A Randomised Controlled Trial of Therapist-Assisted, Internet-Delivered Cognitive Behavior Therapy for Women with Maternal Depression

Abstract

Postpartum depression impacts up to 15% of Canadian women following childbirth. Remarkably, many women suffering from this disorder do not receive appropriate treatment. The aim of this study was to conduct a parallel-group randomized controlled trial to determine the efficacy of Therapist-Assisted Internet-delivered Cognitive Behavior Therapy (TA-ICBT) for the treatment of postpartum depression. This study was registered with the International Standard Randomized Controlled Trials (ISRCTN: 85456371) and received funding from Canadian Institutes of Health Research (#101526) and the Saskatchewan Health Research Foundation. Fifty women who gave birth to an infant in the past year, who scored above 10 on the Edinburgh Postnatal Depression Scale (EPDS), and who resided in Saskatchewan, Canada were eligible to participate. Participants were randomly assigned to receive either TA-ICBT (n = 25) or waitlist control (n = 25). The efficacy of the treatment was investigated at baseline and at seven- to 10-week follow-up. TA-ICBT participants were also contacted four-weeks following treatment completion. Symptoms of postpartum depression decreased more for participants in the TA-ICBT group (average reduction of 6.24 points on the EPDS; n = 21 included in analyses) compared to those participants in the waitlist control group (average reduction of 2.42 points on the EPDS; n = 20 included in analyses), and these results were clinically significant and maintained at four-week follow-up. TA-ICBT participants demonstrated a reduction in postnatal anxiety, general stress, and parental distress, and an increase in psychological and environmental quality of life when compared to the waitlist control participants. Study implications, limitations, and future research directions are discussed.Trial RegistrationControlled-Trials.com ISRCTN85456371

Randomized Controlled Trial of a Computerized Interactive Media-Based Problem Solving Treatment for Depression

“…We also compared imbPST to studies of face-to-face psychotherapy (Agnew-Davies, Stiles, Hardy, Barkham, & Shapiro, 1998) and the CB therapy program BtB (Ormrod et al, 2010) on their ability to develop therapeutic alliance. We found that imbPST creates a strong therapeutic alliance equivalent to face-to-face psychotherapy (Berman et al, 2014), consistent with previous CB therapy literature (Andersson et al, 2012; Kiropoulos et al, 2008; Knaevelsrud & Maercker, 2006, 2007; Pugh, Hadjistavropoulos, & Dirkse, 2016; Sucala et al, 2012). Despite these promising findings, to date imbPST has not been subjected to a randomized controlled trial.…”

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

“…[71][72][73] An increasing body of evidence also supports the use of therapist-assisted Internet-based behavioural activation and CBT, whereas the effectiveness of unsupported Internet-based psychotherapeutic interventions has not been established. [74][75][76] While not extensively studied in the postpartum period, mindfulnessbased CBT and supportive, couples, and psychodynamic psychotherapy may have a role for selected women.…”

Therapist-Supported Internet-Based Cognitive Behavior Therapy for Stress, Anxiety, and Depressive Symptoms Among Postpartum Women: A Systematic Review and Meta-Analysis

“…All of the studies were conducted between 2011 [47] and 2016 [31], with 2016 having the highest number of publications (38%, 3/8) [28,29,31]. …”

“…Contrary to previous findings on the equivalent effect of support type for stress symptoms in a meta-analytic review [13], our finding showed that exclusive therapist support has a better effect than therapist support with self-care component in the subgroup analysis. A possible interpretation of this result is that the different attrition rates reached 2.9%–60.8% by therapist support with self-care components [28,32,33] compared with the 7.0%–31.3% rates by exclusive therapist support [29-31,46,47]. This finding supported the fact that exclusive therapist support was preferred to reduce stress symptoms, whether by phone, email, text, or interactive computer interface [10,11].…”