The Managing Stress and Anxiety programme and the Managing Your Mood programme are two separate ICBT programmes developed for older adults with symptoms of anxiety and depression, respectively (Zou et al. 2012; Dear et al. 2013). Both programmes comprise 5 core lessons and are delivered over 8 weeks. Participants are encouraged to complete 1 core lesson every 7–10 days and the programmes are designed to prevent participants from accessing later materials before completing earlier materials. The programmes also include lesson summaries and homework tasks as well as additional resources, including assertiveness skills, problem-solving, managing beliefs and improving sleep. Participants in these programmes are provided with brief weekly contact with a clinician, via a secure messaging system or email, and also a large range of comments, feedback and suggestions from previous participants. These programmes also include a number of automatic emails, which alert participants to new content, congratulate participants for completing materials and remind participants about content that has yet to be completed.

The material in these programmes is presented in a combination of didactic and narrative formats and participants follow cartoon-based illustrated characters and stories throughout the programmes. The material in these programmes was drawn from previous programmes (Titov et al. 2011; Dear et al. 2011) but was modified to include age-appropriate characters, stories and examples and to account for issues relevant to older adults, including health status and role transitions. Importantly, the Managing Stress and Anxiety and Managing Your Mood programmes are very similar and differ only in their focus on symptoms of anxiety or depression, as well as the illustrated stories, which provide examples of older adults with either symptoms of anxiety or depression. The only other difference was the sequencing of the lessons. In particular, the presentation of information and skills for managing the physical symptoms was presented before thought challenging in the Managing Your Mood programme and vice versa in the Managing Stress and Anxiety programme. Each lesson in both programmes begins with a summary of the key information and skills described in prior lessons, provides an agenda for the current lesson and provides detailed illustrated examples of characters with similar symptoms using the skills and summary of the key points and skills covered in the lesson.

The Managing Stress and Anxiety Course and the Managing Your Mood Course are two entirely new ICBT interventions (Dear et al. (2015a) and Titov et al. (2015)), which were developed based on the structure of the earlier programmes for older adults.¹ These courses also comprise 5 core lessons and are also delivered over 8 weeks with all of the same therapeutic material and self-management skills covered. However, the materials and content were completely recreated for these newer programmes for older adults. As with the previous programmes, the materials of these newer courses were written in both a didactic format and narrative format, except that, instead of illustrated cartoons, these newer courses used detailed case studies (called Case Stories) to explain the information presented and to demonstrate the application of the skills. The Case Stories were used to facilitate learning, adherence and engagement, while reducing defensiveness and normalising the difficulties of learning the materials and applying the skills covered in the course.

These newer ICBT courses cover all of the same materials and skills as the previous programmes but were created in a way that they could be administered with or without clinician guidance, that is, in a clinician-guided or self-guided format. For example, Do It Yourself Guides were created for every lesson and these included recommendations for skills practice and detailed examples, covering a broad range of problems and symptoms, which participants could use to guide their own practice of the skills. A very comprehensive set of automatic emails was also created to more closely guide participants through the course and to support participants to consistently practice the skills taught. Specifically, as described elsewhere (Titov et al. 2013), emails were triggered (1) when participants completed a lesson during the course, (2) if a lesson was not completed within 7 days of becoming available, (3) each week when new lessons became available or to suggest some tasks for the week and (4) when participants were known to experience increases in symptoms or to have increased difficulties practicing skills. The emails were written and designed to (1) make sure participants always knew about new content available on the site, (2) remind participants about unread materials, (3) reinforce progress and skills practice, (4) ‘normalise’ the challenges of learning new skills and (5) emphasise and explain that symptom reduction required gentle, but consistent, practice of the skills over time.

There is a large ongoing project focussed on developing an individually tailored Internet-based treatment for anxiety and depression by the Internet, Health and Clinical Psychology Research Group at Linköping University, Sweden (Carlbring et al. 2011; Andersson et al. 2011; Johansson et al. 2012; Bergman et al. 2013). This individually tailored treatment is designed to identify participant’s unique symptom profile and to provide information and skills that were likely to be helpful based on a participant’s symptom profile. Importantly, in recent years, this project has been extended to also tailor on the basis of age, specifically for adolescents (Silfvernagel et al. 2015), young adults (Silfvernagel et al. 2012) and older adults (Silfvernagel et al. unpublished).

Individually tailored ICBT aims to tailor the treatment according to the participant’s needs and symptoms with transdiagnostic components (Silfvernagel et al. 2012). The goal is to identify and target participant’s specific psychosocial difficulties and psychological comorbidities with the aim of increasing the relevance, comprehensiveness and clinical outcomes of ICBT treatments. Importantly, the treatment package for older adults consists of modules derived from previous ICBT treatments, which have been adapted to make them suitable for an older population (Silfvernagel et al. unpublished). The first module (i.e. the introduction module) and the last module (i.e. a relapse prevention module) are fixed and the following are optional for the therapists to prescribe within an 8-week timeframe: cognitive restructuring (2 modules), panic disorder (2 modules), agoraphobia (1 module), generalised anxiety (3 modules), social anxiety (2 modules), behavioural activation (2 modules), applied relaxation (1 module), stress (1 module), mindfulness (1 module), problem-solving (1 module) and insomnia (1 module). There are also long and short versions for the diagnosis-specific modules for the therapist to choose from. The modules are all based on established and evidence-based CBT treatments and modules contain relevant components like psychoeducation, exposure exercises and behavioural experiments. All modules contain homework assignments for the participants, which consist of questions on the psychoeducational sections and tasks for the participant to complete, such as exposure exercises. Therapist guidance is included in the treatment and there are no automatic emails; all contact is initiated by either the therapist or the participant.

An online version of the Dutch CWD course (Cuijpers 2000) was developed by the Trimbos Institute within the Netherlands Institute of Mental Health and Addiction (Spek et al. 2007, 2008). The original Coping with Depression (CWD) course (Lewinsohn et al. 1992) is a structured course based on CBT and social learning theory (Bandura 1977). It consists of 12 2-h group sessions over 8 weeks with sessions held twice weekly for the first 4 weeks. The course provides psychoeducation about depression as well as strategies for reducing depression, such as cognitive restructuring, pleasant activity scheduling and relapse prevention. However, the online CWD course consists of 8 online modules, delivered over 8 weeks. The online CWD comprises a mixture of didactic text, practice exercises, videos and figures. The online version of the CWD course is designed to be administered in a self-guided format with no clinician contact throughout the course. Importantly, while the original and online CWD courses were not designed for older adults, one study has examined its efficacy in reducing subclinical symptoms of depression among adults over the age of 50 and up to 75 years of age (Spek et al. 2007, 2008). Hence, the Course and the results of these trials are included in this review.