Clinical effectiveness of online computerised cognitive-behavioural therapy without support for depression in primary care: Randomised trial

Erasmus Medical Centre, Department of Medical Psychology and Psychotherapy, P.O. Box 2040, Rotterdam 3000 CA, The Netherlands.
The British journal of psychiatry: the journal of mental science (Impact Factor: 7.99). 08/2009; 195(1):73-80. DOI: 10.1192/bjp.bp.108.054429
Source: PubMed


Computerised cognitive-behavioural therapy (CCBT) might offer a solution to the current undertreatment of depression.
To determine the clinical effectiveness of online, unsupported CCBT for depression in primary care.
Three hundred and three people with depression were randomly allocated to one of three groups: Colour Your Life; treatment as usual (TAU) by a general practitioner; or Colour Your Life and TAU combined. Colour Your Life is an online, multimedia, interactive CCBT programme. No assistance was offered. We had a 6-month follow-up period.
No significant differences in outcome between the three interventions were found in the intention-to-treat and per protocol analyses.
Online, unsupported CCBT did not outperform usual care, and the combination of both did not have additional effects. Decrease in depressive symptoms in people with moderate to severe depression was moderate in all three interventions. Online CCBT without support is not beneficial for all individuals with depression.

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Available from: Heleen Riper, Sep 09, 2014
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    • "Johansson & Andersson, 2012; Richards & Richardson, 2012). Similarly, self-help and minimal contact therapies have demonstrated their effectiveness in the treatment of anxiety and subthreshold mood disorders (Cuijpers, Smit, & van Straten, 2007; Newman, Szkodny, Llera, & Przeworski, 2011). Most of these interventions are based on CBT; however, early interventions in the field of acceptance and commitment therapy (ACT) for people at risk of depression have also recently been developed (Bohlmeijer, Fledderus, Rokx, & Pieterse, 2011; Fledderus, Bohlmeijer, Pieterse, & Schreurs, 2012). "
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    ABSTRACT: Low-intensity interventions for people suffering from depressive symptoms are highly desirable. The aim of the present study was to investigate the outcomes of a web-based acceptance and commitment therapy (ACT)-based intervention without face-to-face contact for people suffering from depressive symptoms. Participants (N = 39) with depressive symptoms were randomly assigned to an Internet-delivered acceptance and commitment therapy (iACT) intervention or a waiting list control condition (WLC). Participants were evaluated with standardized self-reporting measures (Beck Depression Inventory [BDI-II], Symptom Checklist-90 [SCL-90], Acceptance and Action Questionnaire [AAQ-2], Five Facet Mindfulness Questionnaire [FFMQ], Automatic Thoughts Questionnaire [ATQ], and White Bear Suppression Inventory [WBSI]) at pre- and post-measurement. Long-term effects in the iACT group were examined using a 12-month follow-up. The iACT program comprised home assignments, online feedback given by master's-level students of psychology over a 7-week intervention period, and automated email-based reminders. Significant effects were observed in favor of the iACT group on depression symptomatology (between effect sizes [ESs] at post-treatment, iACT/WLC, g = .83), psychological and physiological symptoms (g = .60), psychological flexibility (g = .67), mindfulness skills (g = .53), and frequency of automatic thoughts (g = .57) as well as thought suppression (g = .53). The treatment effects in the iACT group were maintained over the 12-month follow-up period (within-iACT ES: BDI-II, g = 1.33; SCL-90, g = 1.04; ATQF/B [Frequency/Believability], FFMQ, WBSI, AAQ-II, g = .74-1.08). The iACT participants stated that they would be happy to recommend the same intervention to others with depressive symptoms. We conclude that an ACT-based guided Internet-delivered treatment with minimal contact can be effective for people with depressive symptoms. © The Author(s) 2015.
    Behavior modification 08/2015; DOI:10.1177/0145445515598142 · 2.23 Impact Factor
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    • "It should also be borne in mind that four of the included studies conducted a diagnostic interview before inclusion of the participants. (Spek et al. 2007b; de Graaf et al. 2009; Vernmark et al. 2010; Berger et al. 2011). This may have enhanced treatment adherence by increasing any feeling of accountability. "
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    ABSTRACT: It is well known that web-based interventions can be effective treatments for depression. However, dropout rates in web-based interventions are typically high, especially in self-guided web-based interventions. Rigorous empirical evidence regarding factors influencing dropout in self-guided web-based interventions is lacking due to small study sample sizes. In this paper we examined predictors of dropout in an individual patient data meta-analysis to gain a better understanding of who may benefit from these interventions. A comprehensive literature search for all randomized controlled trials (RCTs) of psychotherapy for adults with depression from 2006 to January 2013 was conducted. Next, we approached authors to collect the primary data of the selected studies. Predictors of dropout, such as socio-demographic, clinical, and intervention characteristics were examined. Data from 2705 participants across ten RCTs of self-guided web-based interventions for depression were analysed. The multivariate analysis indicated that male gender [relative risk (RR) 1.08], lower educational level (primary education, RR 1.26) and co-morbid anxiety symptoms (RR 1.18) significantly increased the risk of dropping out, while for every additional 4 years of age, the risk of dropping out significantly decreased (RR 0.94). Dropout can be predicted by several variables and is not randomly distributed. This knowledge may inform tailoring of online self-help interventions to prevent dropout in identified groups at risk.
    Psychological Medicine 04/2015; 45(13):1-10. DOI:10.1017/S0033291715000665 · 5.94 Impact Factor
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    • "Web-based interventions have shown to be well accepted by participants [29,30] and to be effective in the acute treatment of MDD [12] as well as in reducing depressive symptoms both in adults and adolescents [31,32]. However, although several web-based interventions are labelled as preventive interventions, i.e. ‘Colour your life’ [33,34], to the best of our knowledge, no study has yet investigated the (cost-) effectiveness of an indicated guided self-help web-based preventive intervention on the onset of diagnosed major depressive disorders. "
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    ABSTRACT: Major depressive disorder (MDD) imposes a considerable disease burden on individuals and societies. Web-based interventions have shown to be effective in reducing depressive symptom severity. However, it is not known whether web-based interventions may also be effective in preventing the onset of MDD. The aim of this study is to evaluate the (cost-) effectiveness of an indicated web-based guided self-help intervention (GET.ON Mood Enhancer Prevention) on the onset of MDD.Methods/design: A randomised controlled trial (RCT) will be conducted to compare the (cost-) effectiveness of the GET.ON Mood Enhancer Prevention training with a control condition exclusively receiving online-based psychoeducation on depression. Adults with subthreshold depression (N = 406) will be recruited from the general population and randomised to one of the two conditions. The primary outcome is time to onset of MDD within a 12-months follow-up period. MDD will be assessed according to DSM-IV criteria as assessed by the telephone-administered Structured Clinical Interview for DSM-IV (SCID). Time to onset of MDD will be assessed using life charts. Secondary outcomes include changes on various indicators of depressive symptom severity, anxiety and quality of life from baseline to post-treatment, to a 6-month and a 12-month follow up. Additionally, an economic evaluation using a societal perspective will be conducted to examine the intervention's cost-effectiveness. This is one of the first randomised controlled trials that examines the effect of an indicated guided self-help web-based intervention on the incidence of major depression. If shown to be effective, the intervention will contribute to reducing the disease burden due to MDD in the general population.Trial registration: German Clinical Trial Registration DRKS00004709.
    BMC Psychiatry 01/2014; 14(1):25. DOI:10.1186/1471-244X-14-25 · 2.21 Impact Factor
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