Online CBT Could Benefit Those Reluctant to Get Professional Help
People with mild or moderate depression are at risk of developing major depression. Nonetheless, many do not seek help, and one of the reasons may be because they are afraid of what other people might think of them if they do. Thus, an Internet course in cognitive-behavioral therapy (CBT) might be a way for them to treat their own depression.
Indeed, several years ago Swedish researchers found that an Internet-based form of CBT, along with participation in an Internet-based discussion group, could significantly improve symptoms in persons with mild to moderate depression (Psychiatric News, December 16, 2005). And now Dutch investigators have found that Internet-based CBT without a discussion group can achieve comparable results.
The lead investigator was Viola Spek, a postdoctoral researcher at Tilburg University in the Netherlands. Study results are in press with Psychological Medicine.
The study included 301 subjects aged 50 or older with subthreshold depression. Subthreshold depression was defined as having a cut-off score above 12 on the Edinburgh Depression Scale, but too few symptoms to meet DSM-IV criteria for major depression.
One-third of the subjects were randomized to attend a group CBT course designed to help people with subthreshold depression, another third were randomized to participate in an Internet-based CBT course for people with subthreshold depression, and the remaining third were randomized to a waiting-list control condition.
The group course consisted of 10 weekly group sessions on psychoeducation, cognitive restructuring, behavior change, and relapse prevention and was led by psychologists and social workers. The Internet-based course covered the same topics as the group course, but was not led by any professionals.
The main outcome yardstick was treatment response after 10 weeks, defined as the difference between pre- and post-treatment scores on the Beck Depression Inventory.
Both the Internet-based CBT course and the group CBT course were found to be significantly better in treating depression than the control condition was. Thus, an Internet-based CBT course may be at least as effective as a group CBT course for treating mild or moderate depression in people over 50 years of age, Spek and her colleagues concluded.
A drawback of the Internet-based course, however, was that the completion rate was much lower than that for the group CBT course. The reason, Spek and her group speculated, is probably because the Internet course did not offer any professional supervision. The Internet CBT course explored by the Swedish researchers also had a high dropout rate. Regular phone calls from a therapist might enhance participants' completion of an Internet CBT course, Spek and her group noted.
Meanwhile, the Internet CBT course that Spek and her colleagues studied will be implemented in the Dutch mental health care system in the very near future, she told Psychiatric News.
Their Internet CBT course for mild or moderately depressed persons will not be the first to become available to the public, she added. One such program, the MoodGym Training Program, is already available from the Australian National University in Canberra, Australia, she said.
The Spek study was funded by the Netherlands Organization for Health Research and Development.
An abstract of “Internet-Based Cognitive-Behavioral Therapy for Sub-Threshold Depression in People Over 50 Years Old: A Randomized Controlled Clinical Trial” is posted at<http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=1005784&ful?>. Information on the Australian program is posted at<www.moodgym.anu.edu.au/default.asp?lang=1>.▪
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Published online: 5 October 2007
Published in print: October 5, 2007
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An Internet-based cognitive-behavioral therapy course can help people with mild or moderate depression. The intervention will soon be implemented in the Netherlands' mental health care system.
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