Trajectories of depression symptoms, anxiety symptoms and functional impairment during internet-enabled cognitive-behavioural therapy

Megan Skelton, Ana Catarino, Stephanie Brown, Ewan Carr, Molly Davies, Alicia J Peel, Christopher Rayner, Gerome Breen, Thalia Eley*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Downloads (Pure)


Underlying classes capture differences between patient symptom trajectories during psychological therapy. This has not been explored for one-to-one internet-delivered therapy or functional impairment trajectories.

Patients experiencing depression or anxiety received cognitive-behavioural therapy with a therapist using an online chat platform (N = 52,029). Trajectory classes of depression symptoms (PHQ9), anxiety symptoms (GAD7) and functional impairment (WSAS) were investigated using growth mixture modelling. Multinomial regressions tested associations between baseline variables and trajectory class.

A four-class trajectory model was selected for each outcome, and these were highly similar. Each outcome showed three classes with initially moderate-severe symptoms or impairment: one demonstrated no change, one gradual improvement and one fast improvement. A fourth class had mild baseline scores and minimal improvement. In the moderate-severe classes, patients in the two with improvement were more likely to be employed and not to have obsessive-compulsive disorder. Fast improvement was likelier than gradual improvement or no change for patients with older age, no disability (e.g., physical, learning), or lower comorbid symptom or impairment scores. Associations with functional impairment classes were more similar to associations with depression classes than anxiety classes. Results were largely consistent with findings from face-to-face therapy. This study is an important step towards personalising therapy in terms of suitability and continuation.
Original languageEnglish
JournalBehaviour Research and Therapy
Publication statusAccepted/In press - 12 Aug 2023


  • psychotherapy
  • structural equation modelling
  • interindividual variability
  • remote therapy
  • Web-based CBT
  • Talking therapy
  • cognitive-behaviour therapy


Dive into the research topics of 'Trajectories of depression symptoms, anxiety symptoms and functional impairment during internet-enabled cognitive-behavioural therapy'. Together they form a unique fingerprint.

Cite this