Internet‐based cognitive behavior therapy for major depressive disorder: A randomized controlled trial

Abstract

Background Prior research has shown that the Sadness Program, a technician-assisted Internet-based cognitive behavioral therapy (iCBT) intervention developed in Australia, is effective for treating major depressive disorder (MDD). The current study aimed to expand this work by adapting the protocol for an American population and testing the Sadness Program with an attention control group. Methods In this parallel-group, randomized controlled trial, adult MDD participants (18–45 years) were randomized to a 10-week period of iCBT (n = 37) or monitored attention control (MAC; n = 40). Participants in the iCBT group completed six online therapy lessons, which included access to content summaries and homework assignments. During the 10-week trial, iCBT and MAC participants logged into the web-based system six times to complete self-report symptom scales, and a nonclinician technician contacted participants weekly to provide encouragement and support. The primary outcome was the Hamilton Rating Scale for Depression (HRSD), and the secondary outcomes were the Patient Health Questionnaire-9 and Kessler-10. Results Intent-to-treat analyses revealed significantly greater reductions in depressive symptoms in iCBT compared with MAC participants, using both the self-report measures and the clinician-rated HRSD (d = −0.80). Importantly, iCBT participants also showed significantly higher rates of clinical response and remission. Exploratory analyses did not support illness severity as a moderator of treatment outcome. Conclusions The Sadness Program led to significant reductions in depression and distress symptoms. With its potential to be delivered in a scalable, cost-efficient manner, iCBT is a promising strategy to enhance access to effective care.

Rostral Anterior Cingulate Cortex Morphology Predicts Treatment Response to Internet-Based Cognitive Behavioral Therapy for Depression

“…Data were derived from a recently published randomized clinical trial of iCBT ( n = 37) versus a MAC ( n = 40) condition for adults (ages 18–45) diagnosed with MDD (5). The study was approved by the Institutional Review Board of Partners Healthcare (ClinicalTrials.gov Identifier: NCT01598922), and all participants provided written informed consent.…”

“…Additional inclusion criteria were the ability to read English, regular access to a phone and computer with Internet access, absence of psychotropic medications for at least 2 weeks (6 weeks for fluoxetine, 6 months for neuroleptics), and right-handedness. For additional details on exclusion criteria and baseline patient characteristics see Supplemental Methods and the original clinical trial report (5). …”

“…Study procedures have been described in detail in a previous publication (5), and are thus only explained briefly here. After completing a telephone screen participants were invited for an initial visit to determine eligibility based on an the PHQ-9, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID)(42), and MRI safety screening.…”

“…Growing evidence supports the efficacy of iCBT programs for reducing depressive symptoms (1, 2). However, similar to face-to-face CBT and pharmacotherapy for depression, rates of treatment nonresponse to iCBT are high, with approximately 40–60% of depressed individuals failing to respond (3–5). Accordingly, research is needed to determine for whom iCBT is most effective, and who might be better suited to an alternative intervention.…”

“…Thus, the inclusion of both an iCBT and control group allows us to test the specificity of ACC volume-treatment outcome associations. Finally, and paralleling the treatment outcome analyses from the clinical trial publication (5), to assess the robustness of predictive effects we tested whether pre-treatment ACC subregion volumes were associated with both self-reported depressive symptom improvement and clinician-rated remission status.…”