Using Internet-based Cognitive Behavioural Therapy at Scarborough Hospital to Deliver More Patient-Focused Care

Rationale / Objectives

Across Canada, there are long wait times for necessary Cognitive Behavioural Therapy (CBT) services. CBT is considered the “gold standard” for the treatment of depression and anxiety. Unfortunately, the long wait lists, due to a shortage and lack of access to therapists, results in a lack of treatment for many individuals. Additionally, to get provincially-funded therapy, it means meeting with a psychiatrist in a group therapy class. To help those suffering from anxiety and depression, Scarborough Hospital’s Mental Health Department introduced a flexible, six-week internet-based cognitive behavioural therapy (iCBT) program. Through this program, patients can access clinically-proven treatment at their own convenience from the comfort of their home.  

Project/Program Description & Major Achievements

The iCBT program is based on a CBT model, that is converted for use over a six-week at home course. The iCBT has been used for years in Sweden, Australia and the UK. In the program, patients learn about CBT-based techniques through five modules. The therapy encourages patients to develop awareness of their own negative thinking patterns, and its effects on their lives. It also provides patients with new skills and tools to cope with these thought patterns. The program has evolved over the past few years based on patient feedback. The latest version of the therapy requires a physician referral and takes 6 weeks to complete instead of the original 8 week long program. These changes have resulted in improved drop-out rates (from 90% to 30%) and improved patient access to therapy.

Lessons Learned

The iCBT program was found to have numerous benefits to mental health care at the hospital. The ability for patients to access treatment in their homes, makes the treatment very convenient to both patients and health providers. The empowerment the treatment provides through its self-directed approach, gives patient as sense of autonomy over their own treatment. Additionally, due to the problems of access to mental health services in Canada, the internet based nature of the iCBT program allows further mental health treatment of the population. iCBT is not ideal for all patients, especially those with severe depression or those who will have difficulty using the technology.

People / Organizations Involved

Further Description

In 2014, the Scarborough hospital became the first place in Canada to offer iCBT. In the program patients are emailed readings, videos and homework; that they are then responsible for sending back. Trained psychiatrists then respond to the patients either by email or phone, which provides the human connection that is necessary to making therapy work. iCBT also requires less time from psychiatrists, and therefore costs less. 

Major Achievements

iCBT program has improved efficiency and productivity by reducing the amount of time spent with each patient. Traditional CBT takes 45 minutes per patient, whereas iCBT only takes 25 minutes for psychiatrists to respond to patients. The program has also utilized client feedback to improve the program. In 2014, the first version of iCBT was released and had a dropout rate of 90%. Incorporating patient’s requests for greater flexibility, more contact with the psychiatrist and more engaging modules has improved the success of the program. With this feedback, the program relaunched in 2015 and developed a reduced dropout rate of 30%. Accreditation Canada awarded the program with status as a leading practice for its work. Other groups in Canada are now studying online-delivered CBT as an alternative treatment option, including the Centre for Addiction and Mental Health, which is studying its use in youth, and the University of Regina, which is studying online therapy for chronic pain, depression, and anxiety.





Dropout rate

decreased by 60%

*between 2014 and 2015 as a result of program improvements based on patient feedback