The Effects of an Internet-based Cognitive Behavioral Therapy Program on Depression in Thai High School Students: A Quasiexperimental Study




Adolescents, Cognitive behavioral therapy, Depression, High school students, Internet, Quasi-experimental


Adolescents with depression often experience negative automatic thoughts, which contribute to the development of suicidal ideation. Internet-based cognitive behavioral therapy has now become a treatment to address negative automatic thoughts to prevent suicide. This quasi-experimental study aimed to assess the effects of an Internet-based Cognitive Behavioral Therapy Program on the depression of Thai adolescents. The participants consisted of 60 adolescent students with a deviation from their usual mood who were enrolled in public high schools in a province adjacent to Bangkok. The participants were conveniently selected, paired based on gender and grade point average, and randomly assigned into two groups. The experimental group received the program, while the control group received usual care (n = 30 each). Data collection instruments included a personal data form and the Healthrelated Self-report Scale. One-way repeated measures ANCOVA was used to compare the mean depression scores between the two groups while controlling for baseline depression scores.

The results indicate that the participants’ depression scores decreased over time in both groups. However, a significant group effect suggests that being in the experimental group was associated with a greater decrease in depression scores both immediately after the intervention and at the two-week follow-up compared to the control group. These findings shed light on the potential benefits of implementing this Internet-based Cognitive Behavioral Therapy Program by school nurses, teachers, or primary care nurses to prevent extreme depression and suicidal ideation among adolescents. Further investigation with longer follow-up is recommended.


Lu CY, Penfold RB, Wallace J, Lupton C, Libby AM, Soumerai SB. Increases in suicide deaths among adolescents and young adults following US Food and Drug Administration antidepressant boxed warnings and declines in depression care. Psych Res Clin Pract. 2020;2(2):43-52. Available from: DOI:

Miller L, Campo JV. Depression in adolescents. N Engl J Med. 2021;385(5):445-9. doi:10.1056/NEJMra2033475. DOI:

Watcharathaksin K, Yumyuang N, Aekwarangkoon S, Vanaleesin S, Nuampet U, Namsa J, Luksavimon L, et al. Guidelines for Muslim adolescents with depression: a systematic review. PNUJR. 2021;13(3):173-94. Available from: (in Thai).

Suntornvijitr S, Hengudomsub P, Vatanasin D, Dethchaiyot P. Predicting factors of depression among secondary school students in extended educational opportunity schools. NJPH. 2018;28(2):53-66. Available from: (in Thai).

Srijan P, Kaesornsamut P, Thanoi W. Factors correlated with depression among adolescents in foster homes. Nurs Sci J Thail. 2020;38(1):86-98. Available from: (in Thai).

Laksaneeyanawin T, Wattanaburanon A. Factors affecting depression of upper secondary school students in Mueang Chonburi district Chonburi province. Res Develop Health Syst J. 2023;15(3):59-73. Available from: (in Thai).

Hangul Z, Cirakli S. Quality of life in adolescents with primary headache may be associated with anxiety, depression, and negative automatic thoughts/Birincil bas agrisi olan ergenlerde yasam kalitesi anksiyete, depresyon ve olumsuz otomatik dusuncelerle iliskili olabilir. Turk J Child Adol Mental Health. 2021;28(3):200-7. Available from: https:// u=anon~123e1b84 &sid=googleScholar&xid= b556686f

Ruchiwit M, Phanphairoj K, Sumneangsanor T, Mamom J. The factors of the holistic health status of Thai elders in the 21st century. Curr Aging Sci. 2021;14(1):19-25. Available from: DOI:

Sunthorn W, Thapinta D, Panuthai S, Xuto P. Factors explaining postpartum depression among Thai adolescent mothers. Pacific Rim Int J Nurs Res. 2021;25(1):48-59. Available from:

Beck AT, Dozois DJ. Cognitive therapy: current status and future directions. Annu Rev Med. 2011;62:397-409. Available from: DOI:

Vatanasin D, Hengudomsub P, Vatanasin S, Asarath T, Chupan S, Srisopa P. Factors predicting depression among health science students. JFONUBUU. 2015; 23(4):1-20 (in Thai). Available from:

Makassawad R. Factors in fluencing depression among high school students in Pathum Thani province. RHPC9Journal. 2021;15(38):528-40. Available from: (in Thai).

Secundino-Guadarrama G, Veytia-López M, Guadarrama- Guadarrama R, Míguez MC. Depressive symptoms and automatic negative thoughts as predictors of suicidal ideation in Mexican adolescents. Salud Ment. 2021;44(1): 3-10. doi: 10.17711/SM.0185-3325.2021.002. DOI:

Choon MW, Abu Talib M, Yaacob SN, Awang H, Tan JP, Hassan S, et al. Negative automatic thoughts as a mediator of the relationship between depression and suicidal behaviour in an at‐risk sample of Malaysian adolescents. Child Adolesc Ment Health. 2015;20(2):89-93. doi: 10.1111/camh.12075. DOI:

Hofmann SG, Asmundson GJ, Beck AT. The science of cognitive therapy. Behav Ther. 2013;44(2):199-212. Available from: DOI:

Okumura Y, Ichikura K. Efficacy and acceptability of group cognitive behavioral therapy for depression: a systematic review and meta-analysis. J Affect Disord. 2014;164:155-64. Available from: 04.023 DOI:

Li J, Li X, Jiang J, Xu X, Wu J, Xu Y, et al. The effect of cognitive behavioral therapy on depression, anxiety, and stress in patients with COVID-19: a randomized controlled trial. Front Psychiatry. 2020;11:580827. Available from: DOI:

Dobkin RD, Mann SL, Gara MA, Interian A, Rodriguez KM, Menza M. Telephone-based cognitive behavioral therapy for depression in Parkinson disease: a randomized controlled trial. Neurology. 2020;94(16):e1764-73. doi: 10.1212/WNL.0000000000009292. DOI:

Farrer L, Christensen H, Griffiths KM, Mackinnon A. Web-based cognitive behavior therapy for depression with and without telephone tracking in national helpline: secondary outcomes from a randomized controlled trial. J Med Internet Res. 2012;14(3):e68. doi: 10.2196/jmir.1859. DOI:

Webb CA, Rosso IM, Rauch SL. Internet-based cognitive behavioral therapy for depression: current progress and future directions. Harv Rev Psychiatry. 2017;25(3):114-22. doi: 10.1097/HRP.0000000000000139. DOI:

Uratanamnee S, Lerdsamran S. Stress, anxiety, and depression of high school teenager in preparation for university admission. J Psychiatr Nurs Ment Health. 2017;31(2):78-94. Available from: (in Thai).

Mercadal Rotger J, Cabré V. Therapeutic alliance in online and face-to-face psychological treatment: comparative study. JMIR Ment Health. 2022;9(5):e36775. doi: 10.2196/36775. DOI:

Gandy M, Pang ST, Scott AJ, Heriseanu AI, Bisby MA, Dudeney J, et al. Internet-delivered cognitive and behavioural based interventions for adults with chronic pain: a systematic review and meta-analysis of randomized controlled trials. Pain. 2022;163(10):e1041-53. doi: 10.1097/j.pain.0000000000002606. DOI:

Mogoașe C, Cobeanu O, David O, Giosan C, Szentagotai A. Internet‐based psychotherapy for adult depression: what about the mechanisms of change? J Clin Psychol. 2017; 73(1):5-64. doi: 10.1002/jclp.22326. DOI:

Topooco N, Byléhn S, Dahlström Nysäter E, Holmlund J, Lindegaard J, Johansson S, et al. Evaluating the efficacy of internet-delivered cognitive behavioral therapy blended with synchronous chat sessions to treat adolescent depression: randomized controlled trial. J Med Internet Res. 2019;21(11):e13393. doi: 10.2196/13393. DOI:

Leibovich L, Mechler J, Lindqvist K, Mortimer R, Edbrooke-Childs J, Midgley N. Unpacking the active ingredients of internet-based psychodynamic therapy for adolescents. Psychother Res. 2023;33(1):108-17. Available from: DOI:

Kasantikul D, Karnjanathanalers N, Limsuwan N, Thongtang O, Vuthiganond S, Khuangsirikul V, et al. Health-related Self-report (HRSR) Scale: the diagnostic screening test for depression in Thai population. J Med Assoc Thai. 1997;80(10):647-57. PMID: 10904568.

Wu Y, Fenfen E, Wang Y, Xu M, Liu S, Zhou L, et al. Efficacy of internet-based cognitive-behavioral therapy for depression in adolescents: a systematic review and meta-analysis. Internet Interv. 2023;34:100673. Available from: DOI:

Vigerland S, Lenhard F, Bonnert M, Lalouni M, Hedman E, Ahlen J, et al. Internet-delivered cognitive behavior therapy for children and adolescents: a systematic review and meta-analysis. Clin Psychol Rev. 2016;50:1-10. Available from: DOI:

Institute for Population and Social Research, Mahidol University In collaboration with the Thai Health Promotion Foundation. Thai Health 2020: two decades of educational reforms: failures and successes institute for population and social research [Internet]. 2020 [cited 2024 Feb 26]. Available from:

Sweeney GM, Donovan CL, March S, Forbes Y. Logging into therapy: adolescent perceptions of online therapies for mental health problems. Internet Interv. 2019;15:93-9. doi: 10.1016/j.invent.2016.12.001. DOI:

Linden A. Assessing regression to the mean effects in health care initiatives. BMC Med Res Methodol. 2013;13:119. doi: 10.1186/1471-2288-13-119. DOI:




How to Cite

Rungrojwatanasiri P, Jirarode A, Petpichetchian W. The Effects of an Internet-based Cognitive Behavioral Therapy Program on Depression in Thai High School Students: A Quasiexperimental Study. PRIJNR [Internet]. 2024 Mar. 23 [cited 2024 May 23];28(2):439-54. Available from: