is a free online training program developed by the Centre for Mental Health Research, ANU. It uses CBT and interpersonal therapy. MoodGYM is available in several languages.

There are many other programs, including:

• THIS WAY UP clinic offers several courses developed by staff at the Clinical Unit of Anxiety and Depression at St Vincent’s Hospital, Sydney, and the University of New South Wales Faculty of Medicine. Patient use requires a GP referral and there is a fee of $55. Progress can be monitored by the referring GP. Courses available include depression, generalised anxiety disorder and mixed depression and anxiety. Clinicians have free access.
• Mental Health Online offers assessment and treatment programs for social anxiety disorder, post-traumatic stress disorder, general anxiety disorder, depression and panic disorder. Mental Health Online is an initiative of the National eTherapy Centre at Swinburne University of Technology, Melbourne, and is funded by the Department of Health and Ageing.
• OnTrack offers free access to online programs, information, quizzes and advice to support the Australian community in achieving mental and physical health and wellbeing.
• MindSpot provides educational and practical exercises, combined with regular contact with a MindSpot therapist, which allows help to be obtained in a discreet, effective way.
• myCompass is an interactive self-help service that aims to promote resilience and wellbeing for all Australians.
• beyondblue has free online programs, including The Desk (for students).

Grading

NHMRC Level 1 evidence.

1. Christensen H, Griffiths KM, Jorm AF. Delivering interventions for depression by using the internet: a randomised controlled trial. BMJ. 2004; doi:10.1136/bmj.37945.566632.EE
2. Kaltenthaler E, Brazier J, De Nigris E, Tumur I, Ferriter M, Beverley C, Parry G, Rooney G, Sutcliffe PA. Computerised cognitive behavioural therapy for depression and anxiety update: as systematic review and economic evaluation. Health Technology Assessment 2006; 10(33):1-186
3. National Collaborating Centre for Mental Health. Depression: the NICE guideline on the treatment and management of depression in adults (updated edition). London: National Institute for Health and Clinical Excellence, 2010. (Accessed 1 March 2013)