Internet treatment for depression: a randomized controlled trial comparing clinician vs. technician assistance

Nickolai Titov, Gavin Andrews, Matthew Davies, Karen McIntyre, Emma Robinson, Karen Solley, Nickolai Titov, Gavin Andrews, Matthew Davies, Karen McIntyre, Emma Robinson, Karen Solley

Abstract

Background: Internet-based cognitive behavioural therapy (iCBT) for depression is effective when guided by a clinician, less so if unguided.

Question: Would guidance from a technician be as effective as guidance from a clinician?

Method: Randomized controlled non-inferiority trial comparing three groups: Clinician-assisted vs. technician-assisted vs. delayed treatment. Community-based volunteers applied to the VirtualClinic (www.virtualclinic.org.au) research program, and 141 participants with major depressive disorder were randomized. Participants in the clinician- and technician-assisted groups received access to an iCBT program for depression comprising 6 online lessons, weekly homework assignments, and weekly supportive contact over a treatment period of 8 weeks. Participants in the clinician-assisted group also received access to a moderated online discussion forum. The main outcome measures were the Beck Depression Inventory (BDI-II) and the Patient Health QUESTIONnaire-9 Item (PHQ-9). Completion rates were high, and at post-treatment, both treatment groups reduced scores on the BDI-II (p<0.001) and PHQ-9 (p<0.001) compared to the delayed treatment group but did not differ from each other. Within group effect sizes on the BDI-II were 1.27 and 1.20 for the clinician- and technician-assisted groups respectively, and on the PHQ-9, were 1.54 and 1.60 respectively. At 4-month follow-up participants in the technician group had made further improvements and had significantly lower scores on the PHQ-9 than those in the clinician group. A total of approximately 60 minutes of clinician or technician time was required per participant during the 8-week treatment program.

Conclusions: Both clinician- and technician-assisted treatment resulted in large effect sizes and clinically significant improvements comparable to those associated with face-to-face treatment, while a delayed treatment control group did not improve. These results provide support for large scale trials to determine the clinical effectiveness and acceptability of technician-assisted iCBT programs for depression. This form of treatment has potential to increase the capacity of existing mental health services.

Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12609000559213.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. CONSORT-R participant flow chart.
Figure 1. CONSORT-R participant flow chart.

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Source: PubMed

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