Internet-Based Treatment of Depression: A Randomized Controlled Trial Comparing Guided with Unguided Self-Help

Abstract

Internet-delivered self-help for depression with therapist guidance has shown efficacy in several trials. Results from meta-analyses suggest that guidance is important and that self-help programs without support are less effective. However, there are no direct experimental comparisons between guided and unguided internet-based treatments for depression. The present study compared the benefits of a 10-week web-based unguided self-help treatment with the same intervention complemented with weekly therapist support via e-mail. A waiting-list control group was also included. Seventy-six individuals meeting the diagnostic criteria of major depression or dysthymia were randomly assigned to one of the three conditions. The Beck Depression Inventory (BDI-II) was used as the primary outcome measure. Secondary outcomes included general psychopathology, interpersonal problems, and quality of life. Sixty-nine participants (91%) completed the assessment at posttreatment and 59 (78%) at 6-month follow-up. Results showed significant symptom reductions in both treatment groups compared to the waiting-list control group. At posttreatment, between-group effect sizes on the BDI-II were d = .66 for unguided self-help versus waiting-list and d = 1.14 for guided self-help versus waiting-list controls. In the comparison of the two active treatments, small-to-moderate, but not statistically significant effects in favor of the guided condition were found on all measured dimensions. In both groups, treatment gains were maintained at 6-month follow-up. The findings provide evidence that internet-delivered treatments for depression can be effective whether support is added or not. However, all participants were interviewed in a structured diagnostic telephone interview before inclusion, which prohibits conclusions regarding unguided treatments that are without any human contact.

An online programme to reduce depression in patients with multiple sclerosis: a randomised controlled trial

“…30 Our results are also in line with randomised trials done in otherwise healthy patients with depression and without comorbid somatic disorders, which lends support to the usefulness of iCBT in general 31 and speci cally the Deprexis programme in patients with major depressive disorder. 18,32,33 Few randomised trials have assessed the e ects of pharmacological or behavioural interventions to treat depression in patients with multiple sclerosis. Findings from studies using antidepressant pharmacotherapy in this population have suggested some e cacy but also indicatedfrequentside-e ects.…”

“…19 Email support might also be useful. 33 Therefore, the e cacy of interventions such as Deprexis in multiple sclerosis might be further enhanced by adding therapist support in one form or another. Whether or not this is indeed bene cial remains to be tested in future studies and is an active area of investigation in our research.…”

Web-Based Interventions for Depression in Individuals with Diabetes: Review and Discussion (Preprint)

“…Synchronous communication can be used in adherence management after the non-response to asynchronous strategies or for urgent cases like deterioration. However, more research is needed to determine how the content, length, and frequency of therapists' messages can affect outcome in guided self-help treatments [75]. On the other hand, because of the oscillating course of depression, it is suggested to monitor depression symptoms and to add a crisis link in the web-site.…”

“…Nonetheless, a study that compared this treatments within the same trial, comparing the benefits of a 10-week web-based unguided self-help treatment for depression (n=25) with the same intervention complemented with weekly therapist support via e-mail, found no significant differences in participant's intervention completion (or symptom reduction) [75]. Authors discuss that the lack of significant differences in relation of the stringent inclusion criteria (Beck Depression Inventory-II > 13), the telephone structured diagnostic interview made at selection and the content of the feedback provided by therapists which was mainly generic and brief.…”

“…Authors discuss that the lack of significant differences in relation of the stringent inclusion criteria (Beck Depression Inventory-II > 13), the telephone structured diagnostic interview made at selection and the content of the feedback provided by therapists which was mainly generic and brief. They suggest more research is needed to determine whether specific screening procedures and/or a short personal contact at the beginning of a treatment can decrease attrition rates in unguided self-help treatments and how the content, length, and frequency of therapists' messages can affect outcome in guided selfhelp treatments [75]. The percentage of enrolled participants who dropped out from the identified interventions (treatment dropout) varies between studies: 42% (52/125) [21], 24% (31/129) [32], 13% (4/29) [31] and 34% (14/41) [33].…”