By Kathleen M Griffiths MAPS, Louise Farrer and Helen Christensen MAPS, The Centre for Mental Health Research, The Australian National University
The internet is playing an increasingly important role in the delivery of self-help treatments for mental disorders. But are such programs effective? Somewhat surprisingly, the answer would appear to be yes. In a recent systematic review of 15 randomised controlled trials (RCTs) of preventive or treatment internet interventions for mental disorders and related conditions, we found consistent evidence that internet programs are efficacious (Griffiths & Christensen, 2006). In fact, only two of the studies failed to report a significant intervention effect relative to control. A further eight RCTs (including one follow up study) have been published since the cut-off date for the 2006 review. All have demonstrated positive results.
Significantly, internet programs have been demonstrated to be helpful in treating or reducing risk factors for a range of different mental health conditions. These include depression (2 studies, 3 programs), anxiety (7 studies plus 1 follow-up, 4 programs), stress (2 studies - one involving people with schizophrenia, 2 programs), insomnia (1 study, 1 program), alcohol misuse (2 studies, 2 programs), headache (2 studies, 1 program), encopresis (1 study, 1 program) and eating disorder (3 studies, 1 program).
Of the 15 programs of demonstrated efficacy for mental health problems, four are accessible in their entirety to the public at no cost to the user. These include the depression interventions ODIN, MoodGYM, and BluePages Depression Information, and the Online Anxiety Prevention Program (OAP). The interested clinician may find the descriptions of these programs in Table 1 of interest. A key challenge for future research will be to investigate the utility of these programs as an adjunct to clinical practice.
Table 1: Free, publicly accessible evidence-based mental health internet programs
ODIN Internet Intervention  (Depression)
An interactive program offering skills and training in cognitive restructuring. The program is self-paced, and organised into eight chapters. Using the main page 'site guide', users can click through the chapters of the program. Chapters include informative text boxes, automatically scored depression quizzes, examples, brief mood exercises, and interactive cartoons. The main interactive component of the program is the counter-thought 'Helper', which allows users to match their personal negative thoughts with positive counter-thoughts. The site is largely text based, mainly coloured in black and white and easy to navigate.
Effective? An initial trial found the program ineffective in reducing depression symptoms relative to a control group. However, positive results were obtained in a second trial in which ODIN participants were provided with telephone and postcard reminders.
MoodGYM  (Depression)
An interactive CBT program comprising five modules based on cognitive restructuring, relaxation, pleasant events, assertiveness training, and problem solving. At the beginning of MoodGYM, users are introduced to a set of characters that illustrate key points throughout the program. A navigation toolbar along the right-hand side of the screen allows users to move through the program and track their progress. MoodGYM employs colour, pictures, text and flash animation to deliver information. It also contains quizzes, exercises, games, and an interactive workbook. A step-by-step MoodGYM clinician manual is available from the authors of the site.
Effective? In a large community-based trial, the program was found to be effective relative to attention control in reducing depressive symptoms and dysfunctional thoughts, and improving CBT literacy.
BluePages Depression Information 
A comprehensive source of depression information that covers symptoms of and treatments for depression, help resources, and depression and anxiety quizzes. Users of the site can access depression information by clicking on titled sections or navigation tabs listed across the top of the homepage. BluePages also includes links to MoodGYM and BlueBoard (an online mutual bulletin board support group). BluePages is colourful and easy to navigate, and uses a mixture of graphics and text to deliver information. For example, a picture-based rating system is used to convey the relative effectiveness of depression treatments.
Effective? In a large community-based trial, BluePages was found to be effective in reducing depressive symptoms and stigma, and improving depression literacy, relative to a control group.
Online Anxiety Prevention Project (OAP) 
A program comprising 6 modules that cover anxiety psychoeducation, relaxation training, interoceptive exposure, cognitive restructuring, and relapse prevention. The main page contains a list of links to a description of the program, anxiety assessments, and each of the six program 'sessions'. Users can navigate through the sessions by clicking through screens or using links on the main page. Step-by-step instructions are provided for various exercises and users can track how often they practice these exercises in an online daily practice schedule. The program is mostly text based, but contains some animations and pictures to illustrate key points.
Effective? In one study, the program was found to improve anxiety related cognitions and symptoms of depression, but not anxiety sensitivity. A follow-up study found that these outcomes were maintained at 6 months post-treatment.
Christensen, H., Griffiths, KM., & Jorm, A. (2004). Delivering interventions for depression by using the internet: Randomised controlled trial.British Medical Journal, 328, 265.  
Clarke, G., Reid, E., Eubanks, D., O'Connor, E., DeBar, L. L., Kelleher, C., et al. (2002). Overcoming depression on the internet (ODIN): A randomized controlled trial of an internet depression skills intervention program. Journal of Medical Internet Research, 4(3), e14. 
Clarke, G., Eubanks, D., Reid, E., Kelleher, C., O'Connor, E., DeBar, L., et al. (2005). Overcoming depression on the internet (ODIN) (2): A randomized trial of a self-help depression skills program with reminders. Journal of Medical Internet Research, 7(2), e16. 
Griffiths, K., Christensen, H., Jorm, A., Evans, K., & Groves, C. (2004). Effect of web-based depression literacy and cognitive behavioural therapy interventions on stigmatising attitudes to depression. British Journal of Psychiatry, 185, 342-349.  
Griffiths K.M. & Christensen H. (2006). Review of randomised controlled trials of Internet interventions for mental disorders and related conditions. Clinical Psychologist, 10, 16-29.
Kenardy, J., McCafferty, K. & Rosa, V. (2003). Internet-delivered indicated prevention for anxiety disorders: A randomised controlled trial. Behavioural and Cognitive Psychotherapy, 31, 279-289. 
Kenardy, J., McCafferty, K. & Rosa, V. (2006). Internet-delivered indicated prevention for anxiety disorders: Six-month follow up. Clinical Psychologist, 10(1), 39-42.