Exploring the role of persuasive design in self-guided internet-delivered cognitive behavioural therapy

Authors: Hugh C. McCall, M.A., Heather D. Hadjistavropoulos, Ph.D., Christopher Sundström, Ph.D.


Internet-delivered cognitive behavioural therapy (ICBT) is an innovative treatment for common mental health problems like depression and anxiety. It is approximately as effective as face-to-face therapy when it is offered with therapist support by phone or secure email. It is not as effective when it is offered in a purely self-guided format, but it is easier to implement on a large scale. Various research groups have suggested that persuasive design—designing an intervention to be more engaging and stimulating for users (e.g., making treatment personalized, streamlined, and interactive)—can help improve the effectiveness of ICBT and other digital interventions for health and mental health problems.

The objective of this research was to review previously published studies to explore the relationship between persuasive design elements and effectiveness in unguided ICBT for depression and anxiety. A systematic search of five databases was conducted to identify relevant studies. A statistical procedure called meta-regression was used to determine whether the effectiveness of each unguided ICBT program was meaningfully related to the number of persuasive design elements it included.


A total of 41 studies were identified through the systematic search. The most common persuasive design elements were related to streamlining tasks of treatment and enabling users to monitor their treatment progress. The results of the meta-regressions showed that the number of persuasive design elements identified in each intervention was meaningfully related to the effectiveness of ICBT for depression but not ICBT for anxiety.


The results suggest that more persuasively designed ICBT interventions are more effective, at least for treating symptoms of depression. Since this research was conducted, PSPNET has begun incorporating new persuasive design elements (e.g., graphs to display to clients their symptom change over time) into its courses. Further research will be required to clarify the role of persuasive design in ICBT. In particular, it would be helpful to explore clients’ perspectives and experiences related to persuasive design elements and to conduct experimental studies that can directly test whether certain persuasive design elements improve the effectiveness of ICBT.