Advantages and limitations of Internet-based interventions for common mental disorders

TLDR

Internet interventions for common mental disorders have been developed and shown to be cost‑effective with outcomes comparable to face‑to‑face therapy, yet questions remain about how to integrate them with traditional care. This paper reviews recruitment pros and cons, evaluates advantages and disadvantages for mood and anxiety disorders, addresses comorbidity management, and discusses dissemination challenges. The authors examine recruitment strategies, online assessment procedures (noting that diagnoses require patient contact), therapist guidance (which improves outcomes mainly through practical support), and strategies for handling comorbidity and scaling interventions. Online questionnaires provide robust data but cannot diagnose without contact; guided interventions outperform unguided ones mainly through practical support, and overall evidence confirms that Internet interventions are effective.

Abstract

Several Internet interventions have been developed and tested for common mental disorders, and the evidence to date shows that these treatments often result in similar outcomes as in face-to-face psychotherapy and that they are cost-effective. In this paper, we first review the pros and cons of how participants in Internet treatment trials have been recruited. We then comment on the assessment procedures often involved in Internet interventions and conclude that, while online questionnaires yield robust results, diagnoses cannot be determined without any contact with the patient. We then review the role of the therapist and conclude that, although treatments including guidance seem to lead to better outcomes than unguided treatments, this guidance can be mainly practical and supportive rather than explicitly therapeutic in orientation. Then we briefly describe the advantages and disadvantages of treatments for mood and anxiety disorders and comment on ways to handle comorbidity often associated with these disorders. Finally we discuss challenges when disseminating Internet interventions. In conclusion, there is now a large body of evidence suggesting that Internet interventions work. Several research questions remain open, including how Internet interventions can be blended with traditional forms of care.