Internet-based cognitive behavioral therapy (iCBT) provides an accessible alternative to traditional treatments for depression. However, little is known about how guided and self-guided iCBT affect individual symptoms. This study applies a network approach to examine how these formats influence depression symptom networks, with and without comorbid anxiety.
We analyzed individual participant data from four randomized controlled trials that directly compared guided and self-guided iCBT. Pre- and post-treatment networks for depression (PHQ-9, BDI-II) and anxiety (GAD-7, BAI) were estimated to assess changes in connectivity, centrality, and bridge symptoms. Both formats reduced overall depression severity and improved most symptoms, with network connectivity increasing after treatment. Guided iCBT produced slightly greater improvements in overall severity and some symptoms, although post-treatment centrality patterns were largely similar between the two formats. The presence of residual central symptoms after treatment highlights the need for follow-up care and symptom-level targets for advancing precision mental health.