Research Evidence

The effectiveness and impact of e-hub Health’s self-help programs have been studied by many published scientific trials undertaken by research groups within and outside Australia.

A recent meta-analysis of 12 studies found moodgym is effective at reducing depression and anxiety in adults, with some evidence suggesting it also reduces general psychological distress.

Studies have shown moodgym may also help reduce hazardous alcohol use, reduce suicide risk in high-risk populations, and improve wellbeing and quality of life.

User satisfaction of moodgym is high, and evaluation studies suggest the program is a viable option for those who cannot access face-to-face therapy or those waiting for traditional services. Translating moodgym has proven to be cost effective.

Ncheka, J. M., Menon, J. A., et al. (2024). Implementing internet-based cognitive behavioural therapy (moodgym) for African students with symptoms of low mood during the COVID-19 pandemic: a qualitative feasibilty study. BMC Psychiatry, 24(1), 92. Lee, Y. Y., Le, L. K.-D., et al. (2021). The cost-effectiveness of delivering an e-health intervention, MoodGYM, to prevent anxiety disorders among Australian adolescents: A model-based economic evaluation. Mental Health & Prevention, 24, 200210. McDermott, R., & Dozois, D. J. A. (2019). A randomized controlled trial of Internet-delivered CBT and attention bias modification for early intervention of depression. Journal of Experimental Psychopathology, 10(2), 2043808719842502. Dorow, M., Stein, J., et al. (2018). [Implementation of the Internet-Based Self-Management Program "moodgym" in Patients with Depressive Disorders in Inpatient Clinical Settings - Patient and Expert Perspectives]. Psychiatr Prax, 45(5), 256-62. Howell, A. N., Rheingold, A. A., et al. (2018). Web-based CBT for the prevention of anxiety symptoms among medical and health science graduate students. Cognitive Behaviour Therapy, 1-21. Lobner, M., Pabst, A., et al. (2018). Computerized cognitive behavior therapy for patients with mild to moderately severe depression in primary care: A pragmatic cluster randomized controlled trial (@ktiv). J Affect Disord, 238, 317-26. Gilbody, S., Brabyn, S., et al. (2017). Telephone-supported computerised cognitive–behavioural therapy: REEACT-2 large-scale pragmatic randomised controlled trial. The British Journal of Psychiatry, 210(5), 362-267. Healey, B. J., Griffiths, K. M., & Bennett, K. (2017). The effect of programme testimonials on registrations for an online cognitive behaviour therapy intervention: a randomised trial. Digital Health, 3, 2055207617729937. Lobner, M., Stein, J., et al. (2017). Innovative E-Health-Ansatze fur komorbide Depressionen bei Patienten mit Adipositas: Nutzungsakzeptanz aus Patienten- und Expertenperspektive. [Innovative E-Health Approaches for Comorbid Depression in Patients with Obesity: Patient and Expert Perspectives on User Acceptance]. Psychiatr Prax, 44(5), 286-95. Yeung, A., Wang, F., et al. (2017). Outcomes of an online computerized cognitive behavioral treatment program for treating chinese patients with depression: A pilot study. Asian Journal of Psychiatry, 38, 102-7. Brabyn, S., Araya, R., et al. (2016). The second Randomised Evaluation of the Effectiveness, cost-effectiveness and Acceptability of Computerised Therapy (REEACT-2) trial: does the provision of telephone support enhance the effectiveness of computer-delivered cognitive behaviour therapy? A randomised controlled trial. Health Technol Assess, 20(89), 1-64. Twomey, C., & O’Reilly, G. (2016). Effectiveness of a freely available computerised cognitive behavioural therapy programme (MoodGYM) for depression: Meta-analysis. Australian and New Zealand Journal of Psychiatry, 51(3), 260-9. Gilbody, S., Littlewood, E., et al. (2015). Computerised cognitive behaviour therapy (cCBT) as treatment for depression in primary care (REEACT trial): large scale pragmatic randomised controlled trial. BMJ, 351. Guille, C., Zhao, Z., et al. (2015). Web-based cognitive behavioral therapy intervention for the prevention of suicidal ideation in medical interns: A randomized clinical trial. JAMA Psychiatry, 1-7. Sorensen Hoifodt, R., Mittner, M., et al. (2015). Predictors of Response to Web-Based Cognitive Behavioral Therapy With High-Intensity Face-to-Face Therapist Guidance for Depression: A Bayesian Analysis. Journal of Medical Internet Research, 17(9), 1-22. Kolstrup, N. (2014). The Internet as a medium for delivering treatment for depression. Possibilities and challenges highlighted by our experiences with MoodGYM. Tidsskrift for Forskning i Sygdom og Samfund, 21, 19-36. Lillevoll, K. R., Vangberg, H. C., et al. (2014). Uptake and adherence of a self-directed internet-based mental health intervention with tailored e-mail reminders in senior high schools in Norway. BMC Psychiatry, 14, 14. Menga, G., Ing, S. M. D., et al. (2014). Fibromyalgia: Can Online Cognitive Behavioral Therapy Help? The Ochsner Journal, 14(3), 343-9. Phillips, R., Schneider, J., et al. (2014). Randomized controlled trial of computerized cognitive behavioural therapy for depressive symptoms: effectiveness and costs of a workplace intervention. Psychological Medicine, 44(4), 741-52. Schneider, J., Sarrami Foroushani, P., et al. (2014). Acceptability of online self-help to people with depression: users' views of MoodGYM versus informational websites. Journal of Medical Internet Research, 16(3), e90. Twomey, C., O'Reilly, G., et al. (2014). A randomized controlled trial of the computerized CBT programme, MoodGYM, for public mental health service users waiting for interventions. Br J Clin Psychol, 53(4), 433-50. Wilhelmsen, M., Høifødt, R. S., et al. (2014). Norwegian General Practitioners’ Perspectives on Implementation of a Guided Web-Based Cognitive Behavioral Therapy for Depression: A Qualitative Study. Journal of Medical Internet Research, 16(9), e208. Calear, A. L., Christensen, H., et al. (2013). Adherence to the MoodGYM program: outcomes and predictors for an adolescent school-based population. J Affect Disord, 147(1-3), 338-44. Christensen, H., Farrer, L., et al. (2013). The effect of a web-based depression intervention on suicide ideation: secondary outcome from a randomised controlled trial in a helpline. BMJ Open, 3(6). Donker, T., Batterham, P. J., et al. (2013). Predictors and moderators of response to internet-delivered Interpersonal Psychotherapy and Cognitive Behavior Therapy for depression. J Affect Disord, 151(1), 343-51. Donker, T., Bennett, K., et al. (2013). Internet-Delivered Interpersonal Psychotherapy Versus Internet-Delivered Cognitive Behavioral Therapy for Adults With Depressive Symptoms: Randomized Controlled Noninferiority Trial. Journal of Medical Internet Research, 15(5), e82. Hoifodt, R. S., Lillevoll, K. R., et al. (2013). The clinical effectiveness of web-based cognitive behavioral therapy with face-to-face therapist support for depressed primary care patients: randomized controlled trial. Journal of Medical Internet Research, 15(8), e153. Lillevoll, K. R., Wilhelmsen, M., et al. (2013). Patients' experiences of helpfulness in guided internet-based treatment for depression: qualitative study of integrated therapeutic dimensions. Journal of Medical Internet Research, 15(6), e126. Lintvedt, O. K., Griffiths, K. M., et al. (2013). Evaluating the translation process of an Internet-based self-help intervention for prevention of depression: a cost-effectiveness analysis. Journal of medical Internet research, 15(1), e18. Lintvedt, O. K., Griffiths, K. M., et al. (2013). Evaluating the effectiveness and efficacy of unguided internet-based self-help intervention for the prevention of depression: a randomized controlled trial. Clinical Psychology & Psychotherapy, 20(1), 10-27. Powell, J., Hamborg, T., et al. (2013). Effectiveness of a web-based cognitive-behavioral tool to improve mental well-being in the general population: randomized controlled trial. Journal of Medical Internet Research, 15(1), e2. Sethi, S. (2013). Treating Youth Depression and Anxiety: A Randomised Controlled Trial Examining the Efficacy of Computerised versus Face‐to‐face Cognitive Behaviour Therapy. Australian Psychologist, 48(4), 249-57. Wilhelmsen, M., Lillevoll, K., et al. (2013). Motivation to persist with internet-based cognitive behavioural treatment using blended care: a qualitative study. BMC Psychiatry, 13, 296. Farrer, L., Christensen, H., et al. (2012). Web-Based Cognitive Behavior Therapy for Depression With and Without Telephone Tracking in a National Helpline: Secondary Outcomes From a Randomized Controlled Trial. Journal of medical Internet research, 14(3), e68. Ellis, L., Campbell, A., et al. (2011). Comparative randomized trial of an online cognitive-behavioral therapy program and an online support group for depression and anxiety. Journal of Cybertherapy and Rehabilitation, 4(4), 461-7. Farrer, L., Christensen, H., et al. (2011). Internet-Based CBT for Depression with and without Telephone Tracking in a National Helpline: Randomised Controlled Trial. PLoS One, 6(11), e28099. Hickie, I. B., Davenport, T. A., et al. (2010). Practitioner-supported delivery of internet-based cognitive behaviour therapy: evaluation of the feasibility of conducting a cluster randomised trial. Med J Aust, 192(11 Suppl), S31-5. Hind, D., O’Cathain, A., et al. (2010). The acceptability of computerised cognitive behavioural therapy for the treatment of depression in people with chronic physical disease: A qualitative study of people with multiple sclerosis. Psychology & Health, 25(6), 699-712. Sethi, S., Campbell, A. J., & Ellis, L. A. (2010). The Use of Computerized Self-Help Packages to Treat Adolescent Depression and Anxiety. Journal of Technology in Human Services, 28(3), 144-60. Topolovec-Vranic, J., Cullen, N., et al. (2010). Evaluation of an online cognitive behavioural therapy program by patients with traumatic brain injury and depression. Brain Injury, 24(5), 762-72. Calear, A. L., Christensen, H., et al. (2009). The YouthMood Project: a cluster randomized controlled trial of an online cognitive behavioral program with adolescents. J Consult Clin Psychol, 77(6), 1021-32. Neil, A. L., Batterham, P., et al. (2009). Predictors of adherence by adolescents to a cognitive behavior therapy website in school and community-based settings. Journal of Medical Internet Research, 11(1), e6. O'Kearney, R., Kang, K., et al. (2009). A controlled trial of a school-based Internet program for reducing depressive symptoms in adolescent girls. Depress Anxiety, 26(1), 65-72. Batterham, P. J., Neil, A. L., et al. (2008). Predictors of adherence among community users of a cognitive behavior therapy website. Patient Prefer Adherence, 2, 97-105. Burgess, N., Christensen, H., et al. (2008). Mental health profile of callers to a telephone counselling service. J Telemed Telecare, 14(1), 42-7. Mackinnon, A., Griffiths, K. M., & Christensen, H. (2008). Comparative randomised trial of online cognitive-behavioural therapy and an information website for depression: 12-month outcomes. The British Journal of Psychiatry, 192(2), 130-4. Christensen, H., & Griffiths, K. (2007). Reaching standards for dissemination: a case study. Stud Health Technol Inform, 129(Pt 1), 459-63. Christensen, H., Griffiths, K., et al. (2006). Free range users and one hit wonders: community users of an Internet-based cognitive behaviour therapy program. Australian and New Zealand Journal of Psychiatry, 40(1), 59-62. Christensen, H., Griffiths, K. M., et al. (2006). Online randomized controlled trial of brief and full cognitive behaviour therapy for depression. Psychological Medicine, 36(12), 1737-46. O'Kearney, R., Gibson, M., et al. (2006). Effects of a cognitive-behavioural internet program on depression, vulnerability to depression and stigma in adolescent males: a school-based controlled trial. Cognitive Behaviour Therapy, 35(1), 43-54. Christensen, H., Griffiths, K. M., & Jorm, A. F. (2004). Delivering interventions for depression by using the internet: randomised controlled trial. BMJ, 328(7434), 265. Christensen, H., Griffiths, K. M., et al. (2004). A comparison of changes in anxiety and depression symptoms of spontaneous users and trial participants of a cognitive behavior therapy website. Journal of Medical Internet Research, 6(4), e46. Griffiths, K. M., Christensen, H., et al. (2004). Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: randomised controlled trial. The British Journal of Psychiatry, 185, 342-9. Christensen, H., Griffiths, K. M., & Korten, A. (2002). Web-based cognitive behavior therapy: analysis of site usage and changes in depression and anxiety scores. Journal of Medical Internet Research, 4(1), e3.

A number of randomised control trials (RCTs) conducted by the ANU, collaborating institutions, and independent researchers have evaluated the e-couch Depression, Anxiety & Worry, and Social Anxiety programs.

Depression program

A recent study shows that the majority of participants found the e-couch Depression program to be beneficial.

Reported benefits include an increased understanding of depression, increased work productivity, a greater capacity to cope with everyday stress, improved relationships with others, and increased enjoyment of life.

Other evidence shows:

a greater reduction in depressive symptoms immediately post-test than an attention control (2012 RCT)
long-term positive outcomes for participants combining e-couch with an online support group
the e-couch CBT and IPT depression toolkits are as effective as moodgym (2013 equivalence trial)
improvements for users over 45 years old, with a history of, or risks for, cardiovascular disease, compared to an attention placebo control

Crisp, D. A., & Griffiths, K. M. (2016). Reducing Depression Through an Online Intervention: Benefits from a User Perspective. Journal of Medical Internet Research, 3(1), 1-11. Crisp, D., Griffiths, K., et al. (2014). An online intervention for reducing depressive symptoms: secondary benefits for self-esteem, empowerment and quality of life. Psychiatry Res, 216(1), 60-6. Donker, T., Batterham, P. J., et al. (2013). Predictors and moderators of response to internet-delivered Interpersonal Psychotherapy and Cognitive Behavior Therapy for depression. J Affect Disord, 151(1), 343-51. Donker, T., Bennett, K., et al. (2013). Internet-Delivered Interpersonal Psychotherapy Versus Internet-Delivered Cognitive Behavioral Therapy for Adults With Depressive Symptoms: Randomized Controlled Noninferiority Trial. Journal of Medical Internet Research, 15(5), e82. Donkin, L., Hickie, I. B., et al. (2013). Rethinking the dose-response relationship between usage and outcome in an online intervention for depression: randomized controlled trial. Journal of Medical Internet Research, 15(10), e231. Glozier, N., Christensen, H., et al. (2013). Internet-delivered cognitive behavioural therapy for adults with mild to moderate depression and high cardiovascular disease risks: a randomised attention-controlled trial. PLoS One, 8(3), e59139. Donkin, L., & Glozier, N. (2012). Motivators and motivations to persist with online psychological interventions: a qualitative study of treatment completers. Journal of Medical Internet Research, 14(3), e91. Griffiths, K. M., Mackinnon, A. J., et al. (2012). The effectiveness of an online support group for members of the community with depression: a randomised controlled trial. PLoS One, 7(12), e53244. Cockayne, N., Glozier, N., et al. (2011). Internet-based treatment for older adults with depression and co-morbid cardiovascular disease: protocol for a randomised, double-blind, placebo controlled trial. BMC Psychiatry, 11(1), 10. Griffiths, K., Crisp, D., et al. (2010). The ANU WellBeing study: a protocol for a quasi-factorial randomised controlled trial of the effectiveness of an Internet support group and an automated Internet intervention for depression. BMC Psychiatry, 10(1), 20.

Anxiety and Worry program

The e-couch Anxiety and Worry program has been trialled as a preventive program for young people in the community.

Other trials have shown:

when combined with email reminders, e-couch significantly decreased anxiety and ‘number of days out of role’ for participants, at least 12 months after using the program (iChill study)
to be effective in the treatment of Generalised Anxiety Disorder (GAD) in young people
both the online program and SSRI medication were shown to be effective in the treatment of GAD compared to a control website

The program has also been evaluated in a clustered randomised controlled trial as a preventive program in Australian schools.

The trial found no significant differences in anxiety symptoms across study conditions, suggesting a different approach may be more effective for reducing anxiety in school-based populations.

Calear, A. L., Batterham, P. J., et al. (2016). Cluster randomised controlled trial of the e-couch Anxiety and Worry program in schools. Journal of Affective Disorders, 196, 210-7. Calear, A. L., Christensen, H., et al. (2016). A pilot randomized controlled trial of the e-couch anxiety and worry program in schools. Internet Interventions, 6, 1-5. Christensen, H., Batterham, P., et al. (2014). Prevention of Generalized Anxiety Disorder Using a Web Intervention, iChill: Randomized Controlled Trial. Journal of Medical Internet Research, 16(9), e199. Christensen, H., Mackinnon, A. J., et al. (2014). The effectiveness of an online e-health application compared to attention placebo or Sertraline in the treatment of Generalised Anxiety Disorder. Internet Interventions, 16(9). Christensen, H., Griffiths, K. M., et al. (2010). Protocol for a randomised controlled trial investigating the effectiveness of an online e health application for the prevention of Generalised Anxiety Disorder. BMC Psychiatry, 10, 25. Christensen, H., Guastella, A. J., et al. (2010). Protocol for a randomised controlled trial investigating the effectiveness of an online e-health application compared to attention placebo or sertraline in the treatment of generalised anxiety disorder. Trials, 11, 48.

Social Anxiety program

A recent, large randomised controlled trial with self-selected community users in England showed use of the e-couch Social Anxiety program was associated with a small but statistically significant improvement in social anxiety symptoms.

A smaller study by another independent research group in the UK (2012) showed a significant reduction in the levels of social anxiety and depression in participants with high social anxiety.

Powell, J., Williams, V., et al. (2020). Effectiveness and cost-effectiveness of a self-guided internet intervention for social anxiety symptoms in a general population sample: randomized controlled trial. J Med Internet Res, 22(1):e16804. Powell, J., Atherton, H., et al. (2017). Effectiveness and cost-effectiveness of a fully self-guided internet-based intervention for sub-clinical social anxiety symptoms: Protocol for a randomised controlled trial. Digital Health, 3, 2055207617702272. Bowler, J. O., Mackintosh, B., et al. (2012). A comparison of cognitive bias modification for interpretation and computerized cognitive behavior therapy: effects on anxiety, depression, attentional control, and interpretive bias. J Consult Clin Psychol, 80(6), 1021-33.

Research shows both BluePages and moodgym reduce the mental health symptoms of anxiety and depression after a 6-week intervention, and BluePages lowers stigma. Improvements were still evident 6-months after the intervention (2003 BlueMood trial).

An online depression strategy combining both BluePages and moodgym has been shown to reduce depression symptoms in participants who were recruited after calling a national suicide helpline.

These types of programs represent a cost-effective way to deliver a comprehensive web-based depression treatment to a large number of people.

Lintvedt, O. K., Griffiths, K. M., et al. (2013). Evaluating the translation process of an Internet-based self-help intervention for prevention of depression: a cost-effectiveness analysis. Journal of Medical Internet Research, 15(1), e18. Farrer, L., Christensen, H., et al. (2012). Web-Based Cognitive Behavior Therapy for Depression With and Without Telephone Tracking in a National Helpline: Secondary Outcomes From a Randomized Controlled Trial. Journal of Medical Internet Research, 14(3), e68. Farrer, L., Christensen, H., et al. (2011). Internet-Based CBT for Depression with and without Telephone Tracking in a National Helpline: Randomised Controlled Trial. PLoS One, 6(11), e28099. Mackinnon, A., Griffiths, K. M., & Christensen, H. (2008). Comparative randomised trial of online cognitive-behavioural therapy and an information website for depression: 12-month outcomes. The British Journal of Psychiatry, 192(2), 130-4. Griffiths, K. M., & Christensen, H. (2007). Internet-based mental health programs: a powerful tool in the rural medical kit. Aust J Rural Health, 15(2), 81-7. Christensen, H., Griffiths, K. M., & Jorm, A. F. (2004). Delivering interventions for depression by using the internet: randomised controlled trial. BMJ, 328(7434), 265. Griffiths, K. M., Christensen, H., et al. (2004). Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: randomised controlled trial. The British Journal of Psychiatry, 185, 342-9. Related publications Donker, T., Griffiths, K. M., Cuijpers, P. & Christensen, H. Psychoeducation for depression, anxiety and psychological distress: A meta-analysis. BMC Medicine 2009; 7(79).

Accredited Digital Mental Health Service

Research Evidence

The effectiveness and impact of e-hub Health’s self-help programs have been studied by many published scientific trials undertaken by research groups within and outside Australia.

QUICK LINKS

USEFUL LINKS

PROGRAMS