Evidence-based online clinics

Macquarie University researchers are using internet-based platforms to help people with anxiety and depression access treatment.

Making treatment easier to access

One in five people experience anxiety or depression in any given year, but less than half of those affected will seek any treatment for their condition.

There can be a number of reasons why people do not seek help when they need it most. The cost of treatment can be a barrier, as can the distance to the nearest town – patients in regional and remote areas can find it very difficult to access psychological assessment and care.

Internet-based platforms

In their search for a solution to the problem, Professor Nick Titov and Dr Blake Dear have developed two internet-based platforms for the provision and validation of treatment for anxiety and depression:

Blake Dear

The eCentreClinic is a research clinic focused on developing and testing new treatments. Once we have sufficient evidence for a treatment and we know it is effective, we move it over to the MindSpot Clinic, which is a national assessment and treatment service for Australians with anxiety and depression.

Dr Blake Dear Professor & Senior Clinical Psychologist, School of Psychological Sciences

Titov and Dear joined Macquarie University in 2011 to establish the internet-based clinics and worked closely with colleagues in the School of Psychological Sciences and the Centre for Emotional Health.

Titov has a wealth of research expertise regarding the treatment of anxiety and depressive disorders, and Dear was trained as a clinical psychologist with a specific interest in helping patients struggling with challenging health conditions such as chronic pain.

Innovative research

“There is a culture of innovation here at Macquarie. The eCentreClinic and the MindSpot Clinics are good examples of how that culture promotes and nurtures paradigm shifts,” says Titov.

“We developed an innovative model which challenges multiple paradigms: how psychological therapy should work; the duration of the therapy; and the relationship with patients. In some cases we have a lot of contact with patients, in other cases very little, particularly if they are socially anxious.”

“The culture at Macquarie gives permission to explore research questions at multiple levels providing they’re informed by evidence and they’re safe. I think that’s rare at a university, there’s something very special about Macquarie.”

The eCentreClinic

As co-directors of the eCentreClinic, Titov and Dear developed evidence-based treatments for a range of conditions, including:

  • social anxiety disorder
  • panic disorder
  • generalised anxiety disorder
  • major depression.

“Internationally, we’ve contributed to innovation in the development of trans-diagnostic interventions,” says Titov. “Clinicians and patients struggle with the fact that different disorders of anxiety and depression can occur at the same time.”

“Our programs work across different age groups. They also work effectively across different disorders.”

Since the eCentreClinic was established in 2011, it has grown from an innovative psychological assessment and treatment model for anxiety and depression into a specialist research clinic, exploring the digital and telephone delivery of psychological care for a whole range of conditions and difficulties.

From the beginning, its mission was clear – the team wanted to help more people to access treatment for anxiety and depression.

“We’re motivated to improve access for patients to evidence-based care. We really want to address the burden of untreated depression and anxiety in the community,” says Titov. “We knew that our internet-based interventions had potential, but we needed to develop a research programme with quality assurance.”

“We needed clinical trials with a very large number of people and we knew it was a challenge. But we’re always up for a big challenge.”

The MindSpot Clinic

To test the treatment models they developed, the eCentreCinic carried out more than 20 clinical trials in its first two years of operation, involving more than 2000 participants across Australia. Soon after, 12 separate treatment programs had been developed and the MindSpot Clinic was launched.

Proven to be as effective as traditional face-to-face treatments, the programs are also designed to be delivered at a fraction of the cost of existing services. Designed to be relevant and practical, the programmes use techniques derived from interpersonal and cognitive behavioural therapy to support patients in the short and long term. Importantly, the treatments have received a resounding endorsement from consumers who find them both effective and engaging.


Since 2012, selected eCentreClinic treatment courses have been offered through the MindSpot Clinic, which is funded by the Australian Government.

Over three years, the internet clinic provided assessment and treatment to 50,000 Australians, offering care to thousands of people who are unable or unwilling to receive support elsewhere.

“We accept referrals from health providers around Australia but in reality the majority of patients who come to us self-refer,” explains Titov. “They hear about our website, they see references to us in articles or online ads and they initiate an assessment without going to a health professional. So we’re making a difference in reducing some of the barriers that prevent people from seeking help.”

Ongoing research

Research is continuing into the best approaches for the delivery of acceptable and effective internet-based care. Titov and Dear are keen to find out more about those who benefit and those who do not, and to continue to develop treatment programs, particularly for people struggling with other challenging health conditions such as chronic pain. While clinical results have been “outstanding,” the pair is dedicated to reaching even more Australians who need treatment.

“We’ve been struck by the sheer number of Australians who have never been taught the fundamental skills and strategies that support psychological wellbeing,” says Titov. “I’m sure it is the same story elsewhere in the world.”

Nick Titov

The internet interventions that we are developing can support people to recover from anxiety and depression. We have a platform and a model for public health that can have a massive impact on the wellbeing of a nation. It is an enormous opportunity and an enormous responsibility.

Professor Nick Titov Executive Director of the MindSpot Clinic, Co-Director of the eCentreClinic