Diminishing Effects After Recurrent Use of Self-Guided Internet-Based Interventions in Depression: Randomized Controlled Trial

Lara Bücker, Patricia Schnakenberg, Eirini Karyotaki, Steffen Moritz, Stefan Westermann, Lara Bücker, Patricia Schnakenberg, Eirini Karyotaki, Steffen Moritz, Stefan Westermann

Abstract

Background: Self-guided internet-based interventions have several advantages over guided interventions and are generally effective in treating psychiatric symptoms.

Objective: We aimed to investigate whether the use of a new self-guided internet-based intervention (MOOD) would lead to a significant reduction in depressive symptoms compared with a care-as-usual (CAU) control group in a sample of individuals with depressive symptoms, most of whom had already used a different self-guided internet-based intervention in a previous trial.

Methods: A total of 125 individuals were randomized to the intervention condition (MOOD) and received access to the intervention for a period of six weeks or a CAU group. After six weeks, all participants were invited to take part in the post assessment. The Beck Depression Inventory-II served as the primary outcome.

Results: Both intention-to-treat as well as per-protocol analyses indicated that the depressive symptomatology decreased in both conditions but showed no advantage for those who had used MOOD. Subsequent moderation analyses suggested that those individuals who had less experience with psychotherapy benefitted to a greater extent compared with those with more experience.

Conclusions: Self-guided internet-based interventions are deemed a suitable first-step approach to the treatment of depression. However, our results indicate that they are more efficacious in those with less psychotherapy experience.

Trial registration: ClinicalTrials.gov NCT03795480; https://ichgcp.net/clinical-trials-registry/NCT03795480.

Keywords: depressive symptoms; eHealth; randomized controlled trial; self-management.

Conflict of interest statement

Conflicts of Interest: None declared.

©Lara Bücker, Patricia Schnakenberg, Eirini Karyotaki, Steffen Moritz, Stefan Westermann. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 02.10.2019.

Figures

Figure 1
Figure 1
Consolidated Standards of Reporting Trials flow diagram. ITT: intention-to-treat; PP: per-protocol.
Figure 2
Figure 2
Interaction effects of current treatment (left), number of prior treatment (right) and group allocation. The graph on the left presents the effects of current treatment (1=yes, 2=no) on symptom reduction. The graph on the right depicts how experience with psychotherapy (number of prior treatments) is related to depressive symptomatology (outcome: reduction on BDI-II). BDI-II: Beck Depression Inventory-II.

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