Journal Article

Internet-Based Treatment for Adults with Depressive Symptoms: Randomized Controlled Trial

Riper, Heleen, van Straten, Annemieke, Warmerdam, Lisanne, Twisk, Jos, Cuijpers, Pim

2008

Overview

Many depressed people do not receive help for their symptoms, and there are various barriers that impede help-seeking. The Internet may offer interesting alternatives for reaching and helping people with depression. Depression can be treated effectively with Internet-based cognitive behavioral therapy (CBT), but a short intervention based on problem solving therapy (PST) could constitute a worthwhile alternative to CBT. In this study we evaluated the effectiveness of Internet-based CBT and Internet-based PST in comparison to a waiting list control group (WL), and we determined the differences between the two treatments. We conducted a 3-arm randomized controlled trial to compare CBT, PST, and WL. The main inclusion criterion was presence of depressive symptoms (>or= 16 on the Center for Epidemiological Studies Depression scale). CBT and PST consisted of eight and five weekly lessons respectively. Participants were supported by email. Self-report measures of depression, anxiety, and quality of life were completed at pretest and after 5, 8, and 12 weeks. A total of 263 participants were randomized to the three conditions (CBT: n=88; PST: n=88; WL: n=87). Of the 263 participants, 184 (70%) completed questionnaires after 5 weeks, 173 (66%) after 8 weeks, and 151 (57%) after 12 weeks. Between-group effect sizes for depressive symptoms were 0.54 for CBT after 8 weeks (95% confidence interval (CI): 0.25 - 0.84) and 0.47 for PST after 5 weeks (95% CI: 0.17 - 0.77). These effects were further improved at 12 weeks (CBT: 0.69, 95% CI: 0.41 - 0.98; PST: 0.65, 95% CI: 0.36 - 0.95). For anxiety, effect sizes were also at a medium level. Effect sizes for quality of life were low. The number of participants showing clinically significant change at 12 weeks was significantly higher for CBT (n = 34, 38.6%) and PST (n = 30, 34.1%), compared to WL (n = 0). Both Internet-based treatments are effective in reducing depressive symptoms, although the effect of PST is realized more quickly. International Standard Randomized Controlled Trial Number (ISRCTN): 16823487; http://www.controlled-trials.com/ISRCTN16823487/16823487 (Archived by WebCite at http://www.webcitation.org/5cQsOj7xf).

• Publisher: Gunther Eysenbach MD MPH, Associate Professor,Gunther Eysenbach,JMIR Publications
• Subject: Adult / Adults / Advertising as Topic / Anxiety / Anxiety Disorders - rehabilitation / Behavior modification / Behavior Therapy - methods / Clinical significance / Clinical trials / Cognition / Cognition & reasoning / Cognitive behavioral therapy / Cognitive-behavioral factors / Confidence Intervals / Consumer health information / Depression - rehabilitation / Depressive Disorder - rehabilitation / Email / Epidemiology / Follow-Up Studies / Help seeking behavior / Humans / Internet / Intervention / Medical treatment / Mental depression / Mental disorders / Mental health / Multimedia / Newspapers as Topic / Original Paper / Patient Selection / Problem Solving / Psychotherapy / Quality of Life / Registration / Reproducibility of Results / Self help / Self report / Self-Help Groups - organization & administration / Therapists / Therapy / Therapy, Computer-Assisted - methods / Time Factors / Treatment methods / Visual aids / Waiting Lists