Patients (N=110; 55 e-CBT participants and 55 in-person CBT participants) aged between 18 and 65 years will be recruited from Queen’s University from the outpatient psychiatry clinic at both the Kingston Health Sciences Center sites (Hotel Dieu Hospital and Kingston General Hospital) as well as from Providence Care Hospital located in Kingston, Ontario, Canada. Additionally, family doctors, physicians, clinicians, and self-referrals will be accepted. Once informed consent is provided, a psychiatrist from the research team will evaluate participants through a secure video appointment to make or confirm a diagnosis of MDD using the Diagnostic and Statistical Manual of Mental Disorders, 5th edition [31].

The inclusion criteria for the study are as follows: aged at least 18 years at the start of the study, diagnosed with MDD according to Diagnostic and Statistical Manual of Mental Disorders, 5th edition by an attending psychiatrist from the research team, competence to consent to participate, ability to speak and read English, and consistent and reliable access to the internet. Exclusion criteria are as follows: active psychosis, acute mania, severe alcohol or substance use disorder, and/or active suicidal or homicidal ideation. If a participant is receiving another form of psychotherapy, they will also be excluded from the study to avoid any confounding effect on the efficacy of this e-CBT program. Participants are eligible for the study if they are receiving pharmacotherapy. However, they must be receiving the same drug and dosage for the duration of the study. If eligible for the study, participants will choose between the e-CBT program (n=55) or the in-person CBT offered individually through this program at Hotel Dieu Hospital (n=55).

During the informed consent process, all participants will be explained that this program is not a crisis resource and that they will not always have access to their therapist. In the case of an emergency, participants will be directed to the proper resources (eg, emergency department or crisis lines), and this event will be reported to the principal investigator of the study. The reasoning behind having a nonrandomized design and allowing patients to choose their treatment is to mimic a real-world setting in which patients have autonomy in their treatment decisions. We recognize that this could be a limitation of this study. We plan to conduct a randomized controlled trial in the future.

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