Clinician-assisted Internet-based treatment is effective for depression: Randomized controlled trial

Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, New South Wales, Australia.
Australian and New Zealand Journal of Psychiatry (Impact Factor: 3.41). 07/2009; 43(6):571-8. DOI: 10.1080/00048670902873722
Source: PubMed


The aim of the present study was to determine the efficacy of an Internet-based clinician-assisted computerized cognitive behavioural treatment (CaCCBT) programme for depression.
Forty-five individuals meeting diagnostic criteria for depression were randomly assigned to the Sadness programme or to a waitlist control group. In the clinician-assisted Sadness programme, participants complete six online lessons, weekly homework assignments, receive weekly email contact from a clinical psychologist, and contribute to a moderated online discussion forum with other participants. An intention-to-treat model was used for data analyses.
A total of 20 (74%) treatment group participants completed all lessons within the 8 week programme, and post-treatment data were collected from 18/27 treatment group and 17/18 waitlist group participants. Treatment group participants reported significantly reduced symptoms of depression as measured by the Beck Depression Inventory-second edition and the Patient Health Questionnaire-Nine Item. Treatment group participants each received an average of eight email contacts (111 min of therapist time]. Mean within- and between-group effect sizes (Cohen's d) across the two measures of depressive symptoms were 0.98 and 0.75, respectively. Participants found the treatment programme acceptable and satisfactory.
These results replicate those from the pilot trial reported by Perini et al. and are consistent with literature indicating that Internet-based programmes for depression and other mental disorders combined with clinical guidance can result in clinically significant improvements. These data provide further support for the development of Internet-based treatment for common mental disorders.

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    • "nalysis of inter - group differences E - mail therapy comprised individualized treatment protocols based on CBT - principles for treating depression , with a focus on case conceptualization , functional analysis , and subsequent applications of components commonly used in CBT for depression including behavior activation and cognitive restructuring Perini et al . ( 2009 ) Forty - five individuals with DSM IV depressive disorder were randomized into either the treatment group ( Sadness Program ) or wait - listed ."

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    • "Internet-based cognitive behavioral therapy (iCBT) has been shown to be efficacious in the treatment of anxiety and depression. Specifically, the efficacy of iCBT has been demonstrated in the treatment of Generalized Anxiety Disorder (Robinson et al., 2010*, Cuijpers et al., 2009), 1 Social Anxiety Disorder (Titov et al., 2008b*, Titov et al., 2009a*, Titov et al., 2009b*, Carlbring et al., 2009), Panic Disorder with and without Agoraphobia (Wims et al., 2010*, Carlbring et al., 2006), Depression (Andersson and Cuijpers, 2009; Perini et al., 2009*), and mixed anxiety and depression (Titov et al., 2011*, Newby et al., 2013*). A recent metaanalysis of 22 studies demonstrated that iCBT had a mean effect size of 0.88 (Number needed to treat = 2.13; Andrews et al., 2010). "
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    ABSTRACT: There is evidence from randomized control trials that internet-based cognitive behavioral therapy (iCBT) is efficacious in the treatment of anxiety and depression, and recent research demonstrates the effectiveness of iCBT in routine clinical care. The aims of this study were to implement and evaluate a new pathway by which patients could access online treatment by completing an automated assessment, rather than seeing a specialist health professional. We compared iCBT treatment outcomes in patients who received an automated pre-treatment questionnaire assessment with patients who were assessed by a specialist psychiatrist prior to treatment. Participants were treated as part of routine clinical care and were therefore not randomized. The results showed that symptoms of anxiety and depression decreased significantly with iCBT, and that the mode of assessment did not affect outcome. That is, a pre-treatment assessment by a psychiatrist conferred no additional treatment benefits over an automated assessment. These findings suggest that iCBT is effective in routine care and may be implemented with an automated assessment. By providing wider access to evidence-based interventions and reducing waiting times, the use of iCBT within a stepped-care model is a cost-effective way to reduce the burden of disease caused by these common mental disorders.
    Internet Interventions 11/2014; 1(4). DOI:10.1016/j.invent.2014.10.003
    • "At the end of each lesson the patient downloaded " homework " tasks which reinforced the content of the lesson. The efficacy of this iCBT depression course has been established previously in two registered randomized controlled trials, Cohen's d¼ 0.73, 1.20 respectively, mean number needed to treat of two (NNT¼ 2) (Perini et al., 2009; Titov et al., 2010). "
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    ABSTRACT: Background: Depression is a major risk factor for suicide. Given the strong association between depression and suicide, treatment for depression should be a fundamental component of suicide prevention. Currently it is not. This study aims to demonstrate the usefulness of internet-delivered cognitive behavioural therapy (iCBT) for depression as a means of reducing suicide ideation. Methods: The sample comprised 484 patients who were prescribed iCBT for depression by their primary care physician. The outcomes of interest were major depression, as indexed by the PHQ-8, and suicidal ideation as measured by question 9 of the PHQ-9. Marginal models were used to appropriately analyse available data without biasing parameter estimates. Results: Following iCBT for depression, suicidal ideation and depression decreased in parallel over time. The prevalence of suicidal ideation reduced from 50% at baseline to 27% after treatment, whilst the prevalence of major depression reduced from 70% to 30%. Depression scores and suicidal ideation decreased after treatment regardless of demographic or clinical variables of interest. Limitations: This is a naturalistic study; randomisation and scientific control were not possible. Conclusions: The current study demonstrates the usefulness of iCBT for depression as a means of reducing suicidal ideation which can be implemented on a large scale without enacting major structural change at the societal level. These findings need to be replicated in randomised controlled trials.
    Journal of Affective Disorders 09/2014; 170C:78-84. DOI:10.1016/j.jad.2014.08.038 · 3.38 Impact Factor
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