Internet-delivered CBT (guided and self-guided)

Domain IX · Biomedical, neuro & digital

What it is

ICBT is a delivery format, not a separate school of therapy. A structured CBT programme (text, video, audio, worksheets, quizzes) carries the treatment content, released as lessons or modules, usually one per week; the client works through it at home and does homework such as exposure or…

Format

• Guided ICBT runs in five phases. Session counts below are what the named programmes publish; local services vary.
• Phase 0: Access and online screening. Goal: identify likely problems and immediate risk before any human contact. Format: online questionnaires. MindSpot uses a structured questionnaire plus K10, PHQ-9 and GAD-7, adding condition-specific measures (e.g. for social anxiety, panic, OCD, PTSD) where…

Who practises it, and how they are trained or regulated

• Australia: MindSpot runs free-to-user online assessment and courses; the Wellbeing Course is offered to Australian residents, with an option of weekly therapist support or contacting the service when needed. THIS WAY UP is provided by St Vincent's Hospital Sydney with UNSW and CRUfAD as partners, states accreditation under the National Safety and Quality Digital Mental Health Standards, and is supported by…
• Regulatory classification (medical-device status, CE/UKCA, DTAC) differs by product and is not summarised here; see 087 for the NHS products NICE assessed.

Evidence status, as the guide reports it

• Evidence status (attributed, brief). Andersson et al. (2019) report that guided ICBT is generally more effective than self-guided ICBT, that self-guided ICBT for depression showed a small effect against controls (g = 0.27), that clinician time averages about 10 minutes per client per week, and that…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Continuing by default. Working: a documented decision with a reason.
• Drift into long, unfocused messages. Working: audit ratings stable and high.
• Silent dropout after early deterioration; client embarrassment. Working: the client logs back in.
• Partial responders who need more; fear of losing support. Working: a written plan the client can name.
• Comparisons that discourage, misinformation, contagion. Working: supportive posts, safety rules respected.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.