The effectiveness of online cognitive behavioral treatment in routine clinical practice

Jeroen Ruwaard, Alfred Lange, Bart Schrieken, Conor V Dolan, Paul Emmelkamp

Research output: Contribution to JournalArticleAcademicpeer-review


CONTEXT: Randomized controlled trails have identified online cognitive behavioral therapy as an efficacious intervention in the management of common mental health disorders.

OBJECTIVE: To assess the effectiveness of online CBT for different mental disorders in routine clinical practice.

DESIGN: An uncontrolled before-after study, with measurements at baseline, posttest, 6-week follow-up, and 1-year follow-up.

PARTICIPANTS & SETTING: 1500 adult patients (female: 67%; mean age: 40 years) with a GP referral for psychotherapy were treated at a Dutch online mental health clinic for symptoms of depression (n = 413), panic disorder (n = 139), posttraumatic stress (n = 478), or burnout (n = 470).

INTERVENTIONS: Manualized, web-based, therapist-assisted CBT, of which the efficacy was previously demonstrated in a series of controlled trials. Standardized duration of treatment varied from 5 weeks (online CBT for Posttraumatic stress) to 16 weeks (online CBT for Depression).

MAIN OUTCOME MEASURES: Validated self-report questionnaires of specific and general psychopathology, including the Beck Depression Inventory, the Impact of Event Scale, the Panic Disorder Severity Scale-Self Report, the Oldenburg Burnout Inventory, and the Depression Anxiety Stress Scales.

RESULTS: Treatment adherence was 71% (n = 1071). Study attrition was 21% at posttest, 33% at 6-week FU and 65% at 1-year FU. Mixed-model repeated measures regression identified large short-term reductions in all measures of primary symptoms (d = 1.9±0.2 to d = 1.2±0.2; P<.001), which sustained up to one year after treatment. At posttest, rates of reliable improvement and recovery were 71% and 52% in the completer sample (full sample: 55%/40%). Patient satisfaction was high.

CONCLUSIONS: Results suggest that online therapist-assisted CBT may be as effective in routine practice as it is in clinical trials. Although pre-treatment withdrawal and long-term outcomes require further study, results warrant continued implementation of online CBT.

Original languageEnglish
Pages (from-to)e40089
JournalPLoS ONE
Issue number7
Publication statusPublished - 2012


  • Adolescent
  • Adult
  • Aged
  • Cognitive Therapy
  • Female
  • Humans
  • Internet
  • Male
  • Mental Disorders
  • Middle Aged
  • Patient Compliance
  • Patient Satisfaction
  • Psychiatric Status Rating Scales
  • Self Report
  • Treatment Outcome
  • Young Adult
  • Clinical Trial
  • Journal Article
  • Research Support, Non-U.S. Gov't


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