INTERACT: Integrated therapist and online CBT for depression in primary care


National Institute for Health (NIHR) Programme Grants for Applied Research (PGfAR) Ref. RP-PG-0514-20012

What is the research question?

Can online Cognitive Behavioural Therapy (CBT) materials be integrated, with input from an accredited CBT therapist, in order to increase the availability of high intensity CBT for patients with depression in UK primary care?

What is the problem?

In recent years the availability of psychological treatments for depression, especially for those with less severe problems, has increased. However, many people with depression are unable to get individual cognitive behavioural therapy (CBT), even though this therapy is recommended by NICE for a wide range of people (those who prefer psychological treatment and those with more severe depression), and we have shown that it is effective for people who do not respond to antidepressants. One of the reasons for this is a lack of CBT therapists; another is cost. To address this problem, computerised self-help packages based on CBT have been developed. However, these are of only modest effectiveness, and patients often do not engage with them.

What is the aim of the research?

Our aim is to integrate online CBT materials and input from an accredited CBT therapist, to deliver effective CBT to those who need it. This could lead to cost savings and increase availability, including for those for whom access is difficult (working full-time/living in remote areas/with caring responsibilities and hard-to-reach groups).

How will this be achieved?

The therapist will meet the patient for the first session, but thereafter will deliver therapy online by instant messaging in real-time at pre-arranged appointments; we have previously shown this is effective and acceptable. Patients will also have high quality materials to work with between sessions. We will improve engagement with online therapy by building the package around the relationship with the therapist. We will use the latest online technology and devices, including smart phones and tablets, to enable people to record their thoughts and feelings with greater accuracy and immediacy and conduct psychological exercises at convenient times.

There will be four elements to our programme of work:

  1. Developmental phase: we will work with stakeholders to develop the IT platform, the online materials and a training package for therapists.
  2. Randomised controlled trial: we will test the package in depressed patients recruited from general practice. We will ask depressed patients if they wish to join the trial and then randomly allocate them to receive either the package developed by us or usual care (including supported computerised CBT). This means we will have an unbiased assessment of the effectiveness of our intervention.
  3. Assessment of the cost effectiveness of the package to see if it represents value for money.
  4. In-depth interview study: we will ask patients and therapists what they think of the package.

Who is leading the research?

Dr Nicola Wiles, Reader in Epidemiology, Population Health Sciences, University of Bristol.

Further information:


For more information or to get involved in this project, please contact

The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.