The promise and pitfalls of the internet for cognitive behavioral therapy

Cognitive behavior therapy (CBT) is an established psychological treatment approach [1] that is regarded as evidence based for several health conditions such as anxiety disorders [2], major depression [3], and health problems such as insomnia [4], headache [5], and tinnitus [6]. Briefly, CBT is a treatment approach that encompasses assessment strategies, cognitive and behavioral treatment techniques, a collaboration between the patient and the clinician, and use of homework assignments [7]. In addition, there are numerous other techniques that are specific for conditions, such as exposure in the treatment of anxiety disorders [8]. While most CBT studies have used the individual treatment format there is plenty of evidence to suggest that CBT works well in the group format [9], and as guided self-help [10]. The most recent development in the field of guided self-help is the use of the internet to deliver this treatment [11], and this paper comments on the potentials and pitfalls of this development.There has been a rapid expansion of outcome studies on internet-delivered CBT in the fields of psychiatry [12-14] and behavioral medicine [15], and there are an increasing number of studies showing that internet-delivered CBT can be equally effective as face-to-face CBT in conditions such as panic disorder [16], depressive symptoms [17], tinnitus [18], with studies on other conditions forthcoming.This paper will highlight the impact the internet has had on CBT, its potentials and limitations, and projections into the future on how internet-delivered CBT will influence the dissemination and development of CBT. Understanding the pros and cons of internet-delivered CBT is important as it may increase access to CBT and hence reach more patients at a lower cost. However, while resources may be saved there is still a need for clinicians to guide the treatment if effects similar to face-to-face CBT are to be obtained.While there are several studies on the effects of internet-deli