With the growing acceptance and use of health care services online, internet-delivered cognitive-behavioural treatment (iCBT) can offer the advantage of being cost effective and easily accessible to people with severe anxiety who are hesitant to seek face-to-face treatment (Mewton et al., 2014).

CBT is recognized as an effective treatment for anxiety disorders (Mewton et al., 2014). Yet, with antidepressants being the most common form of treatment for anxiety, few people actually receive empirically-supported psychotherapy.

Researchers agree that iCBT can be a valuable alternative for people living in small towns, where wait-lists are long and access to mental health care is limited. In a recent study conducted in Sweden (Nordgren and colleagues, 2014), one hundred participants with an anxiety disorder diagnosis took part in iCBT or a wait-list control condition. Participants in the control group expected to receive treatment after ten weeks. This ensured that symptom changes resulted from the online treatment and not spontaneously with the passage of time. Participants in the iCBT group completed 7 to 10 weekly assigned modules guided by online therapists for ten weeks.

Similar strategies were delivered in iCBT as in face-to-face CBT, such as psychoeducation, worry exposure, problem solving, relaxation and mindfulness, and relapse prevention. Treatment modules were tailored to the core symptoms of each participant – a clever addition to iCBT that may address the issue of comorbidity across anxiety disorders.

Following treatment, 46% of the participants in the iCBT group showed decreases not only in symptoms of anxiety, but also in the symptoms of depression, physical ailments, and trauma. Also notable, 33% of iCBT participants sustained treatment outcomes one year after completion of the study.

Of course, internet delivered treatment may not be appropriate for all mental health difficulties. It would be interesting for future research to show how iCBT measures up relative to face-to-face CBT for other severe conditions, and how iCBT may be incorporated in out-patient settings. Therapists and researchers who view the interpersonal relationship between client and clinician as critical for treatment may interpret these findings with caution; thus research into the importance of the therapeutic relationship in iCBT is needed. Given that the rate of sustained improvement at 1-year follow-up was about 1/3, more research is needed to figure out how to improve the effectiveness of online CBT so that gains are maintained well after people have stopped using the online modules.

Research is still in its early phases. In the meantime, compelling evidence suggests that iCBT may be a potentially useful treatment for anxiety and other comorbid disorders.