Differences in long-term outcome: face to face v internet enabled cognitive behavioural therapy (CBT)

INTERVENTION: Patients in a South London psychological service will be invited to participate in this study. These patients will have been referred for CBT by their GP for treatment for either anxiety or depression. Normally these patients would receive CBT face‐to face in a clinic or hospital out‐patient department. In this study the patients, will be allocated to a CBT therapist, as usual, but they will then be randomly assigned to either the: 1. Treatment arm ‐ internet enabled cognitive behaviour therapy 2. Control arm ‐ face‐to face cognitive behaviour therapy They will undergo treatment with the same therapist that they were allocated to. If a patient is unhappy about the method of delivery they have been assigned to (either face‐to face or IECBT) they can quickly be offered the alternative method. They will remain with the same therapist so this will not effect the continuity of their treatment. Patients who ask to be transferred to a different method will not be counted in the final data analysis for this study because this study is only interested in people who have had a full course of treatment in either face‐to face CBT or IECBT. All the patients who have completed treatment in this study (both face‐face and IECBT) will be contacted 6 months after their therapy ended. The patients will be asked to complete the depression (PHQ‐9) and anxiety (GAD‐7) questionnaires again. This study wants to understand if there is any difference in longer term gains from CBT between face‐to face CBT and IECBT. Patients will also be asked how much they remember about the treatment they had. It is anticipated that patients who have had IECBT are likely to remember more about their treatment than patients who have had face‐to face CBT. CONDITION: Anxiety disorders and depression ; Mental and Behavioural Disorders PRIMARY OUTCOME: 1. Severity of depression, measured using the Patient Health Questionnaire (PHQ‐9); 2. Severity of anxiety symptoms, measured using the Generalised Anxiety Disorder Questionnaire (GAD‐7); ; Questionnaires to be completed at every appointment and again 6 months after they have completed the treatment. SECONDARY OUTCOME: Patient feelings about their relationship with their therapist, measured using the Working Alliance Inventory INCLUSION CRITERIA: 1. Patients (all genders) who are referred to to (or who self refer) to a South London NHS IAPT service 2. Patients who are aged 18 or older 3. Patients who have been assessed as suitable for high intensity cognitive behavioural therapy 4. Patients who have access to an Internet Enabled Device and are able to use the device to send and receive emails and access web based platforms