Email Helps Decrease Symptoms of Anxiety and Depression

Depression and anxiety are among the most commonly diagnosed mental health conditions in the world. Symptoms can range from mild to severe. Both conditions can be debilitating or chronic for many people. Treatments aimed at reducing symptom severity and improving quality of life vary by method and mode and can be accessed through a variety of avenues.

One of the newest and most accessible methods of treatment is Internet psychotherapy (iPT). This mode of treatment allows clients to gain the benefits of ongoing therapy without having to leave their homes. Additionally, they can participate in treatment when it is convenient for them and as often as they need to. Some iPT programs are delivered under the guidance of a therapist, while others are self-guided. Both methods have been shown to be effective, but unfortunately, the adherence rate is very low.

Strategies to improve adherence have included short text message (SMS) and email reminders. But to date, email reminders have yet to be tested to determine if they have a positive impact on adherence and symptom reduction for self-guided iPT designed to treat both anxiety and depression. To test email reminders in this context, Nickolai Titov of the Centre for Emotional Health at the Department of Psychology of Macquarie University in Australia recently enrolled 257 adults with symptoms of depression and anxiety into an eight-week program of iPT or a wait list control condition. The iPT participants were divided into two groups, one of which received email reminders, the other of which did not.

After eight weeks, Titov assessed the adherence rates and symptom severity of the participants and found that those in the iPT all had decreases in symptoms. However, those who received the email reminders had more significant decreases. This was especially evident in the participants with the most severe symptoms prior to the iPT. Adherence also increased from 35% without reminders to 58% with reminders.

“The overall results indicate that adding automated emails can facilitate adherence and outcomes in self-guided Internet-delivered interventions,” said Titov. In conclusion, the results of this study clearly show that not only is iPT effective, adherence to iPT and other self-guided therapy approaches can be maximized with the implementation of a simple and cost-effective email reminder system.

Titov, N., Dear, B.F., Johnston, L., Lorian, C., Zou, J., et al. (2013). Improving adherence and clinical outcomes in self-guided Internet treatment for anxiety and depression: Randomised controlled trial. PLoS ONE 8(7): e62873. doi:10.1371/journal.pone.0062873

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  • sharon


    July 27th, 2013 at 1:15 AM

    there are just so many people without access to therapy.they could reap the benefits of this as long as they have internet connectivity.would help spread therapy just as the internet has helped spread knowledge.I’m all for this.

  • Sully


    July 27th, 2013 at 4:32 AM

    With everything being so technology driven today, I am far more likely to check my email ans text messages than I am to check and listen to voicemail or the answering machine. And I’m old! So I know that the younger generations are even more likely to do that.

  • Val


    July 27th, 2013 at 7:13 AM

    If this is working for a large part of the population then I would see no reason to stop it. Internet treatment is a growing trend, something that those who have a fear of leaving home can work with as well as those who need help but have little access to it in their area where they live. This is very good news for a lot of people who may have before had very few options but who now have the opportunity to get well again.

  • Davis


    July 27th, 2013 at 9:23 PM

    on a personal level I dont think something like this would work for me.i mean therapys okay but the absence of seone seeing you in person just doesnt cut it for and text reminders are fine for some people may work really well but for some of us we are old school!

  • Tony G

    Tony G

    July 28th, 2013 at 8:03 PM

    Very interesting and informing article! I can fully relate as I lived in agony for 40 years with anxiety, depression, panic attacks and a destroyed sense of self and identity. I wish that every person afflicted with these inner struggles to find peace and happiness and a way to control the emotions and behaviors associated with them. For those interested, I have a simple blog up with my experiences and my story, along with a few reviews of products/techniques that have helped me in my quest to find solutions. I sincerely want to spread the word about what helped me because after so many doctors and so many types of medicine I was at the point of believing nothing was ever going to help. I’m happy to share my story and hope it may help others!

    Many blessings to all!

  • Brittany


    July 28th, 2013 at 9:50 PM

    well a lot also depends on the severity,don’t you think?a distance program such as this may help less severe depression but anything that’s already big,maybe not.

    also,they should try and administer this program only to those that show they can benefit,otherwise it may seem like the person’s being treated when in reality there’s no treatment taking place.

  • Kenneth


    July 29th, 2013 at 4:30 AM

    Even something automated helps to keep you somewhat accountable, know what I mean? I might be willing to blow it off if I thought that no one would remember, but the email would kind of make me remem ber that someone DOES remember what I am supposed to be doing, I am taking up that time and that I owe it to myself and to them to go through with the session.
    Added to that, I just think that it gives you a sense of how the real world works, keeps you in mind of the importance of keeping scheduled appointment times, that this is not only your time but also that of someone else. All of life is like that and the time is too important to just blow off.

  • bella t

    bella t

    July 29th, 2013 at 10:50 AM

    I like the email and phone call reminders, but I also prefer the face to face meetings. Luckily I live in an area with no shortage of therapists so this is not a hardship for me.

  • andrea


    July 29th, 2013 at 7:43 PM

    depression directly means low adherence to treatment.these sort of reminder methods should be used not just for online therapy but offline too.missing therapist’s appointment is a pet peeve to many a people i’m sure.

  • Quinn


    July 30th, 2013 at 4:29 AM

    While I love the idea of in home therapy for many people, I think that there are still those people who will use it as a crutch. You know, they are afraid to go out of the house so this is their way to appear to get some help for that without really addressing those real deep seeded feras. If they are open and honest about the things that are going on with them and the therapist helps them slowly open up and address those then I think that this could be very valuable to them. But I hope that they would not use this at home option to just hide behind because that would be such a wasted opportunity.

  • p cooper

    p cooper

    July 31st, 2013 at 12:00 AM

    if email can help internet psychotherapy,that is good news.having had experience with going to a psychologist and of missing appointments,I would love to have a mechanism for offline therapy methods too.perhaps a phone call reminder would help?is there any study on the effect of a phone call reminder?and how would changing email or text message reminders to a phone call help?I am pretty sure it would increase adherence due to the human element in it.they should definitely expand this study to include phone call reminders if you ask me.

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