During the last 15 years we have seen a dramatic increase in the administration of effective drug treatment for anxiety disorders and major depression due to the introduction of SSRIs. Lately psychological treatments has been shown to be similarly effective in these conditions. Thus evidence from repeated randomized clinical trials (RCT) shows that CBT is an evenly effective alternative to SSRIs for major depression and anxiety disorders. However, due to limited availability of skilled CBT therapists we have an effective alternative to drug treatment out of reach for most patients regardless of preferences.

Fortunately, CBT provided in self-help-based approaches seems to be effective for e.g. depression, panic disorder, phobias, depression, eating disorders, PTSD and social phobia. A significant number of patients may however find it difficult to complete the treatment on their own. Thus Internet treatment with CBT in self-help format accompanied with minimal therapist contact by email seems to be a cost effective procedure to provide effective treatment to an increasing number of patients. This approach may to some extent overcome the limitation in therapist number and increase treatment accessibility. Patients may still enjoy the benefit of an individual therapist contact and thus improve the number of treatment program completers. Results from RCTs with Internet treatment in clinical settings with patients referred from general practitioners will be provided. Moreover, issues of patient selection/recruitment, web-technology and treatment limitations and clinical impressions of treating patients in this way will be discussed.