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additional treatments in the follow-up period, which further limits the conclusions that can be drawn about relapse rates and the extent to which patients maintain treatment gains following an acute phase of iCBT. Taken together, the empirical literature exploring relapse rates following an acute phase of iCBT treatment for anxiety and depres- sion is scarce, and our understanding of the factors associated with relapse in remitted patients is comparably limited. Therefore, the aim of the present study was to add to the existing literature by investigating relapse and remission rates following the completion of iCBT interventions for anxiety and depressive symptoms, within a routine care setting. More specifically, the objectives of this study were to quantify post-treatment relapse rates at 3-, 6- and 9-month follow-up from end of treatment, and to explore predictors of time- to-relapse. 2 | M E T H O D 2.1 | Ethics statement This study utilized existing data from a trial that was originally approved by the NHS England Research Ethics Committee [REC Ref- erence: 17/NW/0311]. 2.2 | Design This is a secondary analysis of data from a recent pragmatic ran- domized controlled trial of internet-delivered CBT interventions (iCBT) for depression and anxiety in routine care, with 12-month follow-up (Richards et al., 2020). In the main study, 361 participants were randomly allocated in a 2:1 ratio to the intervention (n = 241) or the waitlist control group (n = 120). For this second- ary analysis, we looked at those in the intervention arm using the 3-month point in the original study as baseline (which is the point where all participants in the intervention arm had completed their treatment), and follow-up for 3–6 and 9 months thereafter. 2.3 | Setting The main trial was delivered within a stepped-care model, the Improv- ing Access to Psychological Therapies (IAPT) programme, within the National Health Service (NHS) in England. iCBT in this setting is offered as one of several low-intensity interventions at Step 2 of the model, for individuals experiencing mild to moderate symptoms of depression and anxiety. It is supported by trained psychological wellbeing practitioners (PWPs), who deliver feedback on the users' progress through the content of the iCBT intervention via weekly asynchronous messages on the platform and on occasion complemen- ted with telephone calls as required. 2.4 | Intervention The iCBT programs used in the current study were SilverCloud Health's 'Space from Depression' and 'Space from Anxiety' programs. SilverCloud Health is a provider of computerized psychological inter- ventions for a variety of mental health and well-being issues. The iCBT programs aim to develop and increase an understanding of one's thoughts, feelings and behaviours while applying a range of coping strategies such as mindfulness, behavioural activation, graded expo- sure, problem solving, activity scheduling and cognitive restructuring. They are delivered online through a variety of multimedia and interac- tive tools. Further details on the therapeutic components and content of each of the programs can be found in the protocol of the original RCT (Richards et al., 2018). During their iCBT treatment, participants are supported by a psy- chological wellbeing practitioner (PWP) trained in the delivery of low- intensity cognitive behaviour therapy interventions (Clark, 2011, 2018). The PWP introduces participants to their programme, monitors their progress throughout the trial and provides regular online and telephone reviews to participants, giving them feedback, guidance and responding to the work they complete between each review. Beyond a basic amount of participant information available to PWPs on the SilverCloud Health platform, participants can determine how much they want to share with their supporters. Over the intervention period, PWPs are advised to complete six to eight separate online reviews with participants, each taking approximately 10–15 min to complete. Supporters are supervised by case managers, responsible for monitoring the content of PWPs' online reviews and the corresponding CBT module and ensuring best practice standards of care. 2.5 | Participants Consistent with the healthcare service delivering the treatment, inclu- sion criteria for the overarching trial were (i) being aged between 18– 80 years; (ii) presence of symptoms of depression and/or anxiety above clinical thresholds at initial assessment, as measured by the Patient-Health Questionnaire-9 (PHQ-9; score ≥10) and/or General- ised Anxiety Disorder-7 (GAD-7; score ≥8); (iii) being deemed suitable for iCBT (i.e., internet access). Participants were excluded from the trial if they reported suicidal ideation or intent (PHQ-9 question 9 score >2 and/or communicated at the time of clinical interview); psychosis; an organic mental health disorder; alcohol and/or drug mis- use; or were current recipients of psychological treatment. Given that the waitlist control group proceeded to receive treat- ment immediately after 8 weeks, the time period allocated to inter- vention, the acquisition of follow-up data was limited to the active intervention arm. Accordingly, participants were included in this sec- ondary analysis if they were allocated to the intervention arm and demonstrated a reliable improvement of depression or anxiety symp- toms at the end of treatment, thus meeting criteria for reliable recov- ery (defined in detail below). 1770 PALACIOS ET AL.