Toronto’s Scarborough Hospital is making it easier for those with depression or anxiety to get the clinically-proven treatment they need, all from the comfort of their home.

Cognitive behavioural therapy, or CBT, has long been the “gold standard” treatment for depression and anxiety, the two most common forms of mental illness in Canada. But in order to get provincially-funded therapy, it has meant meeting with a psychiatrist in a group therapy class at a community or hospital-based clinic.

That can be difficult for those who live hours away from the hospital. It’s not much easier for those who can’t afford to take time off work, or can’t arrange child care so that they can attend weekly meetings, which could be the reason why so many therapy groups report consistently poor attendance.

But the Scarborough Hospital is trying to change that with Internet-based CBT, or iCBT. Used for years now in Sweden, Australia and the U.K, iCBT breaks down many of these access barriers by allowing patients to complete therapy sessions from their own homes, on their own time.

In 2014, the Scarborough Hospital became the first in Canada to deliver iCBT through its outpatient clinic. Psychiatrist Dr. David Gratzer says it’s often the only way for someone with significant anxiety or phobia issues to try it.

“We’ve had patients who say, ‘Your clinic sounds great, but I’m too anxious to even get on a bus, never mind do group therapy... So we can now say to them, ‘OK, how about iCBT,’” Gratzer told

After seeking a doctor’s referral to the iCBT2 program, patients learn about CBT-based techniques through five lessons, or modules. The therapy encourages patients to become aware of the negative thinking patterns that cripple their ability to function and then gives them skills and tools to learn new ways of coping.

The patients are emailed readings to do on their own time, watch videos on a designated website, complete their homework, and then submit the modules back.

Trained TSH psychotherapists then email the patients feedback or speak to them by phone personally, if needed. Patients still have that human connection with their therapist that is crucial to making therapy work, Gratzer says, but each therapist can potentially remotely help many patients at once.

“Therapist-guided CBT doesn’t require as much time for the therapist as one-on-one therapy. In fact, some of the Swedish studies found it takes one-sixth as much time. And as a result, the costs were much lower,” he says, adding that iCBT has been offered across Sweden for years.

While Internet-delivered mental health care is still a new idea to Canada, it makes sense for us, Gratzer says. Not only is it less labour-intensive than traditional CBT, it allows patients to receive a proven therapy method that they wouldn’t otherwise be able to access.

“We see this as having numerous benefits: one is convenience; two is empowerment (because the treatment is self-directed); and three is it can help address some of the access problems we have in Canada,” he said.

What’s more, the method works. Gratzer says his clinic has been tracking its own progress and has found that even though the people who choose iCBT are often just as ill as those doing traditional CBT, the dropout rate is lower with the Internet-based format, and the patients report better scores in mood and anxiety after completing the program.

Gratzer would love to be able to offer iCBT to even more patients, including perhaps cancer patients who are experiencing depression or anxiety as a result of their diagnosis.  

“It’s often difficult to get those patients to come in and do group therapy because they’re in treatment. So maybe that’s a group that would be interested in this,” he says.

Other groups in Canada are now studying online-delivered CBT as an alternative treatment option, including the Centre for Addictions and Mental Health, which is studying its use in youth, and the University of Regina, which is studying online therapy for chronic pain, depression, and anxiety.

Gratzer says iCBT is not for everyone. It’s not well suited to those with severe depression, or those with difficulty managing the technology involved. Nor is it meant to replace traditional CBT. Indeed, many patients prefer the face-to-face of group therapy, and that’s still offered as an option.

“We’re not arguing that this is for everyone. This is just another tool in the toolkit.”