The National Institute for Health and Clinical Excellence
(NICE) recommends cognitive behavioral therapy (CBT)
for mild-to-moderate depression [7]. Traditional CBT
consists of 12 to 20 1-hour sessions with a mental health
expert and can be delivered in primary care settings [8].
However, it remains difficult to provide this high-intensity
(HI) specialist CBT due to the large volume of patients
with low mood, and as a result waiting lists are long. An
alternative is to supplement HI delivery with low-intensity
(LI) CBT [9]. Several separate strands of LI delivery exist,
including CBT delivered using bibliotherapy (written
self-help books) and computerized CBT (cCBT) [10], as well
as LI forms of classes/groups and behavioral activation.
These are recommended as part of stepped-care approaches
before HI CBT for mild-to-moderate depression. NICE [7]
and Gellatly and colleagues [11] recommend that including
guidance/support in using bibliotherapy and cCBT significantly
improves outcomes for those with depression using
these approaches. Crucially, the support does not need
to be delivered by a mental health or CBT expert and
the focus can be on supportive monitoring [11].