Internet-Delivered Cognitive Behavior
Therapy as a Prequel to Face-To-
Face Therapy for Depression and
Anxiety: A Naturalistic Observation
Daniel Duffy
1,2
*
†
, Angel Enrique
1,2
*
†
, Sarah Connell
1
, Conor Connolly
1
and Derek Richards
1,2
1
Clinical Research and Innovation, SilverCloud Health, Dublin, Ireland,
2
E-Mental Health Research Group, School of
Psychology, Trinity College, Dublin, Ireland
Background: The UK's Improving Access to Psychological Therapies (IAPT) program is a
stepped-care model treating individuals with depression and anxiety disorders. Internet-
delivered cognitive behavioral therapy (iCBT) is routinely offered to individuals with mild to
moderate symptoms, but its applicability to individuals with severe clinical symptoms and
requiring a high-intensity intervention is relatively unknown. The current study sought to
investigate the potential impacts of using iCBT as a prequel for patients requiring high-
intensity treatment (HIT; face-to-face) for depression and anxiety in IAPT.
Methods: The study utilized an open study design. One hundred and twenty-four
participants who were on a waiting list for high-intensity, face-to-face psychological
treatment were offered iCBT. Psychometric data on symptoms of depression, anxiety,
and functioning were collected from participants before starting and on finishing iCBT and
at the point of service exit. Therapeutic alliance data were collected from patients and
clinicians during treatment. Patient pathway data, such as number of treatment sessions
and time in treatment, was also collected and incorporated into the analysis.
Results: Significant reductions across primary outcome measures of depression and
anxiety, as well as improved functioning, were observed from baseline to iCBT treatment
exit, and from iCBT exit to service exit. Analysis of the therapeutic alliance data for patients
and clinicians illustrated differences in outcome for those who dropped out and those who
completed treatment.
Discussion: This study illustrates the potential for using iCBT as a prequel to high-
intensity therapy for depression and anxiety disorders and is the first of its kind to do so
within IAPT stepped care. The results show that iCBT is a valuable option reducing waiting
times and enhancing clinical efficiency. The study contributes to the well-established
evidence on online psychological treatments worldwide, but further clinical and service
development research is necessary to scale these treatments appropriately.
Keywords: depression, anxiety, internet-delivered interventions, internet-delivered cognitive behavioral therapy
(iCBT), Improving Access to Psychological Therapies (IAPT)
Frontiers in Psychiatry | www.frontiersin.org January 2020 | Volume 10 | Article 902 1
Edited by:
Lina Gega,
University of York,
United Kingdom
Reviewed by:
François Borgeat,
Université de Montréal,
Canada
Pawel Izdebski,
Kazimierz Wielki University of
Bydgoszcz, Poland
*Correspondence:
Daniel Duffy
duffyd8@tcd.ie
Angel Enrique
enriquea@tcd.ie
†
These authors share first authorship
Specialty section:
This article was submitted to
Public Mental Health,
a section of the journal
Frontiers in Psychiatry
Received: 03 May 2019
Accepted: 14 November 2019
Published: 09 January 2020
Citation:
Duffy D, Enrique A, Connell S,
Connolly C and Richards D (2020)
Internet-Delivered Cognitive Behavior
Therapy as a Prequel to Face-To-Face
Therapy for Depression and Anxiety:
A Naturalistic Observation.
Front. Psychiatry 10:902.
doi: 10.3389/fpsyt.2019.00902
ORIGINAL RESEARCH
published: 09 January 2020
doi: 10.3389/fpsyt.2019.00902
