Integrating internet CBT into clinical practice: a practical guide for clinicians

Objective: This paper offers clinical insights and practical guidelines for clinicians about how internet-delivered cognitive behaviour therapy (iCBT) can be safely and effectively integrated into routine psychological therapy practice, in a 'blended' care model. Method: For over a decade, the Clinical Research Unit for Anxiety and Depression (CRUfAD) has developed, tested, and disseminated iCBT programs for anxiety and depression, into routine care settings. This paper outlines examples of the available iCBT options for clinicians and details the advantages of integrating iCBT for anxiety and/or depression into psychological practice. We address common barriers to using iCBT, offer practical solutions based on our research and clinical experience, and present the lived experiences of 'real-world' clinicians using iCBT in their private practises and specialist clinics. Considerations associated with risk management, funding arrangements, and flexible models of care (e.g., stepped, blended and adjunct care) are discussed. Results: Flexible and judicious use of iCBT in our outpatient routine care clinic has reduced treatment waitlists and enabled clinicians to dedicate more time to sophisticated therapeutic interventions (e.g., experiential work) and to support clients with complex needs. Conclusion: iCBT can be safely and effectively integrated into routine psychological practice, and enhance client care. What is already known about this topic: (1) Internet cognitive behavioural therapy (iCBT) is effective for treating anxiety and depression. (2) iCBT includes psychoeducation and core CBT components (e.g., thought challenging) delivered over the internet. (3) To date, most iCBT programs have been used as stand-alone interventions, either as self-help or under guidance from a clinician. What this paper adds: (1) Outlines examples of iCBT options, their advantages and disadvantages, indications and contraindications. (2) Outlines a variety of ways to integrate iCBT into routine clinical practice settings, including prequel to therapy, as an adjunct, and relapse prevention tool. (3) Offers practical solutions to address common barriers and concerns to using iCBT in routine practice.