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International students are particularly affected by issues related to physical health, academic studies, and social and psychological matters. Despite sometimes-enormous emotional distress, there is evidence to suggest that these students are reticent to use counselling services to address these issues. The purpose of this study is to examine the rate of utilisation of counselling services by students at two Australian university campuses. Ninety participants completed a survey that examined their help-seeking behavior, the barriers that hindered them from seeking counselling, and how they eventually came to access the service. Follow-up interviews with a subset of these students (n=21) were used to gain more detailed information about their use and experience of counselling services. Counsellors were also interviewed to obtain their perspective on these issues. It was found that several factors hindered students' use of counselling services and that an overwhelming majority seek help from their friends and other fellow international students rather than counselling services. However, some sought assistance unilaterally, or by referral from academic staff. It was concluded that international students were indeed reticent to attend counselling services, and there is a strong need for counselling services to be aware of cultural attitudes that act as a blockage to their utilisation.

Background: Acceptance, adherence and efficacy aspects of Cognitive Behavioural Therapy (CBT) online have invited significant interest, especially in the context of “stepped care” models, which advocate progressive stages of intervention in addressing depression. Objectives: The current work aspires to comprehensively identify critical factors linked to the applicability of online CBT, in order to inform clinical practices and future research targeting depressive behaviors in early and middle adulthood. Methods: To serve these goals: a) the PRISMA systematic literature perspective is followed; b) a systematic search of online databases between 2008-2018 was undertaken and; c) a compositehybrid model, resulting from the integration of broadly adopted conceptualizations from the areas of psychological treatment and internet use behaviors, was combined with an interpretative phenomenological analysis perspective to organize the findings. Results: In total, 28 studies were included in the present review. Factors defining the efficacy, adherence and acceptability of online CBT targeting depression (during early and middle adulthood) were classified into parameters related to the individual receiver, the context and the CBT activities involved. Conclusion: Despite the cautiousness warranted by the limitations, as well as the diverge methodology of the reviewed studies, findings appear to favour the provision of brief, therapist supported, online CBT interventions, especially in addressing moderate depression during early and middle adulthood.

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