Internet interventions: In review, in use, and into the future.

The provision of health care over the Internet is a rapidly evolving and potentially beneficial means of delivering treatment otherwise unsought or unobtainable. Internet interventions are typically behavioral treatments operationalized and transformed for Web delivery with the goal of symptom improvement. The literature on the feasibility and utility of Internet interventions is limited, and there are even fewer outcome study findings. This article reviews empirically tested Internet interventions and provides an overview of the issues in developing and/or using them in clinical practice. Future directions and implications are also addressed. Although Internet interventions will not likely replace face-to-face care, there is little doubt that they will grow in importance as a powerful component of successful psychobehavioral treatment. With the advancement of computer technologies over the past 20 years, a flood of new ways to communicate, provide, and deliver psychological treatments has emerged. The Internet has the ability to reach people all over the world and provide highly specialized psychological interventions otherwise not sought or obtainable. There is a new but growing literature on the use of the Internet as a means of delivering treatment. These Internet treatments are typically focused on behavioral issues, with the goal of instituting behavior change and subsequent symptom improvement. They are usually self-paced, interactive, and tailored to the user, and they make use of the multimedia format offered by the Internet. Individuals with computer and Internet access who use these treatments may also overcome many of the barriers to obtaining traditional care because they can seek such treatments at any time, any place, and often at significantly reduced cost. Clearly, people are using computers and the Internet in greater frequency and with the specific purpose of obtaining mental health information (see Crutsinger, 2000; Employment Policy Foundation, 2001; Pew Research Center, 2002; Rabasca, 2000). This new field of Internet interventions is only going to grow and expand. The benefits are vast, as there is the potential for greater numbers of people to receive more services than ever before. However, to meet this potential, Internet interventions, like any other treatment, must first demonstrate feasibility and efficacy through rigorous scientific testing. In this article we present a critical examination of the current state of the available literature focused on the development and testing of these types of interventions. In addition, issues that should be addressed when constructing Internet interventions are enumerated, followed by a discussion of possible future directions and implications for research and clinical practice.