Internet-based treatment for adults with depressive symptoms: randomized controlled trial
Lisanne Warmerdam, Annemieke van Straten, Jos Twisk, Heleen Riper, Pim Cuijpers, Lisanne Warmerdam, Annemieke van Straten, Jos Twisk, Heleen Riper, Pim Cuijpers
Abstract
Background: 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.
Objective: 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.
Methods: 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.
Results: 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).
Conclusions: Both Internet-based treatments are effective in reducing depressive symptoms, although the effect of PST is realized more quickly.
Trial registration: International Standard Randomized Controlled Trial Number (ISRCTN): 16823487; http://www.controlled-trials.com/ISRCTN16823487/16823487 (Archived by WebCite at http://www.webcitation.org/5cQsOj7xf).
Conflict of interest statement
None declared.
Figures
References
- World Health Organization Department of Mental Health and Substance Abuse, authors. Prevention of Mental Disorders: Effective Interventions and Policy Options. Geneva, Switzerland: World Health Organization; 2004.
- Mathers Colin D, Loncar Dejan. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006 Nov;3(11):e442. doi: 10.1371/journal.pmed.0030442. 06-PLME-RA-0071R2
- McKendree-Smith Nancy L, Floyd Mark, Scogin Forrest R. Self-administered treatments for depression: a review. J Clin Psychol. 2003 Mar;59(3):275–88. doi: 10.1002/jclp.10129.
- Spek Viola, Cuijpers Pim, Nyklícek Ivan, Riper Heleen, Keyzer Jules, Pop Victor. Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med. 2007 Mar;37(3):319–28. doi: 10.1017/S0033291706008944.S0033291706008944
- Lépine J P, Gastpar M, Mendlewicz J, Tylee A. Depression in the community: the first pan-European study DEPRES (Depression Research in European Society) Int Clin Psychopharmacol. 1997 Jan;12(1):19–29.
- Cuijpers P. Bibliotherapy in unipolar depression: a meta-analysis. J Behav Ther Exp Psychiatry. 1997 Jun;28(2):139–47. doi: 10.1016/S0005-7916(97)00005-0.S0005-7916(97)00005-0
- Hollon Steven D, Stewart Michael O, Strunk Daniel. Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety. Annu Rev Psychol. 2006;57(1):285–315. doi: 10.1146/annurev.psych.57.102904.190044.
- Cuijpers Pim, van Straten Annemieke, Warmerdam Lisanne. Problem solving therapies for depression: a meta-analysis. Eur Psychiatry. 2007 Jan;22(1):9–15. doi: 10.1016/j.eurpsy.2006.11.001.S0924-9338(06)00188-X
- Malouff John M, Thorsteinsson Einar B, Schutte Nicola S. The efficacy of problem solving therapy in reducing mental and physical health problems: a meta-analysis. Clin Psychol Rev. 2007 Jan;27(1):46–57. doi: 10.1016/j.cpr.2005.12.005.S0272-7358(05)00168-6
- van Straten Annemieke, Cuijpers Pim, Smits Niels. Effectiveness of a web-based self-help intervention for symptoms of depression, anxiety, and stress: randomized controlled trial. J Med Internet Res. 2008;10(1):e7. doi: 10.2196/jmir.954. v10i1e7
- Bowman D, Scogin F, Lyrene B. The efficacy of self-examination therapy and cognitive bibliotherapy in the treatment of mild to moderate depression. Psychotherapy Research. 1995;5:131–140.
- Bowman V, Ward L C, Bowman D, Scogin F. Self-examination therapy as an adjunct treatment for depressive symptoms in substance abusing patients. Addict Behav. 1996;21(1):129–33. doi: 10.1016/0306-4603(95)00027-5.0306460395000275
- Bowman D, Scogin F, Floyd M, Patton E, Gist L. Efficacy of self-examination therapy in the treatment of generalized anxiety disorder. Journal of Counseling Psychology. 1997;44(3):267–273. doi: 10.1037/0022-0167.44.3.267.
- Floyd Mark, McKendree-Smith Nancy, Bailey Elaine, Stump Jamie, Scogin Forrest, Bowman Daniel. Two-year follow-up of self-examination therapy for generalized anxiety disorder. J Anxiety Disord. 2002;16(4):369–75. doi: 10.1016/S0887-6185(02)00105-6.
- Bouma J, Ranchor AV, Sanderman R, Van Sonderen E. Assessment of Depressive Symptoms with the CES-D. Manual (in Dutch) Groningen: Noordelijk Centrum voor Gezondheidsvraagstukken/Rijksuniversiteit Groningen; 1995.
- Lewinsohn PM, Antonuccio DO, Breckenridge JS, Teri L. The Coping with Depression Course: A Psychoeducational Intervention for Unipolar Depression. Eugene, OR: Castalia Publishing; 1984.
- Cuijpers P, Bonarius M, Van den Heuvel A. De “omgaan met depressie” cursus: een handreiking voor begeleiders en organisatoren [The Coping with Depression Course: A Manual] Utrecht, The Netherlands: NcGv; 1995.
- Spek Viola, Nyklícek Ivan, Smits Niels, Cuijpers Pim, Riper Heleen, Keyzer Jules, Pop Victor. Internet-based cognitive behavioural therapy for subthreshold depression in people over 50 years old: a randomized controlled clinical trial. Psychol Med. 2007 Dec;37(12):1797–806. doi: 10.1017/S0033291707000542.S0033291707000542
- Spek V, Cuijpers P, Nyklícek I, Smits N, Riper H, Keyzer J, Pop V. One-year follow-up results of a randomized controlled clinical trial on internet-based cognitive behavioural therapy for subthreshold depression in people over 50 years. Psychol Med. 2008 May;38(5):635–9. doi: 10.1017/S0033291707002590.S0033291707002590
- Furukawa T, Hirai T, Kitamura T, Takahashi K. Application of the Center for Epidemiologic Studies Depression Scale among first-visit psychiatric patients: a new approach to improve its performance. J Affect Disord. 1997 Oct;46(1):1–13. doi: 10.1016/S0165-0327(97)00079-7.S0165-0327(97)00079-7
- Haringsma R, Engels G I, Beekman A T F, Spinhoven Ph. The criterion validity of the Center for Epidemiological Studies Depression Scale (CES-D) in a sample of self-referred elders with depressive symptomatology. Int J Geriatr Psychiatry. 2004 Jun;19(6):558–63. doi: 10.1002/gps.1130.
- Yang Hao-Jan, Soong Wei-Tsuen, Kuo Po-Hsiu, Chang Hsueh-Ling, Chen Wei J. Using the CES-D in a two-phase survey for depressive disorders among nonreferred adolescents in Taipei: a stratum-specific likelihood ratio analysis. J Affect Disord. 2004 Nov 1;82(3):419–30. doi: 10.1016/j.jad.2004.04.008.S0165032704001715
- Spinhoven P, Ormel J, Sloekers P P, Kempen G I, Speckens A E, Van Hemert A M. A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med. 1997 Mar;27(2):363–70. doi: 10.1017/S0033291796004382.
- Brooks R. EuroQol: the current state of play. Health Policy. 1996 Jul;37(1):53–72. doi: 10.1016/0168-8510(96)00822-6.0168851096008226
- Cohen J. Statistical Power Analysis for the Behavioural Sciences. 2nd edition. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.
- Jacobson N S, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991 Feb;59(1):12–9. doi: 10.1037/0022-006X.59.1.12.
- Ilardi SS, Craighead WE. The Role of Nonspecific Factors in Cognitive-Behavior Therapy for Depression. Clinical Psychology: Science and Practice. 1994;1:138–155. .
- Cuijpers Pim, van Straten Annemieke, Warmerdam Lisanne. Behavioral activation treatments of depression: a meta-analysis. Clin Psychol Rev. 2007 Apr;27(3):318–26. doi: 10.1016/j.cpr.2006.11.001.S0272-7358(06)00136-X
- Andersson Gerhard, Bergström Jan, Holländare Fredrik, Carlbring Per, Kaldo Viktor, Ekselius Lisa. Internet-based self-help for depression: randomised controlled trial. Br J Psychiatry. 2005 Nov;187(5):456–61. doi: 10.1192/bjp.187.5.456. 187/5/456
- Clarke Greg, Eubanks Donna, Reid Ed, Kelleher Chris, O'Connor Elizabeth, DeBar Lynn L, Lynch Frances, Nunley Sonia, Gullion Christina. Overcoming Depression on the Internet (ODIN) (2): a randomized trial of a self-help depression skills program with reminders. J Med Internet Res. 2005;7(2):e16. doi: 10.2196/jmir.7.2.e16. v7i2e16
- Christensen Helen, Griffiths Kathleen M, Jorm Anthony F. Delivering interventions for depression by using the internet: randomised controlled trial. BMJ. 2004 Jan 31;328(7434):265. doi: 10.1136/.
- Proudfoot J, Goldberg D, Mann A, Everitt B, Marks I, Gray J A. Computerized, interactive, multimedia cognitive-behavioural program for anxiety and depression in general practice. Psychol Med. 2003 Feb;33(2):217–27. doi: 10.1017/S0033291702007225.
- Carlbring Per, Gunnarsdóttir Magdalena, Hedensjö Linda, Andersson Gerhard, Ekselius Lisa, Furmark Tomas. Treatment of social phobia: randomised trial of internet-delivered cognitive-behavioural therapy with telephone support. Br J Psychiatry. 2007 Feb;190(2):123–8. doi: 10.1192/bjp.bp.105.020107. 190/2/123
- Eysenbach Gunther. The law of attrition. J Med Internet Res. 2005 Mar;7(1):e11. doi: 10.2196/jmir.7.1.e11. v7e11
- Radloff LS. The CES-D Scale: a self-report depression scale for research in the general population. Applied Psychological Measurement. 1977;1:385–401. .
Source: PubMed