Internet-Delivered Interpersonal Psychotherapy Versus Internet-Delivered Cognitive Behavioral Therapy for Adults With Depressive Symptoms: Randomized Controlled Noninferiority Trial

Abstract

BackgroundFace-to-face cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are both effective treatments for depressive disorders, but access is limited. Online CBT interventions have demonstrated efficacy in decreasing depressive symptoms and can facilitate the dissemination of therapies among the public. However, the efficacy of Internet-delivered IPT is as yet unknown.ObjectiveThis study examines whether IPT is effective, noninferior to, and as feasible as CBT when delivered online to spontaneous visitors of an online therapy website.MethodsAn automated, 3-arm, fully self-guided, online noninferiority trial compared 2 new treatments (IPT: n=620; CBT: n=610) to an active control treatment (MoodGYM: n=613) over a 4-week period in the general population. Outcomes were assessed using online self-report questionnaires, the Center for Epidemiological Studies Depression scale (CES-D) and the Client Satisfaction Questionnaire (CSQ-8) completed immediately following treatment (posttest) and at 6-month follow-up.ResultsCompleters analyses showed a significant reduction in depressive symptoms at posttest and follow-up for both CBT and IPT, and were noninferior to MoodGYM. Within-group effect sizes were medium to large for all groups. There were no differences in clinical significant change between the programs. Reliable change was shown at posttest and follow-up for all programs, with consistently higher rates for CBT. Participants allocated to IPT showed significantly lower treatment satisfaction compared to CBT and MoodGYM. There was a dropout rate of 1294/1843 (70%) at posttest, highest for MoodGYM. Intention-to-treat analyses confirmed these findings.ConclusionsDespite a high dropout rate and lower satisfaction scores, this study suggests that Internet-delivered self-guided IPT is effective in reducing depressive symptoms, and may be noninferior to MoodGYM. The completion rates of IPT and CBT were higher than MoodGYM, indicating some progress in refining Internet-based self-help. Internet-delivered treatment options available for people suffering from depression now include IPT.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 69603913; http://www.controlled-trials.com/ISRCTN69603913 (Archived by WebCite at http://www.webcitation.org/6FjMhmE1o)

Results from a trial of an unsupported internet intervention for depressive symptoms

“…The problem is exacerbated with unsupported interventions (Christensen et al, 2006; Donker et al, 2013), and indeed, in this study, while the follow-up rate is certainly less than ideal, it is in fact similar to that found with other unsupported interventions (Donker et al, 2013; Newman et al, 2011). High attrition rates raise concerns regarding the representativeness of those who do return for follow-up, specifically that these individuals might be the ones who benefited from the intervention the most, which increases effect sizes.…”

“…Indeed, studies that are described as self-help or unguided have used financial incentives (Clarke et al, 2005; Clarke et al, 2002) or phone interviews (Berger et al, 2011; Christensen et al, 2004a; Spek et al, 2007; Vernmark et al, 2010), or were administered in a structured setting such as a school (O'Kearney et al, 2006; O'Kearney et al, 2009). The few truly unsupported studies (Christensen et al, 2002; Christensen et al, 2004b; Donker et al, 2013; Meyer et al, 2009) used randomization, which may have turned away participants who were reluctant to receive a control condition or their non-preferred condition. Thus, the goal of this study was to understand the efficacy of an ecologically valid fully-automated, unsupported intervention for the reduction of depressive symptoms.…”

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