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Online CBT Is Effective in Overcoming Cultural and Language Barriers in Patients With Depression


Journal of Psychiatric Practice®: January 2016 - Volume 22 - Issue 1 - p 2–8
doi: 10.1097/PRA.0000000000000119

Objective: The goal of this study was to evaluate the efficacy of weekly email in delivering online cognitive behavioral therapy (CBT) to treat mild to moderately depressed individuals. The effectiveness of the online CBT was measured following treatment and then again at a 6-month follow-up and was compared with outcomes in a waitlist control group.

Methods: Participants were recruited through announcements on psychology Web sites, Iranian organization Web sites, and weblogs and flyers. Ninety-three individuals who met inclusion criteria, including a score >18 on the Beck Depression Inventory (BDI), participated in the study, with 47 randomly assigned to the CBT group and 46 to the control group. The CBT group received 10 to 12 sessions of online CBT conducted by a psychiatrist and a psychiatry resident. Following completion of the CBT, a second BDI was sent to participants. Another BDI was then sent to participants 6 months after the completion of treatment.

Results: Email-based CBT significantly reduced BDI scores compared with results in a waitlist control group following 10 to 12 weeks of treatment and at 6-month follow-up.

Conclusions: Email is a viable method for delivering CBT to individuals when face-to-face interaction is not possible. Limitations and future directions are discussed.

ALAVI, HIRJI, SUTTON, and NAEEM: Department of Psychiatry, Queen’s University, Kingston, ON, Canada

The authors declare no conflicts of interest.

Please send correspondence to: Nazanin Alavi, MD, Department of Psychiatry, Queen’s University, 166 Brock St, Kingston, ON, Canada K7L 5G2 (e-mail:

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