Innovating CBT and Answering New Questions: the Role of Internet-Delivered CBT

Abstract

Internet-delivered cognitive behavior therapy (ICBT) was developed in the late 1990s, and since then, a large number of studies have been conducted. Many programs have been developed and sometimes implemented, and ICBT has become a major way to investigate and innovate CBT including important questions regarding mechanisms and moderating factors. The aim of this narrative review was to comment on the treatment format, the evidence behind ICBT, innovations, and finally challenges. ICBT has been developed and tested for a range of conditions including both psychiatric and somatic health problems and also transdiagnostic problems like loneliness and poor self-esteem. Meta-analytic reviews suggest that guided ICBT can be as effective as face-to-face CBT and by using individual patient data meta-analytic methods (IPDMA), it is now possible have better power for the search of moderators. There are also several reports of how well ICBT works in regular clinical settings, mostly replicating the results reported in efficacy studies. Cost-effectiveness has also been documented as well as studies using qualitative methodology to document client and clinician experiences. In terms of innovation, there are now studies on problems for which there is limited previous face-to-face research, and one major advancement is the use of factorial design trials in which more than one independent variable is tested. Finally, ICBT has the potential to be useful in times of crisis, with the COVID-19 pandemic being one recent example. Future challenges include use of artificial intelligence in both treatment development and possibly treatment delivery. Another urgent priority is to reach less favored parts of the world as most studies and programs have been tested and implemented in Western countries. In conclusion, ICBT is now an established as a way to develop, test, and deliver CBT.