Researchers from the Brain and Mind Research Institute at the University of Sydney in New South Wales, Australia, evaluated the effectiveness of internet-delivered Cognitive Behavioral Therapy (iCBT) on depressive symptom severity and adherence to medical advice (including lifestyle interventions) in adults with mild to moderate depression and high cardiovascular disease (CVD) risk.

This was a randomized, double-blind, 12 week attention-controlled trial comparing an iCBT program (E-couch) with an internet-delivered attention control health information package (HealthWatch, n = 282).

The primary outcome measured was depression symptom level on the nine-item Patient Health Questionnaire (PHQ-9) (trial registration: ACTRN12610000085077).

Out of 562 subjects, there were 487 completers (88%) who lasted to the final assessment.

Of those, 383 (70%) were being treated for cardiovascular disease and 314 (56%) had at least one other co-morbid condition.

In the ITT analysis of the 562 participants, results showed that the iCBT condition produced a greater decline in the mean PHQ-9 (depression) score, as compared to the attention control of 1.06 (95% CI: 0.23-1.89) points.

Differences between the two arms increased over the intervention period (time by treatment effect interaction p = .012).

There were also larger improvements in adherence to medical advice (2.16 points; 95% CI: 0.33-3.99), reductions in anxiety (0.96 points; 95% CI: 0.19-1.73), and a greater proportion engaging in beneficial physical activity (Odds Ratio 1.91, 95%CI: 1.01-3.61) in the iCBT participants.
There was no effect on disability.
The investigators conclude that in people with mild to moderate depression and high levels of CVD risk factors, a freely accessible iCBT program ( produced a small, but robust improvement in depressive symptoms, adherence and some health behaviors.

Citation: Glozier N1, Christensen H, Naismith S, Cockayne N, Donkin L, Neal B, Mackinnon A, Hickie I. Internet-delivered cognitive behavioural therapy for adults with mild to moderate depression and high cardiovascular disease risks: a randomised attention-controlled trial. PLoS One. 2013;8 (3):e59139. [email protected]