Improving Retention in Online Cognitive Behavioral Therapy

High Dropout Rates in Online Therapy for University Students

The increasing prevalence of mental health issues among university students has necessitated innovative therapeutic interventions. Internet-based cognitive behavioral therapy (iCBT) is one such approach that has shown promise in treating conditions such as depression and anxiety. However, despite its advantages, iCBT faces significant challenges, primarily high dropout rates. Research indicates that up to 50% of participants in these programs do not complete them (Koelen et al., 2022). This phenomenon is particularly concerning given that dropout can severely diminish the effectiveness of the intervention (Fernandez et al., 2015).

Many factors contribute to these high dropout rates. A study by Koelen et al. (2025) identified personal issues such as competing priorities, perceived difficulty of the interventions, and a lack of human interaction as significant barriers to completion. Students often juggle academic pressures, social obligations, and personal challenges, making it difficult to prioritize mental health interventions. Moreover, the perceived complexity or redundancy of the CBT exercises tends to discourage continued engagement. Addressing these dropout rates is crucial not only to ensure the efficacy of iCBT but also to optimize mental health outcomes for students.

Key Factors Influencing Completion of Internet-Based CBT

Understanding the factors that influence the completion of iCBT programs is essential for improving retention rates. Research identifies several key determinants, including the clarity of the intervention, perceived effectiveness, and the quality of participant support. For instance, individuals who received guidance from a therapist often reported higher satisfaction and engagement levels compared to those who participated in unguided programs (Koelen et al., 2024).

Another significant factor is the personalization of the therapeutic content. Studies have shown that interventions tailored to meet individual needs tend to yield better retention rates. Participants who felt that the iCBT content was relevant to their specific challenges reported higher levels of engagement and motivation (Ciharova et al., 2023). Additionally, the functionality of the digital platform influences usability and subsequent adherence. Features such as reminders, interactive elements, and opportunities for peer support can significantly enhance the user experience and encourage completion.

Enhancing Engagement in Digital Mental Health Interventions

Engagement is a critical factor in the success of digital mental health interventions. To enhance engagement in iCBT, it is vital to create an interactive and user-friendly platform. Research has shown that incorporating gamification elements, such as rewards for completing modules or progress tracking, can motivate participants to stay committed to the program (Fleming et al., 2017). Additionally, providing opportunities for social interaction, such as group discussions or forums, can foster a sense of community and reduce feelings of isolation that often accompany mental health struggles.

The integration of technology, such as chatbots or virtual therapists, can also facilitate real-time interactions and support, addressing participants’ queries as they progress through the program. This immediacy can enhance the therapeutic alliance and increase the likelihood of completion. Furthermore, ensuring that the platform is accessible across various devices and operating systems can help students engage with the content at their convenience, thereby reducing barriers to participation.

The Role of Personalization and Human Support in iCBT

Personalization and human support are crucial to the effectiveness of iCBT. As highlighted in the findings from Koelen et al. (2025), participants who received tailored feedback and support from therapists reported a greater sense of accountability and motivation. Personalized interventions that adapt to the user’s progress and responsiveness not only enhance engagement but also cater to individual learning styles, making the therapeutic process more effective.

Furthermore, the presence of human support, whether through a therapist or peer interactions, can mitigate feelings of alienation that often accompany online therapy. Participants who felt connected to their therapists or peers were more likely to continue with their treatment. Therefore, integrating personalized elements and human contact into digital therapy models is essential for improving retention rates.

Strategies for Improving Retention in Online Mental Health Programs

To effectively reduce dropout rates in iCBT, a multifaceted approach is necessary. Here are several strategies that can enhance retention in online mental health programs:

1. Set Realistic Expectations: Educating participants about the demanding nature of therapy and potential challenges they may encounter can help adjust expectations and encourage persistence.

2. Personalized Interventions: Utilizing algorithms to offer tailored content based on individual responses and engagement patterns can enhance relevance and maintain interest.

3. Regular Check-ins and Support: Implementing scheduled check-ins with therapists or facilitators can provide participants with the necessary support and accountability.

4. Social Connectivity: Creating avenues for peer support and interaction can foster a sense of community and reduce feelings of isolation.

5. Gamification and Engagement: Incorporating gamified elements such as rewards or progress tracking can motivate participants and make the therapeutic process more engaging.

6. Feedback Mechanisms: Providing participants with feedback on their progress can help reinforce their commitment to the program and encourage continued participation.

7. Flexible Scheduling: Allowing participants to engage with the content at their convenience can alleviate the pressure of strict timelines, thereby enhancing overall adherence.

By addressing both the psychological and logistical barriers to participation, these strategies can significantly improve retention rates in online cognitive behavioral therapy programs.

FAQ

What is internet-based cognitive behavioral therapy (iCBT)?

iCBT is a form of cognitive behavioral therapy delivered online, allowing participants to engage with therapeutic content at their convenience, often with varying levels of human support.

Why do students drop out of online therapy programs?

High dropout rates in online therapy programs can be attributed to competing priorities, perceived difficulty of the interventions, lack of human interaction, and feelings of isolation.

How can engagement in online mental health interventions be improved?

Engagement can be improved by creating interactive platforms, integrating gamification elements, providing social support, and ensuring easy accessibility across devices.

What role does personalization play in iCBT?

Personalization enhances the relevance of therapeutic content to individual users, which can significantly improve engagement and retention rates.

What strategies can reduce dropout rates in online mental health programs?

Strategies to reduce dropout rates include setting realistic expectations, providing personalized interventions, ensuring regular support, fostering social connectivity, incorporating gamification, and offering flexible scheduling.

References

1. Koelen, J., Klein, A., Wolters, N., Bol, E., De Koning, L., & Roetink, S. (2025). Dropout and completion in iCBT for university students: Insights from a thematic analysis. Internet Interventions, 21, 100831. https://doi.org/10.1016/j.invent.2025.100831

2. Fernandez, E. S., Salem, D. S., & Swift, J. K. (2015). Meta-analysis of dropout from cognitive behavioral therapy: Magnitude, timing, and moderators. Journal of Consult and Clinical Psychology, 83(6), 1081-1122

3. Fleming, T. M., Bavin, L., Stasiak, K., & Hetrick, S. E. (2017). Serious games and gamification for mental health: Current status and promising directions. Frontiers in Psychiatry, 7, 215. https://doi.org/10.3389/fpsyt.2016.00215

4. Ciharova, M., Cuijpers, P., Amanvermez, Y., Riper, H., & Klein, A. (2023). Use of tailoring features and reasons for dropout in a guided internet-based transdiagnostic individually-tailored cognitive behavioral therapy for symptoms of depression and/or anxiety in college students. Internet Interventions, 34, 100646. https://doi.org/10.1016/j.invent.2023.100646

5. Koelen, J. A., Vonk, A., Klein, A., De Koning, L., & Wiers, R. (2024). Online cognitive behavioral therapy: A meta-analysis on the added value of human support in text-based internet treatments for mental disorders. Clinical Psychology Review, 96, 102179. https://doi.org/10.1016/j.cpr.2022.102179