***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Substantial evidence exists that positive therapy outcomes are related to the therapist – client working alliance . Objectives To report two studies that examined ( 1 ) the quality of the working alliance in online cognitive behavior therapy ( CBT ) , with minimal therapist contact , for anxiety disorders in youth , and ( 2 ) the role of working alliance and compliance in predicting treatment outcome . Methods Study 1 participants were 73 adolescents aged 12 to 18 years who met diagnostic criteria for an anxiety disorder , plus one or more of their parents . Participants were r and omly assigned to clinic or online delivery of CBT , with working alliance being assessed for youth and parents after session 3 . Study 2 participants were 132 children and adolescents aged 7 to 18 years who met diagnostic criteria for an anxiety disorder , plus one or more of their parents . Youths and parents participated in a minimally therapist-assisted online CBT program supported by brief , weekly emails and a single , short phone call . Results Study 1 revealed a strong working alliance for both online and clinic CBT , with no significant difference in working alliance between conditions for adolescents ( F 1,73 = 0.44 , P = .51 , ηp 2 = 0.006 , Cohen d = 0.15 ) . Parents also reported high working alliance in both conditions , although a slight but significantly higher working alliance in clinic-based therapy ( F 1,70 = 6.76 , P = .01 , ηp 2 = 0.09 , Cohen d = 0.64 ) . Study 2 showed a significant and substantial decrease in anxiety symptoms  following online therapy ( P < .001 for all outcome measures ) . Adolescents improved significantly more in overall functioning when working alliance ( beta = .22 , t 79 = 2.21 , P = .03 ) and therapy compliance ( beta = .22 , t 84 = 2.22 , P = .03 ) were higher , with working alliance also predicting compliance ( beta = .38 , F 1,80 = 13.10 , P = .01 ) . No such relationships were evident among younger children .  Conclusions Working alliance is important in determining clinical outcome for online treatment for anxiety among adolescents , with minimal therapist assistance , although this was not the case for younger children . Trial Registration Australian New Zeal and Clinical Trials Registry : ACTRN12611000900910 ; http://www.anzctr.org.au/trial_view.aspx?ID=343375 ( Archived by WebCite at http://www.webcitation.org/674C4N3JJ INTRODUCTION Although depression can be treated effectively with Cognitive Behaviour Therapy ( CBT ) , only a small percentage of Chinese Australians access evidence -based treatment due to practical and cultural barriers . The present study examined the efficacy and acceptability of an Internet delivered CBT ( iCBT ) program to treat Chinese Australians with depression . METHODS The Chinese depression iCBT program ( the Brighten Your Mood Program ) is a culturally adapted version of the clinical ly efficacious Sadness iCBT Program . Fifty-five Chinese Australians with depression were r and omly allocated to either an immediate treatment group or to a waitlist control group . Treatment consisted of an 8 week program with 6 CBT online educational lessons , homework assignments , additional re sources presented in Chinese and English , and weekly telephone support with M and arin/Cantonese-speaking support personnel . An intention-to-treat model was used for data analyses . RESULTS Seventeen of twenty-five ( 68 % ) treatment group participants completed all lessons within the timeframe . Compared to controls , treatment group participants reported significantly reduced symptoms of depression on the Chinese versions of the Beck Depression Inventory ( CBDI ) and Patient Health Question naire-9 item ( CB-PHQ-9 ) . The within- and between-group effect sizes ( Cohen 's d ) were 1.41 and 0.93 on the CBDI , and 0.90 and 0.50 on the CB-PHQ-9 , respectively . Participants rated the procedure as acceptable , and gains were sustained at three-month follow-up . LIMITATIONS The study included several sub clinical participants and some measures that have not been previously vali date d with Chinese Australians . CONCLUSIONS Results provide preliminary support for the efficacy and acceptability of an iCBT program at reducing symptoms of depression in Chinese Australians Background : Depression is an important health issue amongst older adults .  Internet-delivered cognitive behaviour therapy ( iCBT ) may help to reduce barriers and improve access to treatment , but few studies have examined its use with older adults . The present study evaluated the efficacy , acceptability and feasibility of a brief iCBT program , the Managing Your Mood Program , to treat depression amongst adults aged 60 years and older . Method : Using an open trial design , 20 participants with elevated symptoms of depression ( Patient Health Question naire 9-item ( PHQ-9 ) total scores ≥ 10 ) received access to five educational lessons and homework summaries , additional re sources , a moderated discussion forum and weekly telephone or email contact from a clinical psychologist . Eighty percent of the sample met diagnostic criteria for a major depressive episode at pre-treatment . Results : Completion rates and response rates were high , with 16/20 participants completing the five lessons within the 8 weeks , and post-treatment and 3-month follow-up data being collected from 17/20 participants . Participants improved significantly on the PHQ-9 and Geriatric Depression Scale ( GDS ) , with large within-group effect sizes ( Cohen ’s d ) at follow-up of 1.41 and 2.04 , respectively . The clinician spent a mean time of 73.75 minutes ( SD = 36.10 minutes ) contacting participants within the trial and the program was rated as highly acceptable by participants . Conclusions : The results are encouraging and support the potential value of iCBT in the treatment of depressive symptoms amongst older adults Background Indigenous Australian youth ( aged 15 to 34 ) have up to four times the risk of suicide compared with their non-Indigenous counterparts . Barriers to help-seeking include shame , feared loss of autonomy and negative attitudes towards healthcare providers . The use of mobile devices and apps continues to rise amongst young people , thus presenting opportunities to utilize these aids in overcoming help-seeking barriers . Apps have been shown to assist in several health-related areas , including weight loss and smoking cessation , although no apps have as yet been evaluated for suicide prevention . Moreover , there is a lack of research that scientifically evaluates suicide prevention interventions within Indigenous communities . Methods / Design In this study , a recently developed self-help app will be evaluated in a r and omized controlled trial . The intervention is based on acceptance and commitment therapy and mindfulness-based cognitive behavioural therapy . It is aim ed at participants who have suicidal thoughts but who are not actively suicidal . In total , 150 participants will be r and omly allocated to the intervention-condition ( N = 75 ) or to the wait-list control condition ( N = 75 ) . Question naires will be completed at baseline , post-test and 6 weeks follow-up . The primary outcome measure is a reduction in frequency and intensity of suicidal thoughts . Secondary outcome measures are the reduction of depression , anxiety and impulsivity . Discussion This study is the first to evaluate the effectiveness of a self-help app for suicidal thoughts amongst young Indigenous people . Several limitations and strengths of the design are discussed . Trial registration Australian New Zeal and Clinical Trials Registry ( ANZCTR ) : ACTRN12613000104752 Fifty-five people with panic disorder ( PD ) were r and omised to internet-based cognitive behavioural panic treatment ( CBT ) ( with email contact ) , therapist-assisted CBT manual or information-only control ( both with telephone contact ) . Both CBT treatments were more effective in reducing PD symptomatology , panic-related cognition , negative affect , and number of GP visits and improving physical health ratings . Internet treatment was more effective than CBT manual in reducing clinician-rated agoraphobia and number of GP visits at post- assessment . At follow-up , these effects were maintained for both CBT groups , with internet CBT better at improving physical health ratings and reducing GP visits . This study provides support for the efficacy of internet-based CBT This study was an open trial evaluation of a 10-week therapist-assisted cognitive behavior therapy ( CBT ) internet intervention ( PTSD Online ) undertaken with people with a primary clinical diagnosis of posttraumatic stress disorder ( PTSD ) ( n=22 ) at pre- assessment . Participants were re-assessed at post- assessment and 3-month follow-up . Significant improvements on PTSD severity ratings and related PTSD symptomatology were observed at post- assessment and maintained at 3-month follow-up . At post- assessment , 69.2 % of the sample showed clinical ly significant improvement and 77 % of the sample at follow-up assessment . Non-significant , yet improved , change was observed on all other general psychological measures . Overall , treatment satisfaction was good ( 69 % ) , participant therapeutic alliance ratings were high ( 87.5 % ) , and the average total therapist time required was 194.5 min . PTSD Online appears to be an efficacious treatment option for people with PTSD that can be provided entirely remotely , with far less therapist time than traditional face-to-face treatment , and without compromising therapeutic alliance BACKGROUND Subthreshold depression is common , impairs functioning and increases the risk of major depression . Improving self-help coping strategies could help subthreshold depression and prevent major depression . AIMS To test the effectiveness of an automated email-based campaign promoting self-help behaviours . METHOD A r and omised controlled trial was conducted through the website : www.moodmemos.com . Participants received automated emails twice weekly for 6 weeks containing advice about self-help strategies . Emails containing general information about depression served as a control . The principal outcome was depression symptom level on the nine-item Patient Health Question naire ( PHQ-9 ) ( trial registration : ACTRN12609000925246 ) . RESULTS The study recruited 1326 adults with subthreshold depression . There was a small significant difference in depression symptoms at post-intervention , favouring the active group ( d = 0.17 , 95 % CI 0.01 - 0.34 ) . There was a lower , although non-significant , risk of major depression in the active group ( number needed to treat ( NNT ) 25 , 95 % CI 11 to ∞ to NNT(harm ) 57 ) . CONCLUSIONS Emails promoting self-help strategies were beneficial . Internet delivery of self-help messages affords a low-cost , easily disseminated and highly automated approach for indicated prevention of depression This study compared Panic Online ( PO ) , an internet-based CBT intervention , to best- practice face-to-face CBT for people with panic disorder with or without agoraphobia . Eighty-six people with a primary diagnosis of panic disorder were recruited from Victoria , Australia . Participants were r and omly assigned to either PO ( n=46 ) or best practice face-to-face CBT ( n=40 ) . Effects of the internet-based CBT program were found to be comparable to those of face-to-face CBT . Both interventions produced significant reductions in panic disorder and agoraphobia clinician severity ratings , self reported panic disorder severity and panic attack frequency , measures of depression , anxiety , stress and panic related cognitions , and displayed improvements in quality of life . Participants rated both treatment conditions as equally credible and satisfying . Participants in the face-to-face CBT treatment group cited higher enjoyment with communicating with their therapist . Consistent with this , therapists ' ratings for compliance to treatment and underst and ing of the CBT material was higher in the face-to-face CBT treatment group . PO required significantly less therapist time than the face-to-face CBT condition Background There have been no previous studies of the variables that predict adherence to online depression and anxiety intervention programs  among adolescents . However , research of traditionally delivered intervention programs for a variety of health conditions in adolescence suggests that health knowledge , type and level of symptomatology , race , socioeconomic status , treatment setting , and support may predict adherence . Objective The aim was to compare adherence rates and identify the predictors of adherence to a cognitive behavior therapy website in two adolescent sample s that were offered the program in different setting s and under different conditions of support . Methods The first adolescent sample consisted of 1000 school students who completed the MoodGYM program in a classroom setting over five weeks as part of a r and omized controlled trial . The second sample consisted of 7207 adolescents who accessed the MoodGYM program spontaneously and directly through the open access URL . All users completed a brief survey before the start of the program that measured background characteristics , depression history , symptoms of depression and anxiety , and dysfunctional thinking . Results Adolescents in the school-based sample completed significantly more online exercises ( mean = 9.38 , SD = 6.84 ) than adolescents in the open access community sample ( mean = 3.10 , SD = 3.85 ; t 1088.62 = −28.39 , P < .001 ) . A multiple linear regression revealed that school-based setting ( P < .001 ) and female gender ( P < .001 ) were predictive of greater adherence , as were living in a rural area ( P < .001 ) and 
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Studies indicate that  e-mental health services  are predominantly used by females , and those who are more educated and socioeconomically advantaged .
Studies examining consumer preferences found a preference for face-to-face therapy over e-therapies  , but not an aversion to e-therapy .
Content relevant to governance was predominantly related to the organizational dimensions of e-mental health  services , followed by implication s for community education .
Financing and payment for e-services and governance of the information communication technology were least commonly discussed .