Standardized Web-Based Cognitive Behavioural Therapy of Mild to Moderate Depression: A Randomized Controlled Trial with a Long-Term Follow-Up

Abstract

Depression is common but undertreated. Web-based self-help provides a widely accessible treatment alternative for mild to moderate depression. However, the lack of therapist guidance may limit its efficacy. The authors assess the efficacy of therapist-guided web-based cognitive behavioural treatment (web-CBT) of mild to moderate depression. Fifty-four individuals with chronic, moderate depression participated in a randomized wait-list controlled trial, with an 18-month follow-up (immediate treatment: n = 36, wait-list control: n = 18). Primary outcome measures were the Beck Depression Inventory (BDI-IA) and the Depression scale of the Symptom Checklist-90-Revised (SCL-90-R. DEP). Secondary outcome measures were the Depression Anxiety Stress Scales and the Well-Being Questionnaire. Five participants (9%) dropped out. Intention-to-treat analyses of covariance revealed that participants in the treatment condition improved significantly more than those in the wait-list control condition (.011 < p < .015). With regard to the primary measures, between-group effects (d) were 0.7 for the BDI-IA and 1.1 for the SCL-90-R DEP. Posttest SCL-90- R DEP scores indicated recovery of 49% of the participants in the treatment group compared with 6% in the control group (odds ratio = 14.5; p < .004). On average, the effects were stable up to 18 months (n = 39), although medication was a strong predictor of relapse. The results demonstrate the efficacy of web-CBT for mild to moderate depression and the importance of therapist guidance in psychological interventions.

Predicting outcome of Internet-based treatment for depressive symptoms

“…This can be explained by the fact that higher scores leave more room for improvement, which replicates earlier findings (Ruwaard et al, 2009;Spek et al, 2008). This result is also in line with findings from a metaregression analysis (Bower et al, 2013).…”

“…As with traditional CBT, studies evaluating the role of initial severity of depression on outcome of Internet-based treatment show mixed results; in a trial evaluating Internetbased CBT for mild to moderate depression it was found that the number of previous episodes of depression was negatively associated with improvement at 6 months follow-up (Andersson, Bergströ m, Holländare, Ekselius, & Carlbring, 2004). Better outcomes were found for participants with higher depression severity in some studies (Ruwaard et al, 2009;Spek et al, 2007). However, in another study baseline severity of depression was not related to the effect of computerized CBT (Proudfoot et al, 2003).…”

Internet-delivered cognitive behavioural therapy in the treatment of psychiatric illness

“…A few studies, including one systematic review, have evaluated therapeutic alliance in guided Internet-delivered CBT for several conditions, mainly com pared with wait-listed controls or email-based therapist interaction. [54][55][56][57][58][59] These studies consistently showed high therapeutic alliance for guided Internet-delivered CBT. Only one RCT directly compared guided with face-to-face Internetdelivered CBT.…”

Therapeutic alliance and different treatment formats when delivering internet-based CBT for depression

“…For example, in the study by Knaevelsrud and Maercker, 86% of the participants receiving treatment for posttraumatic stress experienced their contact with their online therapist as personal and 76% were positive to being treated online instead of by faceto-face CBT (Knaevelsrud & Maercker, 2007). Ruwaard et al (2009) found similar results were 87% experienced online therapy as pleasant and 89% did not miss face-to-face contact.…”