Effects of an Internet-based cognitive behavioral therapy (iCBT) program in Manga format on improving subthreshold depressive symptoms among healthy workers: a randomized controlled trial

Kotaro Imamura, Norito Kawakami, Toshi A Furukawa, Yutaka Matsuyama, Akihito Shimazu, Rino Umanodan, Sonoko Kawakami, Kiyoto Kasai, Kotaro Imamura, Norito Kawakami, Toshi A Furukawa, Yutaka Matsuyama, Akihito Shimazu, Rino Umanodan, Sonoko Kawakami, Kiyoto Kasai

Abstract

Objective: The purpose of this study was to develop a new Internet-based computerized cognitive behavior therapy (iCBT) program in Manga format, the Japanese cartoon, for workers and to examine the effects of the iCBT program on improving subthreshold depression using a randomized controlled trial (RCT) design among workers employed in private companies in Japan.

Method: All workers in a company (n = 290) and all workers in three departments (n = 1,500) at the headquarters of another large company were recruited by an invitation e-mail. Participants who fulfilled the inclusion criteria were randomly allocated to intervention or control groups (N = 381 for each group). A six-week, six-lesson iCBT program using Manga (Japanese comic) story was developed. The program included several CBT skills: self-monitoring, cognitive restructuring, assertiveness, problem solving, and relaxation. The intervention group studied the iCBT program at a frequency of one lesson per week. Depression (Beck Depression Inventory II; BDI-II) was assessed as a primary outcome at baseline, and three- and six-month follow-ups for both intervention and control groups were performed.

Results: The iCBT program showed a significant intervention effect on BDI-II (t = -1.99, p<0.05) with small effect sizes (Cohen's d: -0.16, 95% Confidence Interval: -0.32 to 0.00, at six-month follow-up).

Conclusions: The present study first demonstrated that a computerized cognitive behavior therapy delivered via the Internet was effective in improving depression in the general working population. It seems critical to improve program involvement of participants in order to enhance the effect size of an iCBT program.

Trial registration: UMIN Clinical Trials Registry UMIN000006210.

Conflict of interest statement

Competing Interests: KI is employed part-time by Chugai Pharmaceutical Company and Medical Care Toranomon as a clinical psychologist. NK has received lecture fees from Meiji, Otsuka, EAP Consulting, Fujitsu Software Technologies, Japan Productivity Center, Occupational Health Foundation, Japan Housing Finance Agency, Aishin-Seiki, and Japan Dental Association, and consultancy fees from Sekisui Chemicals, Junpukai Health Care Center, and Osaka Chamber of Commerce and Industry. He has received royalties from Igaku-Shoin, Taishu-kan, Nanko-do, Nanzan-do, PHP Publication, and Fujitsu Software Technologies, Ltd., and research grants from The Japanese Ministry of Education, Science, and Technology, the Japanese Ministry of Health, Labor and Welfare, Fujitsu Software Technologies, Ltd., Softbank, Co., Ltd., and Japan Management Association. TAF has received lecture fees from Eli Lilly, Meiji, Mochida, MSD, Pfizer and Tanabe-Mitsubishi, and consultancy fees from Sekisui and Takeda Science Foundation. He is diplomate of the Academy of Cognitive Therapy. He has received royalties from Igaku-Shoin, Seiwa-Shoten and Nihon Bunka Kagaku-sha. The Japanese Ministry of Education, Science, and Technology, the Japanese Ministry of Health, Labor and Welfare, and the Japan Foundation for Neuroscience and Mental Health have funded his research projects. YM has received lecture fees from Union of Japanese Scientists and Engineers, EPS Co., Ltd., and statcom Co., Ltd., and consultancy fees from Zeria pharmaceutical Co., Ltd., Ono pharmaceutical Co., Ltd., Mebix Co., Ltd. He has received royalties from Igaku-Shoin and Ewanami-Shoten. AS works for Hitachi Systems, Ltd. as a part-time consultant. He is on the advisory board for Junpukai Health Care Center and Ds's Mental Health Labo. He has received royalties from Baifukan, Kawashima-shoten, Seishin-shobou, and Seiwa-Shoten. RU is employed by Health Wave, Co., Ltd. as a clinical psychologist. SK is employed by Square-Enix Co., Ltd., as a contract employee. She received scholarship from the Japan Society for the Promotion of Science, and worked part-time for Dice Creative, Co, Ltd. KK has received lecture fees from Astellas, Novartis, Eli Lilly, Otsuka, Dainippon-Sumitomo, and Yoshitomi pharmaceutical companies. He has received collaborative research grants from Astellas, Hitachi Co, and Hitachi Medical, and research grants from Yoshitomi, Dainippon-Sumitomo, Astellas, and GSK. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

Figures

Figure 1. A screen shot of an…
Figure 1. A screen shot of an Internet-based cognitive behavioral therapy (iCBT) program developed in “Manga” (the Japanese cartoon or comic story) format in this study.
Figure 2. Participant flowchart.
Figure 2. Participant flowchart.

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