Effects of an Internet-Based Cognitive Behavioral Therapy (iCBT) Program in Manga Format on Improving Subthreshold Depressive Symptoms among Healthy Workers: A Randomized Controlled Trial

Abstract

ObjectiveThe purpose of this study was to develop a new Internet-based computerized cognitive behavior therapy (iCBT) program in Manga format, the Japanese cartoon, for workers and to examine the effects of the iCBT program on improving subthreshold depression using a randomized controlled trial (RCT) design among workers employed in private companies in Japan.MethodAll workers in a company (n = 290) and all workers in three departments (n = 1,500) at the headquarters of another large company were recruited by an invitation e-mail. Participants who fulfilled the inclusion criteria were randomly allocated to intervention or control groups (N = 381 for each group). A six-week, six-lesson iCBT program using Manga (Japanese comic) story was developed. The program included several CBT skills: self-monitoring, cognitive restructuring, assertiveness, problem solving, and relaxation. The intervention group studied the iCBT program at a frequency of one lesson per week. Depression (Beck Depression Inventory II; BDI-II) was assessed as a primary outcome at baseline, and three- and six-month follow-ups for both intervention and control groups were performed.ResultsThe iCBT program showed a significant intervention effect on BDI-II (t = −1.99, p<0.05) with small effect sizes (Cohen's d: −0.16, 95% Confidence Interval: −0.32 to 0.00, at six-month follow-up).ConclusionsThe present study first demonstrated that a computerized cognitive behavior therapy delivered via the Internet was effective in improving depression in the general working population. It seems critical to improve program involvement of participants in order to enhance the effect size of an iCBT program.Trial RegistrationUMIN Clinical Trials Registry UMIN000006210

Clinical Factor 2015

“…In a randomized controlled trial conducted in Japan, Imamura et al [15] investigated whether an Internet-based computerized CBT can decrease the risk of major depression during a 12-month follow-up among workers of 2 companies. This report is basically an extension of their previous report [16] in which they reported 6-month follow-up results. Participants included those who did not report major depression within the past month, with no lifetime diagnosis of bipolar disorder, no treatment for mental health problems within the last month, and no more than 15 sick days in the previous 3 months (all reported via Internet, after being recruited via e-mail).…”

Does Internet-based cognitive behavioral therapy (iCBT) prevent major depressive episode for workers? A 12-month follow-up of a randomized controlled trial

“…Among these, three studies used a program called 'MoodGYM' (Christensen et al 2002), which was compromised of cognitive restructuring, behavioral technique, assertiveness and selfesteem training, and problem-solving technique, with findings of a favorable effect of the program in reducing self-reported symptoms of depression among male adolescents (Calear et al 2009), university students (Lintvedt et al 2013), and in a community population (Christensen et al 2004). We also have reported that a six-session iCBT program improved symptoms of depression in a RCT in the workplace (Imamura et al 2014). One remaining study used an original program including cognitive restructuring, behavioral technique, and psychoeducation for sleep hygiene and stimulus control and alcohol consumption, but did not show a significant effect on depressive symptoms in a community population (Patten, 2003).…”

Effects of an Internet-Based Cognitive Behavioral Therapy Intervention on Improving Work Engagement and Other Work-Related Outcomes

“…[23][24][25] The iCBT program provides basic information and skills on the basis of the same CBT principles as face-to-face CBT programs, with a highly structured format that comprises educational lessons, homework assignments, and supplementary resources. 26 Although most studies of iCBT programs have focused on the treatment of patients with depression and anxiety disorders in clinical settings, showing favorable effects, 27 the effects of iCBT programs on improving subthreshold depression have also been documented among healthy workers.…”

“…26 Although most studies of iCBT programs have focused on the treatment of patients with depression and anxiety disorders in clinical settings, showing favorable effects, 27 the effects of iCBT programs on improving subthreshold depression have also been documented among healthy workers. 25 Nevertheless, no previous study has investigated the beneficial effects of an iCBT program on improving work engagement and work performance among workers. The effects of iCBT have been shown to vary depending on the extent of therapist involvement.…”

“…We analyzed data of these work-related outcomes, which were collected as secondary outcomes at 3-and 6-month follow-ups in an RCT that primarily targeted improving subthreshold depressive symptoms among the nonclinical general working population in Japan. 25 We also tested whether the effect of the intervention on work-related outcomes was partly mediated by improvement of depression, the primary outcome of the study.…”