Effectiveness of a Web-Based Self-Help Intervention for Symptoms of Depression, Anxiety, and Stress: Randomized Controlled Trial

FPP, Department of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
Journal of Medical Internet Research (Impact Factor: 4.67). 03/2008; 10(1):e7. DOI: 10.2196/jmir.954
Source: PubMed

ABSTRACT Self-help therapies are often effective in reducing mental health problems. We developed a new Web-based self-help intervention based on problem-solving therapy, which may be used for people with different types of comorbid problems: depression, anxiety, and work-related stress.
The aim was to study whether a Web-based self-help intervention is effective in reducing depression, anxiety, and work-related stress (burnout).
A total of 213 participants were recruited through mass media and randomized to the intervention (n = 107) or a waiting list control group (n = 106). The Web-based course took 4 weeks. Every week an automated email was sent to the participants to explain the contents and exercises for the coming week. In addition, participants were supported by trained psychology students who offered feedback by email on the completed exercises. The core element of the intervention is a procedure in which the participants learn to approach solvable problems in a structured way. At pre-test and post-test, we measured the following primary outcomes: depression (CES-D and MDI), anxiety (SCL-A and HADS), and work-related stress (MBI). Quality of life (EQ-5D) was measured as a secondary outcome. Intention-to-treat analyses were performed.
Of the 213 participants, 177 (83.1%) completed the baseline and follow-up questionnaires; missing data were statistically imputed. Of all 107 participants in the intervention group, 9% (n = 10) dropped out before the course started and 55% (n = 59) completed the whole course. Among all participants, the intervention was effective in reducing symptoms of depression (CES-D: Cohen's d = 0.50, 95% confidence interval (CI) 0.22-0.79; MDI: d = 0.33, 95% CI 0.03-0.63) and anxiety (SCL-A: d = 0.42, 95% CI 0.14-0.70; HADS: d = 0.33, 95% CI 0.04-0.61) as well as in enhancing quality of life (d = 0.31, 95% CI 0.03-0.60). Moreover, a higher percentage of patients in the intervention group experienced a significant improvement in symptoms (CES-D: odds ratio [OR] = 3.5, 95% CI 1.9-6.7; MDI: OR = 3.7, 95% CI 1.4-10.0; SCL-A: OR = 2.1, 95% CI 1.0-4.6; HADS: OR = 3.1, 95% CI 1.6-6.0). Patients in the intervention group also recovered more often (MDI: OR = 2.2; SCL-A: OR = 2.0; HADS < 8), although these results were not statistically significant. The course was less effective for work-related stress, but participants in the intervention group recovered more often from burnout than those in the control group (OR = 4.0, 95% CI 1.2-13.5).
We demonstrated statistically and clinically significant effects on symptoms of depression and anxiety. These effects were even more pronounced among participants with more severe baseline problems and for participants who fully completed the course. The effects on work-related stress and quality of life were less clear. To our knowledge, this is the first trial of a Web-based, problem-solving intervention for people with different types of (comorbid) emotional problems. The results are promising, especially for symptoms of depression and anxiety. Further research is needed to enhance the effectiveness for work-related stress.
International Standard Randomized Controlled Trial Number (ISRCTN) 14881571.

  • Source
    • "a statistical power ( 1 - Beta ) of 0 . 80 in a one - tailed test , we would need to recruit 100 respondents in each of the conditions . 2 . 6 . Intervention : internet - based problem solving treatment The Internet - based intervention applied in conditions 1 , 2 , and 3 is a brief problem - solving therapy ( PST ) called " Allesondercontrole " ( Van Straten et al . , 2008 ; Warmerdam et al . , 2008 ) . In PST , partic - ipants learn to regain control over their problems and their lives by learning how to deal with problems in a structured way . The gen - eral idea is that symptoms of anxiety and depression will decrease when individuals experience more control . We used a Dutch adaptation of self - exami"
    [Show abstract] [Hide abstract]
    ABSTRACT: Internet-based interventions can be effective treatments for anxiety and depression. Meta-analytic evidence suggests that they should be delivered with human support to reach optimal effects. These findings have not consistently been replicated in direct comparisons of supported and unsupported interventions, however. This study examined the role of support in Internet-based problem solving treatment (PST) for symptoms of anxiety and/or depression. Adults with mild to moderate symptoms of anxiety and/or depression were recruited from the general population and randomized to: (1) PST without support (n = 107), (2) PST with support on request (n = 108), (3) PST with weekly support (n = 106), (4) no Internet-based intervention but non-specific chat or email (n = 110), or (5) waitlist control (WLC; n = 106). Primary outcomes were symptoms of anxiety (HADS) and depression (CES-D) measured at baseline and 6 weeks later. Analyses were first based on the intention-to-treat principle (ITT) and repeated with intervention completers. Only participants who received PST with weekly support improved significantly more than WLC for depressive symptoms. Results for anxiety were less robust but in favor of the weekly support condition. The results underscore the importance of structural support in Internet-based interventions for depression and anxiety. Published by Elsevier Ltd.
    Behaviour Research and Therapy 07/2015; 72:63-71. DOI:10.1016/j.brat.2015.06.013 · 3.85 Impact Factor
  • Source
    • "While Awa et al. [16], for example, showed that a wide spectrum of approaches for burnout prophylaxis is available, they regretfully refrain from making statements regarding the efficacy of the different approaches reported. Van Straten et al. [17] showed first empirical results of an innovative strategy to prevent burnout using an internet-based treatment manual conceptualized as a self-help intervention to reduce work-related stress. Another possible strategy to prevent burnout could be breath therapy. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background. Early retirement of teachers due to burnout is frequent in Germany. In this study short- and medium-term effects of AFA breathing therapy were evaluated. Methods. This study was designed as a longitudinal controlled intervention design with four points of measurements: before assessment (T1), after intervention (T2), three months (follow up 1) (T3) after intervention, and six months (follow up 2) after intervention (T4). The intervention lasted a total of 11 weeks (weekly group therapy for eight weeks and three weeks of individual breathing session). The effects of intervention were measured with the questionnaire "work-related behaviour and experience Patterns" (AVEM) at four times. Results. In the intervention group 64 teachers and in the self-selected control group 27 teachers were included. The AVEM scales "subjective significance of work" and "professional ambition" changed over time and within both groups (interaction effect). Significant improvements over the four measurements were observed in the intervention group in two AVEM scales: "emotional distancing" (F = 6.3; P < 0.01) and "balance and mental stability" (F = 4.4; P < 0.02). Conclusions. AFA breathing therapy showed short- and medium-term effects in the intervention group over four points of measurements. It may be assumed that breath therapy supports teachers in resisting occupational demand.
    Evidence-based Complementary and Alternative Medicine 08/2013; 2013:798260. DOI:10.1155/2013/798260 · 1.88 Impact Factor
  • Source
    • "Griffiths and colleagues (Griffiths et al., 2010) recently published a review of all the available randomized control trials (RCTs) of internet-based interventions for depression: the first trial was published in 2002 (Clarke et al., 2002), with nine additional trials published in the subsequent years (Billings et al., 2008; Christensen et al., 2004; Clarke et al., 2005; Meyer et al., 2009; Patten, 2003; Perini et al., 2009; Spek et al., 2007; van Straten et al., 2008; Warmerdam et al., 2008). Seven of the trials were community based (Christensen et al., 2004; Meyer et al., 2009; Patten, 2003; Perini et al., 2009; Spek et al., 2007; van Straten et al., 2008; Warmerdam et al., 2008), two were undertaken in the context of a health care organization (Clarke et al., 2002; Clarke et al., 2005), and one in the workplace (Billings et al., 2008). The sample sizes ranged from 48-786 patients with an average age of the participants from 30-50 years. "
    Brain Injury - Functional Aspects, Rehabilitation and Prevention, 03/2012; , ISBN: 978-953-51-0121-5
Show more