Article

Internet-Based and Other Computerized Psychological Treatments for Adult Depression: A Meta-Analysis

Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
Cognitive behaviour therapy 12/2009; 38(4):196-205. DOI: 10.1080/16506070903318960
Source: PubMed

ABSTRACT

Computerized and, more recently, Internet-based treatments for depression have been developed and tested in controlled trials. The aim of this meta-analysis was to summarize the effects of these treatments and investigate characteristics of studies that may be related to the effects. In particular, the authors were interested in the role of personal support when completing a computerized treatment. Following a literature search and coding, the authors included 12 studies, with a total of 2446 participants. Ten of the 12 studies were delivered via the Internet. The mean effect size of the 15 comparisons between Internet-based and other computerized psychological treatments vs. control groups at posttest was d = 0.41 (95% confidence interval [CI]: 0.29-0.54). However, this estimate was moderated by a significant difference between supported (d = 0.61; 95% CI: 0.45-0.77) and unsupported (d = 0.25; 95% CI: 0.14-0.35) treatments. The authors conclude that although more studies are needed, Internet and other computerized treatments hold promise as potentially evidence-based treatments of depression.

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    • "In this review, the umbrella term Internet intervention is used to refer to any kind of psychological intervention in which mental health care professionals use the Internet to provide mental health services. Internet interventions are then divided according to various criteria: A first possible distinction relates to the intensity and amount of therapist contact and support provided during treatment (Berger & Andersson, 2009). There are (i) Web-based unguided self-help programs that only use the Internet to provide information and that do not include any contact with a clinician during treatment, (ii) Internet-based guided self-help approaches, in which the presentation of a Web-based self-help program is combined with minimal but regular therapist contact, and (iii) Internet-based psychotherapies such as e-mail, chat, or videoconferencing therapies, in which the Internet is exclusively used as a communication medium between the therapist and the patient. "
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    ABSTRACT: Objectives: Research on Internet interventions has grown rapidly over the recent years and evidence is growing that Internet-based treatments often result in similar outcomes as conventional face-to-face psychotherapy. Yet there are still unanswered concerns such as whether a therapeutic alliance can be established over the Internet and whether the alliance is important in this new treatment format. Methods: A narrative review of studies formally assessing the therapeutic alliance in Internet interventions was conducted. It is the first review summarizing findings on the therapeutic alliance that (i) distinguishes between different forms of Internet interventions and (ii) does not restrict itself to specific Internet-based treatment formats such as guided self-help treatments, e-mail or videoconferencing therapies. Results: Independent of communication modalities, diagnostic groups and amount of contact between clients and therapists, client-rated alliance scores were high, roughly equivalent to alliance ratings found in studies on face-to-face therapy. Mixed results were found regarding the therapist-rated alliance and alliance-outcome associations. Conclusions: The review points to the limitations of the available evidence and identifies unanswered questions. It is concluded that one of the major tasks for future research is to identify unique characteristics of the therapeutic alliance in the different treatment formats.
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    • "In fact, research shows that PTSD outcomes for online treatment are often of a comparable magnitude to those found for the same kinds of interventions when delivered face to face, as has been generally found for internet therapy of other affective disorders (Andersson and Cuijpers 2009; Cowpertwait and Clarke 2013; Cuijpers et al. 2011; Spek et al. 2007). Indeed, the first study of internet treatment of PTSD was completed more than a decade ago and demonstrated , among 20 college students previously exposed to interpersonal violence, that providing CBT interventions for emotion regulation in addition to exposure-based narrative writing about traumatic events conducted via email resulted in clinically significant reductions in posttreatment PTSD symptoms (Lange et al. 2000). "
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    • "There are several meta-analyses, however, showing that ICBT with therapist guidance results in larger symptom improvement compared to self-guided ICBT (Richards and Richardson, 2012, Baumeister et al., 2014). ICBT for depression, for example, has been found to be twice as effective when supported by a therapist compared to when it is completely self-guided (Andersson and Cuijpers, 2009). Johansson and Andersson (2012) found a strong association between the amount of support offered in ICBT and outcome. "
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