Digital & Low-Intensity Therapies
Established psychological treatments can be delivered through structured self-help materials, internet programmes and applications, with efficacy that approaches face-to-face therapy when a human being provides even brief support, and falls away sharply when nobody does.
The question is no longer whether it works, but how little human contact it can survive.
Who built it
Gerhard Andersson & Per Carlbring
Psychologists, Linköping
Built the internet-delivered CBT research programme, including the guided/unguided comparisons that define the field’s central finding.
iCBTDavid Clark & Richard Layard
Psychologist and economist
The Improving Access to Psychological Therapies programme in England — the largest attempt anywhere to deliver evidence-based psychological treatment at population scale, built on a stepped-care model with low-intensity interventions at its base.
Stepped care
Theory of personality
No theory of its own. Digital therapies are a delivery mechanism for existing models — overwhelmingly cognitive-behavioural, because those are the models that manualise cleanly.
Theory of psychopathology
Inherited from the parent model.
Theory of change
The distinctive question in this field is not mechanism but dose of human contact, and the evidence is unusually clear.
| Format | Human contact | Effect size vs. control | Completion |
|---|---|---|---|
| Guided iCBT | Brief weekly support, often 10–15 minutes, sometimes by non-specialists | Comparable to face-to-face | Good |
| Unguided iCBT | None | Substantially smaller | Poor — frequently under 20% |
| Apps, self-directed | None | Small, and inflated by weak controls | Very poor |
| Blended care | Face-to-face plus digital modules | Comparable to face-to-face, fewer sessions | Good |
Key concepts
The vocabulary you need to read the literature and to be understood in supervision.
Where it sits in the transtheoretical grid
Which change processes the system leans on, and at what level of content it aims.
- Consciousness raising
Increasing information about oneself and the problem - feedback, interpretation, education, observation.
- Self-liberation (choosing)
Choosing and committing to act, plus the belief that one can change - the deliberate exercise of agency.
- Counterconditioning
Substituting an incompatible response for the problem response - relaxation, assertion, exposure, defusion, opposite action.
- Stimulus control
Restructuring the environment so that problem cues are less likely and healthy cues more likely.
- Contingency management
Rewarding oneself or being rewarded by others for making changes; managing consequences deliberately.
- Symptom & situational problems
- Maladaptive cognitions