Improving adherence and clinical outcomes in self-guided internet treatment for anxiety and depression: randomised controlled trial

PLoS One. 2013 Jul 3;8(7):e62873. doi: 10.1371/journal.pone.0062873. Print 2013.


Background: Depression and anxiety are common, disabling and chronic. Self-guided internet-delivered treatments are popular, but few people complete them. New strategies are required to realise their potential.

Aims: To evaluate the effect of automated emails on the effectiveness, safety, and acceptability of a new automated transdiagnostic self-guided internet-delivered treatment, the Wellbeing Course, for people with depression and anxiety.

Method: A randomised controlled trial was conducted through the website: Two hundred and fifty seven people with elevated symptoms were randomly allocated to the 8 week course either with or without automated emails, or to a waitlist control group. Primary outcome measures were the Patient Health Questionnaire 9-Item (PHQ-9) and the Generalized Anxiety Disorder 7-Item (GAD-7).

Results: Participants in the treatment groups had lower PHQ-9 and GAD-7 scores at post-treatment than controls. Automated emails increased rates of course completion (58% vs. 35%), and improved outcomes in a subsample with elevated symptoms.

Conclusions: The new self-guided course was beneficial, and automated emails facilitated outcomes. Further attention to strategies that facilitate adherence, learning, and safety will help realise the potential of self-guided interventions.

Trial registration: Australian and New Zealand Clinical Trials Registry ACTRN12610001058066.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anxiety / therapy*
  • Australia
  • Depression / therapy*
  • Electronic Mail*
  • Female
  • Humans
  • Internet*
  • Male
  • Medication Adherence
  • Middle Aged
  • New Zealand
  • Patient Satisfaction
  • Psychotherapy*
  • Surveys and Questionnaires
  • Therapy, Computer-Assisted
  • Treatment Outcome
  • Young Adult

Grants and funding

This research was enabled by funding from the Australian National Health and Medical Research Council Project Grant No. #630560. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.