I have been aware of the use of internet based CBT, including the development of cellphone apps, for about a decade. We are now at the meta analysis stage of evaluating this technology. I would suggest any interested people read the paper, as it is freely available.

As a clinician, the attractive thing about iCBT is not that it is more effective than face to face therapy — this is not tested in this analysis — but that it is more available.

Self-guided iCBT produces results that are encouraging. The absence of a significant difference in treatment outcomes associated with clinical and sociodemographic characteristics implies that self-guided iCBT can be used by most individuals with depressive symptoms regardless of the severity of their symptoms or their sociodemographic background. Currently, antidepressant medications are widely used in the treatment of depressive symptoms, whereas psychotherapeutic interventions are provided to a lesser degree, despite many individuals with depressive symptoms preferring psychotherapy to antidepressants.46 However, the high treatment costs and the limited number of trained clinicians hamper the implementation of psychotherapy in practice.

The findings of the present IPD meta-analysis suggest that self-guided iCBT may be a viable alternative to current first-step treatment approaches for symptoms of depression, particularly in those individuals who are not willing to have any therapeutic contact. This form of intervention seems to be valuable for patients with primary depressive problems and those with depressive symptoms in the context of a primary somatic problem.47,48 This self-help form of CBT can provide treatment access at low cost to large numbers of individuals worldwide who have depressive symptoms. Although it is beyond the scope of this study, unguided iCBT has several limitations that should be addressed before it is disseminated as part of routine care (eg, high dropout rates, small effects compared with face-to-face and guided internet interventions, and possible participant selection bias).

The americans seem quite cautious. In the Antipodes we are less so. The Australian Federal government funds this way up, which uses techniques from mood gym, one of the first proven internet based treatments for depression. And this is not limited to Aussies. I recommend to my primary care colleagues that they give the link to this or other services to their patients and then follow them up, before they reach for the prescription pad, or, if prescribing for depression, at the same time.