Journal of Contemporary Psychotherapy

, Volume 43, Issue 4, pp 235–242 | Cite as

Technology-Assisted Psychotherapy (TAP): Adapting Computerized Treatments into Traditional Psychotherapy for Depression

  • James C. OverholserEmail author
Original Paper


Technology may be changing the process of psychotherapy. Unfortunately, some therapists lack the computer skills or financial resources needed for the newest technology. The literature is reviewed for journal articles on the treatment of depression published during the past 7 years in which treatments have been guided by technology. Six findings are summarized that may be helpful when therapists lack skills or resources for advanced technology. (1) The assessment of depression can be facilitated by technology, whether using standardized questionnaires or simple ratings of mood submitted each day. (2) Technology tools can be used to send daily reminders to help clients develop more adaptive habits in thoughts or actions. (3) Clients can confront their problems through therapeutic dialogue, whether conducted in person, over the telephone, or via videoconference. (4) Depressed clients can confront their negative attitudes, often triggered by some form of loss, failure, or rejection, whether real, imagined, or anticipated. (5) Clients can use writing assignments to identify, label, explore and express their thoughts and feelings. These writing assignments can be conducted via email, or internet forms. (6) Clients value rapport with a therapist, and this bond seems important to ensure participation and adherence with treatment. Therapists can strengthen the treatment of depression using basic technology tools to extend, or supplement traditional sessions. However, it is important to protect the rapport needed for sustained participation in psychotherapy sessions.


Depression Psychotherapy Technology 



I am grateful to Bob Butler, Julia DiFilippo, and Patti Watson for providing thoughtful and critical comments on earlier versions of this paper.


  1. Aguilera, A., & Muench, F. (2013). There’s an app for that: Information technology applications for cognitive behavioral practitioners. The Behavior Therapist, 35(4), 65–73.Google Scholar
  2. Almlov, J., Carlbring, P., Berger, T., Cuijpers, P., & Andersson, G. (2009). Therapist factors in internet-delivered cognitive behavioural therapy for Major Depressive Disorder. Cognitive Behaviour Therapy, 38(4), 247–254.PubMedCrossRefGoogle Scholar
  3. Andersson, G., Carlbring, P., Berger, T., Almlov, J., & Cuijpers, P. (2009). What makes internet therapy work? Cognitive Behaviour Therapy, 38(S1), 55–60.PubMedCrossRefGoogle Scholar
  4. Andersson, G., & Cuijpers, P. (2009). Internet-based and other computerized psychological treatments for adult depression: A meta-analysis. Cognitive Behaviour Therapy, 38(4), 196–205.PubMedCrossRefGoogle Scholar
  5. Bee, P., Bower, P., Lovell, K., Gilbody, S., Richards, D., Gask, L., et al. (2008). Psychotherapy mediated by remote communication technologies: A meta-analytic review. BMC Psychiatry, 8, 60.PubMedCrossRefGoogle Scholar
  6. Bell, A., & D’Zurilla, T. (2009). Problem-solving therapy for depression: A meta-analysis. Clinical Psychology Review, 29, 348–353.PubMedCrossRefGoogle Scholar
  7. Berger, T. (2004). Computer-based technological applications on psychotherapy training. Journal of Clinical Psychology, 60(3), 301–315.PubMedCrossRefGoogle Scholar
  8. Berger, T., Hammerli, K., Gubser, N., Andersson, G., & Caspar, F. (2011). Internet-based treatment of depression. Cognitive Behaviour Therapy, 40(4), 251–266.PubMedCrossRefGoogle Scholar
  9. Calear, A., Christensen, H., Mackinnon, A., Griffiths, K., & O’Kearney, R. (2009). The YouthMood Project: A cluster randomized controlled trial of an online cognitive behavioral program with adolescents. Journal of Consulting and Clinical Psychology, 77(6), 1021–1032.PubMedCrossRefGoogle Scholar
  10. Cartreine, J., Ahern, D., & Locke, S. (2010). A roadmap to computer-based psychotherapy in the United States. Harvard Review of Psychiatry, 18, 80–95.PubMedCrossRefGoogle Scholar
  11. Cavanagh, K., & Shapiro, D. (2004). Computer treatment for common mental health problems. Journal of Clinical Psychology, 60(3), 239–251.PubMedCrossRefGoogle Scholar
  12. Cavanagh, K., Shapiro, D., VandenBerg, S., Swain, S., Barkham, M., & Proudfoot, J. (2009). The acceptability of computer-aided cognitive behavioural therapy. Cognitive Behaviour Therapy, 38(4), 235–246.PubMedCrossRefGoogle Scholar
  13. Chirita, V., Ilinca, M., Chirita, R., Bisca, M., & Chele, G. (2006). Virtual therapy in patients with depression. Annual Review of CyberTherapy and Telemedicine, 4, 181–185.Google Scholar
  14. Christensen, H., Griffiths, K., & Farrer, L. (2009). Adherence in internet interventions for anxiety and depression: Systematic review. Journal of Medical Internet Research, 11(2), e13.PubMedCrossRefGoogle Scholar
  15. Christensen, H., Griffiths, K., & Jorm, A. (2004a). Delivering interventions for depression using the internet. British Medical Journal, 328(7434), 265.PubMedCrossRefGoogle Scholar
  16. Christensen, H., Griffiths, K., Korten, A., Brittliffe, K., & Groves, C. (2004b). A comparison of changes in anxiety and depression symptoms of spontaneous users and trial participants of a cognitive behavior therapy website. Journal of Medical Internet Research, 6(4), e46.PubMedCrossRefGoogle Scholar
  17. Clarke, G., Kelleher, C., Hornbrook, M., DeBat, L., Dickerson, J., & Gullion, C. (2009). Randomized effectiveness trial of an internet, pure self-help, cognitive behavioral intervention for depressive symptoms in young adults. Cognitive Behaviour Therapy, 38(4), 222–234.PubMedCrossRefGoogle Scholar
  18. Cuijpers, P., vanStraten, A., & Warmerdam, L. (2007). Problem solving therapies for depression: A meta-analysis. European Psychiatry, 22, 9–15.PubMedCrossRefGoogle Scholar
  19. deGraaf, L., Gerhards, S., Arntz, A., Riper, H., Metsemakers, J., Evers, S., et al. (2011). One-year follow-up results of unsupported online computerized cognitive behavioural therapy for depression in primary care. Journal of Behavior Therapy and Experimental Psychiatry, 42, 89–95.CrossRefGoogle Scholar
  20. Farrer, L., Christensen, H., Griffiths, K., & Mackinnon, A. (2011). Internet-based CBT for depression with and without telephone tracking in a national helpline. PLoS ONE, 6(11), e28099.PubMedCrossRefGoogle Scholar
  21. Greenberg, L. (2004). Emotion-focused therapy. Clinical Psychology & Psychotherapy, 11, 3–16.CrossRefGoogle Scholar
  22. Griffiths, F., Lindenmeyer, A., Powell, J., Lowe, P., & Thorogood, M. (2006). Why are health care interventions delivered over the internet? Journal of Medical Internet Research, 8(2), e10.PubMedCrossRefGoogle Scholar
  23. Hanley, T. (2009). The working alliance in online therapy with young people. British Journal of Guidance and Counseling, 37(3), 257–269.CrossRefGoogle Scholar
  24. Kaltenthaler, E., Parry, G., Beverley, C., & Ferriter, M. (2008). Computerised cognitive behavioural therapy for depression. British Journal of Psychiatry, 193, 181–184.PubMedCrossRefGoogle Scholar
  25. Kenwright, M., Marks, I., Graham, C., Franses, A., & Mataix-Cols, D. (2005). Brief scheduled phone support from a clinician to enhance computer-aided self-help for obsessive-compulsive disorder. Journal of Clinical Psychology, 61(12), 1499–1508.PubMedCrossRefGoogle Scholar
  26. Malouff, J., Thorsteinsson, E., & Schutte, N. (2007). The efficacy of problem solving therapy in reducing mental and physical health problems. Clinical Psychology Review, 27, 46–57.PubMedCrossRefGoogle Scholar
  27. Marks, I., Cavanagh, K., & Gega, L. (2007). Computer-aided psychotherapy: Revolution or bubble? British Journal of Psychiatry, 191, 471–473.PubMedCrossRefGoogle Scholar
  28. Meyer, B., Berger, T., Caspar, F., Beevers, C., Andersson, G., & Weiss, M. (2009). Effectiveness of a novel online treatment for depression (Deprexis). Journal of Medical Internet Research, 11(2), e15.PubMedCrossRefGoogle Scholar
  29. Mohr, D., Hart, S., Julian, L., Catledge, C., Honos-Webb, L., Vella, L., et al. (2005). Telephone-administered psychotherapy for depression. Archives of General Psychiatry, 62, 1007–1014.PubMedCrossRefGoogle Scholar
  30. Morris, M., Kathawala, Q., Leen, T., Gorenstein, E., Guilak, F., Labhard, M., et al. (2010). Mobile therapy: Case study evaluations of a cell phone application for emotional self-awareness. Journal of Medical Internet Research, 12(2), e10.PubMedCrossRefGoogle Scholar
  31. Nezu, A., Nezu, C., & D’Zurilla, T. (2013). Problem-Solving Therapy: A treatment manual. New York: Springer.Google Scholar
  32. Overholser, J. C. (1993). Elements of the Socratic method: I. Systematic questioning. Psychotherapy, 30, 67–74.CrossRefGoogle Scholar
  33. Overholser, J. C. (1995a). Cognitive-behavioral treatment of depression. Part I: Assessment of depression and suicide risk. Journal of Contemporary Psychotherapy, 25, 185–204.CrossRefGoogle Scholar
  34. Overholser, J. C. (1995b). Cognitive-behavioral treatment of depression. Part III: Reducing cognitive biases. Journal of Contemporary Psychotherapy, 25, 311–329.CrossRefGoogle Scholar
  35. Overholser, J. C. (1996a). Cognitive-behavioral treatment of depression. Part IV: Improving problem-solving skills. Journal of Contemporary Psychotherapy, 26(1), 43–57.CrossRefGoogle Scholar
  36. Overholser, J. C. (1996b). Cognitive-behavioral treatment of depression. Part VII: Coping with precipitating events. Journal of Contemporary Psychotherapy, 26(4), 337–360.CrossRefGoogle Scholar
  37. Overholser, J. C. (2003). Cognitive-behavioral treatment of depression: A three-stage model to guide treatment planning. Cognitive and Behavioral Practice, 10, 231–239.CrossRefGoogle Scholar
  38. Overholser, J. C. (2010). Psychotherapy according to the Socratic method: Integrating ancient philosophy with contemporary cognitive therapy. Journal of Cognitive Psychotherapy, 24(4), 354–363.CrossRefGoogle Scholar
  39. Overholser, J. C. (2011). Collaborative empiricism, guided discovery, and the Socratic method: Core processes for effective cognitive therapy. Clinical Psychology: Science and Practice, 18(1), 62–66.CrossRefGoogle Scholar
  40. Overholser, J. C. (2012). Treating depression during a recession: Psychotherapy with indigent clients. Journal of Contemporary Psychotherapy, 42(1), 1–6.CrossRefGoogle Scholar
  41. Overholser, J. C. (2013). Guided discovery: Problem-solving therapy integrated within the Socratic method. Journal of Contemporary Psychotherapy, 43(2), 73–82.CrossRefGoogle Scholar
  42. Overholser, J. C., & Silverman, E. (1999). Cognitive-behavioral treatment of depression. Part VIII: Developing and utilizing the therapeutic relationship. Journal of Contemporary Psychotherapy, 28(2), 199–213.CrossRefGoogle Scholar
  43. Perini, S., Titov, N., & Andrews, G. (2009). Clinician-assisted internet-based treatments effective for depression. Australian and New Zealand Journal of Psychiatry, 43, 571–578.PubMedCrossRefGoogle Scholar
  44. Proudfoot, J., Ryden, C., Everitt, B., Shapiro, D., Goldberg, D., Mann, A., et al. (2004). Clinical efficacy of computerised cognitive-behavioural therapy for anxiety and depression in primary care. British Journal of Psychiatry, 185, 46–54.PubMedCrossRefGoogle Scholar
  45. Rhee, W., Merbaum, M., Stube, M., & Self, S. (2005). Efficacy of brief telephone psychotherapy with callers to a suicide hotline. Suicide and Life-Threatening Behavior, 35(3), 317–328.PubMedCrossRefGoogle Scholar
  46. Ruwaard, J., Schreiken, B., Schrijver, M., Broeksteeg, J., Dekker, J., Vermeulen, H., et al. (2009). Standardized web-based cognitive behavioural therapy of mild to moderate depression. Cognitive Behaviour Therapy, 38(4), 206–221.PubMedCrossRefGoogle Scholar
  47. Selmi, P., Klein, M., Greist, J., Sorrell, S., & Erdman, H. (1990). Computer-administered cognitive-behavioral therapy for depression. American Journal of Psychiatry, 147, 51–56.PubMedGoogle Scholar
  48. Sethi, S., Campbell, A., & Ellis, L. (2010). The use of computerized self-help packages to treat adolescent depression and anxiety. Journal of Technology in Human Services, 28, 144–160.CrossRefGoogle Scholar
  49. Shapiro, J., Bauer, S., Andrews, E., Pisetsky, E., Bulik-Sullivan, B., Hamer, R., et al. (2010). Mobile therapy. International Journal of Eating Disorders, 43, 513–519.PubMedCrossRefGoogle Scholar
  50. Spek, V., Cuijpers, P., Nyklicek, I., Riper, H., Keyzer, J., & Pop, V. (2007a). Internet-based cognitive behaviour therapy for symptoms of depression and anxiety. Psychological Medicine, 37, 319–328.PubMedCrossRefGoogle Scholar
  51. Spek, V., Cuijpers, P., Nyklicek, I., Smits, N., Riper, H., Keyzer, J., et al. (2008). One-year follow-up results of a randomized controlled clinical trial on internet-based cognitive behavioural therapy for subthreshold depression in people over 50 years. Psychological Medicine, 38, 635–639.PubMedCrossRefGoogle Scholar
  52. Spek, V., Nyklicek, I., Smits, N., Cuijpers, P., Piper, H., Keyzer, J., et al. (2007b). Internet-based cognitive behavioural therapy for subthreshold depression in people over 50 years old: A randomized controlled clinical trial. Psychological Medicine, 37, 1797–1806.PubMedGoogle Scholar
  53. Titov, N. (2007). Status of computerized cognitive behavioural therapy for adults. Australian and New Zealand Journal of Psychiatry, 41, 95–114.PubMedCrossRefGoogle Scholar
  54. VanDenBerg, S., Shapiro, D., Bickerstaffe, D., & Cavanagh, K. (2004). Computerized cognitive-behaviour therapy for anxiety and depression: A practical solution to the shortage of trained therapists. Journal of Psychiatric and Mental Health Nursing, 11, 508–513.CrossRefGoogle Scholar
  55. Vernmark, K., Lenndin, J., Bjarehed, J., Carlsson, M., Karlsson, J., Oberg, J., et al. (2010). Internet administered guided self-help versus individualized e-mail therapy. Behavior Research and Therapy, 48, 368–376.CrossRefGoogle Scholar
  56. Wagner, B., Knaevelsrud, C., & Maercker, A. (2006). Internet-based cognitive-behavioral therapy for complicated grief. Death Studies, 30, 429–453.PubMedCrossRefGoogle Scholar
  57. Waller, R., & Gilbody, S. (2009). Barriers to the uptake of computerized cognitive behavioural therapy. Psychological Medicine, 39, 705–712.PubMedCrossRefGoogle Scholar
  58. Wantland, D., Portillo, C., Holzemer, W., Slaughter, R., & McGhee, E. (2004). The effectiveness of web-based vs. non-web-based interventions. Journal of Medical Internet Research, 6(4), e40.PubMedCrossRefGoogle Scholar
  59. Warmerdam, L., Van Straten, A., Jongsma, J., Twisk, J., & Cuijpers, P. (2010). Online cognitive behavioral therapy and problem-solving therapy for depressive symptoms. Journal of Behavior Therapy and Experimental Psychiatry, 41, 64–70.PubMedCrossRefGoogle Scholar
  60. Zautra, A., Davis, M., Reich, J., Sturgeon, J., Arewsikporn, A., & Tennen, H. (2012). Phone based interventions with automated mindfulness and mastery messages improve the daily functioning for depressed middle-aged community residents. Journal of Psychotherapy Integration, 22(3), 206–228.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of PsychologyCase Western Reserve UniversityClevelandUSA

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