Internet-Based and Other Computerized Psychological Treatments for Adult Depression: A Meta-Analysis (original) (raw)
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Revista De Psicopatologia Y Psicologia Clinica, 2014
Guided internet-delivered cognitive behaviour therapy (ICBT) has been tested in many trials since the early studies dating back to the late 1990's. The aim of this review was to investigate the most recent literature on guided ICBT for depression. We identified 11 controlled studies published between January 2013 and September 2014. Overall, large treatment effects were observed with a few exceptions. A majority (7 studies) provided some information regarding unwanted effects such as deterioration. Three studies directly compared guided ICBT against face-to-face CBT. We added an earlier study and calculated meta-analytic summary statistics for the four studies involving a total of 336 participants. The average effect size difference was Hedges g = 0.12 (95% CI:-0.08~0.32) in the direction of favouring guided ICBT, but with no practical importance. We conclude that guided ICBT is a promising treatment for depression and mood disorders and that the research is rapidly expanding.
Depression is a high prevalence disorder, displaying high rates of lifetime incidence, early age onset, high chronicity, and role impairment. In Ireland 12-month prevalence of depression has been reported to be 10.3%. A large percentage of affected individuals have no medical diagnosis nor seek treatment. Cognitive Behavior Therapy (CBT) has established itself as an option for the treatment of depression. Many Irish adults with depression find it difficult to access evidence-based CBT, this is due to several factors, like stigma and costs. However, systematic factors including the shortage of trained professionals and the relative underdevelopment of services also make access difficult.Stepped-care can increase access to evidence-based CBT. One option is tailored internet-delivered treatment programs. Preliminary research from Ireland needs now to include large-scale studies on effectiveness. Thus the current study seeks to examine the potential of an internet-delivered low-intensity treatment for symptoms of depression in an Irish adult community sample.Method/Design: The study is a randomized controlled trial of an online CBT (iCBT) program for the treatment of adults with depressive symptoms. The trial will include an active treatment group and a waiting-list control group. The active condition will consist of 8 weekly modules of iCBT, with post-session feedback support. Participants in the waiting list will receive access to the treatment at week 8. Participants will complete the Beck Depression Inventory (BDI-II) and eligibility criteria will also apply. Primary outcomes are depressive symptoms. Secondary outcomes include quality of life indicators, significant events and satisfaction with online treatment. Data will be collected at baseline and at post-treatment, week 8, and at follow-up week 20 (3-months) and week 32 (6-months). Analysis will be conducted on the intention-to-treat basis.
Expert Review of Pharmacoeconomics & Outcomes Research, 2007
Psychiatric problems such as mood and anxiety disorders are highly prevalent and are associated with high societal costs and individual suffering. Evidence-based psychological treatments obtain good results but are not available to the required extent due to the lack of practitioners with adequate training. One way to solve this problem is to provide minimal-contact self-help treatments, for example, with the assistance of computers. Recently, internet-delivered cognitive-behavioral treatment has been tested in a series of controlled trials. However, the interventions come in many forms with different levels and kinds of therapist input, which have implications for the costs of the treatments and possibly their effectiveness. In this review we found evidence for a strong correlation between therapist input and outcome. While emerging evidence attests to the efficacy of internet-delivered treatment when at least minimal therapist guidance is provided, most studies in the field have not included a formal evaluation of cost-effectiveness. Future research needs are discussed.
BMC Psychiatry, 2007
Background Depression is a highly prevalent condition, affecting more than 15% of the adult population at least once in their lives. Guided self-help is effective in the treatment of depression. The purpose of this study is to investigate the effectiveness of two Internet-based guided self-help treatments with adults reporting elevated depressive symptoms. Other research questions concern the identification of potential mediators and the search for subgroups who respond differently to the interventions. Methods This study is a randomized controlled trial with three conditions: two treatment conditions and one waiting list control group. The two treatment conditions are Internet-based cognitive behavior therapy and Internet-based problem-solving therapy. They consist of 8 and 5 weekly lessons respectively. Both interventions are combined with support by e-mail. Participants in the waiting list control group receive the intervention three months later. The study population consists of adults from the general population. They are recruited through advertisements in local and national newspapers and through banners on the Internet. Subjects with symptoms of depression (≥ 16 on the Center for Epidemiological Studies Depression scale) are included. Other inclusion criteria are having sufficient knowledge of the Dutch language, access to the Internet and an e-mail address. Primary outcome is depressive symptoms. Secondary outcomes are anxiety, quality of life, dysfunctional cognitions, worrying, problem solving skills, mastery, absence at work and use of healthcare. We will examine the following variables as potential mediators: dysfunctional cognitions, problem solving skills, worrying, anxiety and mastery. Potential moderating variables are: socio-demographic characteristics and symptom severity. Data are collected at baseline and at 5 weeks, 8 weeks, 12 weeks and 9 months after baseline. Analyses will be conducted on the intention-to-treat sample. Discussion This study evaluates two Internet-based treatments for depression, namely cognitive behavioral therapy and problem-solving therapy. The effectiveness of Internet-based problem-solving therapy suggest that this may be a worthwhile alternative to other more intensive treatment options. Strengths and limitations of this study are discussed. Trial registration Current Controlled Trials ISRCTN16823487
Internet-based psychological treatments for depression
Expert Review of Neurotherapeutics, 2012
Major depression is highly prevalent, and is associated with high societal costs and individual suffering. Evidence-based psychological treatments obtain good results, but access to these treatments is limited. One way to solve this problem is to provide internet-based psychological treatments, for example, with therapist support via email. During the last decade, internetdelivered cognitive-behavioral therapy (ICBT) has been tested in a series of controlled trials. However, the ICBT interventions are delivered with different levels of contact with a clinician, ranging from nonexisting to a thorough pretreatment assessment in addition to continuous support during treatment. In this review, the authors have found an evidence for a strong correlation between the degree of support and outcome. The authors have also reviewed how treatment content in ICBT varies among treatments, and how various therapist factors may influence outcome. Future possible applications of ICBT for depression and future research needs are also discussed.
Effectiveness of guided Internet-based cognitive behavior therapy in regular clinical settings
Therapeutengeleitete internetbasierte Verhaltenstherapie (ICBT) wurde in zahlreichen kontrollierten Studien evaluiert, die im Forschungssetting durchgeführt worden waren. Inzwischen ist anerkannt, dass dieses neuartige Behandlungsformat bei einer Vielzahl klinischer Fälle Wirkung zeigt. Weniger bekannt ist, ob die vielversprechenden Resultate, die Wirksamkeitsstudien zeigten, in die routinemäßige klinische Praxis übertragen werden können. In der vorliegenden Arbeit überprüfen wir Belege aus Wirksamkeitsstudien und beleuchten Herausforderungen, die mit der Implementierung von ICBT verbunden sind. Im Rahmen einer Literaturrecherche konnten wir 4 kontrollierte und 8 offene Studien identifizieren, die insgesamt 3888 Patienten umfassten. Derzeit wächst die Anzahl an Studien zur Wirkung von ICBT mit Bezug auf Panikstörungen, soziale Angststörung, generalisierte Angststörung, posttraumatische Belastungsstörung, Depression, Tinnitus und Reizdarmsyndrom. Sämtliche Studien weisen darauf hin, dass es möglich ist, ICBT mit nachhaltigen Auswirkungen und mittleren bis hohen Effektstärken in die klinische Praxis zu übertragen. Jedoch ist noch nicht geklärt, welches Modell für die Leistungsanforderung angewandt werden soll. Daher muss die Verbreitung von ICBT in weiteren Studien erhoben werden. Darüber hinaus sind die Erkenntnisse zu Prädiktoren von Ergebnissen aus kontrollierten Wirksamkeitsstudien möglicherweise weniger relevant, und Studien mit großen klinisch repräsentativen Stichproben sind notwendig, um zu erheben, für welche Patienten sich ICBT eignet. In der vorliegenden Übersicht wurde die bestehende Datenlage kombiniert und für eine Erhebung von Ergebnisprädiktoren ausgewertet.
Internet-Based Treatment for Adults with Depressive Symptoms: Randomized Controlled Trial
Journal of Medical Internet Research, 2008
Background: Depression is a highly prevalent condition, affecting more than 15% of the adult population at least once in their lives. Guided self-help is effective in the treatment of depression. The purpose of this study is to investigate the effectiveness of two Internet-based guided self-help treatments with adults reporting elevated depressive symptoms. Other research questions concern the identification of potential mediators and the search for subgroups who respond differently to the interventions.
Computer- and internet-based psychotherapy interventions
Current Directions in Psychological Science, 2003
Computers and Internet-based programs have great potential to make psychological assessment and treatment more cost-effective. Computer-assisted therapy appears to be as effective as face-to-face treatment for treating anxiety disorders and depression. Internet support groups also may be effective and have advantages over face-to-face therapy. However, research on this approach remains meager.