Clinician-assisted Internet-based treatment is effective for depression: randomized controlled trial.
ABSTRACT 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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ABSTRACT: Relapse Prevention interventions for Bipolar Disorder are effective but implementation in routine clinical services is poor. Web based approaches offer a way to offer easily accessible access to evidence based interventions at low cost, and have been shown to be effective for other mood disorders. This protocol describes the development and feasibility testing of the ERPonline web based intervention using a single blind randomised controlled trial. Data will include the extent to which the site was used, detailed feedback from users about their experiences of the site, reported benefits and costs to mental health and wellbeing of users, and costs and savings to health services. We will gain an estimate of the likely effect size of ERPonline on a range of important outcomes including mood, functioning, quality of life and recovery. We will explore potential mechanisms of change, giving us a greater understanding the underlying processes of change, and consequently how the site could be made more effective. We will be able to determine rates of recruitment and retention, and identify what factors could improve these rates. The findings will be used to improve the site in accordance with user needs, and inform the design of a large scale evaluation of the clinical and cost effectiveness of ERPonline. They will further contribute to the growing evidence base for web based interventions designed to support people with mental health problems. Copyright © 2015. Published by Elsevier Inc.Contemporary clinical trials. 01/2015;
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ABSTRACT: Background The Internet is of great importance in today¿s health sector, as most Internet users utilize online functions for health related purposes. Concerning the mental health care sector, little data exist about the Internet use of psychiatric patients. It is the scope of this current study to analyze the quantity and pattern of Internet usage among mental health patients.Methods Patients from all services of the Department of Psychiatry at a university hospital were surveyed by completing a 29-item questionnaire. The data analysis included evaluation of frequencies, as well as group comparisons.Results337 patients participated in the survey, of whom 79.5% were Internet users. Social media was utilized by less than half of the users: social networks (47.8%), forums (19.4%), chats (18.7%), blogs (12.3%). 70.9% used the Internet for mental health related reasons. The contents accessed by the patients included: information on mental disorders (57.8%), information on medication (43.7%), search for mental health services (38.8%), platforms with other patients (19.8%) and platforms with mental health professionals (17.2%).Differences in the pattern of use between users with low, medium and high frequency of Internet use were statistically significant for all entities of social media (p¿<¿0.01), search for mental health services (p¿=¿0.017) and usage of platforms with mental health professionals (p¿=¿0. 048).The analysis of differences in Internet use depending on the participants¿ type of mental disorder revealed no statistically significant differences, with one exception. Regarding the Internet¿s role in mental health care, the participants showed differing opinions: 36.2% believe that the Internet has or may have helped them in coping with their mental disorder, while 38.4% stated the contrary.Conclusions Most psychiatric patients are Internet users. Mental health related Internet use is common among patients, mainly for information seeking. The use of social media is generally less frequent. It varies significantly between different user types and was shown to be associated with high frequency of Internet use. The results illustrate the importance of the Internet in mental health related contexts and may contribute to the further development of mental health related online offers.BMC Psychiatry 12/2014; 14(1):13. · 2.24 Impact Factor
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ABSTRACT: Background Blending online modules into face-to-face therapy offers perspectives to enhance patient self-management and to increase the (cost-)effectiveness of therapy, while still providing the support patients need. The aim of this study was to outline optimal usage of blended care for depression, according to patients and therapists.MethodsA Delphi method was used to find consensus on suitable blended protocols (content, sequence and ratio). Phase 1 was an explorative phase, conducted in two rounds of online questionnaires, in which patients¿ and therapists¿ preferences and opinions about online psychotherapy were surveyed. In phase 2, data from phase 1 was used in face-to-face interviews with therapists to investigate how blended therapy protocols could be set up and what essential preconditions would be.ResultsTwelve therapists and nine patients completed the surveys. Blended therapy was positively perceived among all respondents, especially to enhance the self-management of patients. According to most respondents, practical therapy components (assignments, diaries and psycho-education) may be provided via online modules, while process-related components (introduction, evaluation and discussing thoughts and feelings), should be supported face-to-face. The preferred blend of online and face-to-face sessions differs between therapists and patients; most therapists prefer 75% face-to-face sessions, most patients 50 to 60%. The interviews showed that tailoring treatment to individual patients is essential in secondary mental health care, due to the complexity of their problems. The amount and ratio of online modules needs to be adjusted according to the patient¿s problems, skills and characteristics. Therapists themselves should also develop skills to integrate online and face-to-face sessions.Conclusions Blending online and face-to-face sessions in an integrated depression therapy is viewed as a positive innovation by patients and therapists. Following a standard blended protocol, however, would be difficult in secondary mental health care. A database of online modules could provide flexibility to tailor treatment to individual patients, which asks motivation and skills of both patients and therapists. Further research is necessary to determine the (cost-) effectiveness of blended care, but this study provides starting points and preconditions to blend online and face-to-face sessions and create a treatment combining the best of both worlds.BMC Psychiatry 12/2014; 14(1):355. · 2.24 Impact Factor