Review of randomised controlled trials of Internet interventions for mental disorders and related conditions KATHLEEN M. GRIFFITHS & HELEN CHRISTENSEN Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia Abstract Self-help Internet interventions have the potential to enable consumers to play a central role in managing their own health. This paper contains a systematic review of 15 randomised controlled trials of the effectiveness of self-help Internet interventions for mental disorders and related conditions. Conditions addressed by the interventions included: depression, anxiety, stress, insomnia, headache, eating disorder and encopresis. Most interventions were reported to be effective in reducing risk factors or improving symptoms, although many of the studies had methodological limitations. Three of the interventions that reported positive outcomes are available without charge to the public. Keywords: Evaluation, internet, mental disorder, self help, world wide web Consumers are increasingly demanding a central role in the management of their own health, and there is growing interest in self-help as a method of addres- sing mental disorders and related conditions. Consistent with this perspective, a number of meta- analyses have demonstrated the efficacy of self-help techniques for the treatment of mental disorders (Apodaca & Miller, 2003; Barlow, Ellard, Hains- worth, Jones, & Fisher, 2005; Cuijpers, 1997; Den Boer, Wiersma, & Van Den Bosch, 2004; Gould & Clum, 1993; Marrs, 1995). Although self-help programs can be conducted without professional or other contact, self-help research programs often incorporate some ongoing contact with participants with the aim of improving adherence to the program and decreasing drop-out rates. Moreover, in prac- tice, many mental health professionals prescribe self- help books to their clients(Adams & Pitre, 2000; Campbell & Smith, 2003; Starker, 1988). For example, Adams and Pitre (2000) reported that 65% of therapists surveyed in their Canadian study recommended bibliotherapy to their clients, with prescribing rates highest among therapists with the most clinical experience. Therapists report prescrib- ing self-help books to ensure that clients take responsibility for their own recovery, as an enhance- ment to face-to-face therapy and in response to client requests (Adams & Pitre, 2000). Websites offer similar potential advantages as books, but the available evidence suggests that therapists are less likely to recommend websites to their clients. Indeed, Campbell and Smith (2003) reported that only one third of psychologists recommended websites to their clients. Websites offer a number of advantages as adjuncts to psychological therapy. They are convenient for the user and in many cases require no payment, and they can be accessed anonymously. There is evidence that health consumers prefer multimedia format to other formats including paperback booklets (Bader & Strickman-Stein, 2003). Websites can be updated frequently and can be tailored to geographical area. They can also link to other online, relevant resources. They can be interactive, tailored to individual circumstances and supported by a data- base that enables clients and clinicians to track client progress. From the clinician’s perspective, a website is a tool that they can provide to clients that will help them consolidate skills learned in therapy sessions. Websites also have the potential to free clinicians from some of the more routine aspects of therapy. One reason for clinician reticence in recommending self-help websites may be concern over their quality. For example, a number of studies have demonstrated that depression websites are of poor quality (Berland et al., 2001; Griffiths & Christensen, 2000, 2002). Correspondence: Dr K. Griffiths, Director, Depression & Anxiety Consumer Research Unit, Centre for Mental Health Research, Australian National University, Canberra, ACT 0200, Australia. E-mail: Kathy.griffiths@anu.edu.au Clinical Psychologist, Vol. 10, No. 1, March 2006, pp. 16 – 29. ISSN 1328-4207 print/ISSN 1742-9552 online ª The Australian Psychological Society Ltd Published by Taylor & Francis DOI: 10.1080/13284200500378696