Standardized Web-Based Cognitive Behavioural Therapy of Mild to Moderate Depression: A Randomized Controlled Trial with a Long-Term Follow-Up

Abstract

Depression is common but undertreated. Web-based self-help provides a widely accessible treatment alternative for mild to moderate depression. However, the lack of therapist guidance may limit its efficacy. The authors assess the efficacy of therapist-guided web-based cognitive behavioural treatment (web-CBT) of mild to moderate depression. Fifty-four individuals with chronic, moderate depression participated in a randomized wait-list controlled trial, with an 18-month follow-up (immediate treatment: n = 36, wait-list control: n = 18). Primary outcome measures were the Beck Depression Inventory (BDI-IA) and the Depression scale of the Symptom Checklist-90-Revised (SCL-90-R. DEP). Secondary outcome measures were the Depression Anxiety Stress Scales and the Well-Being Questionnaire. Five participants (9%) dropped out. Intention-to-treat analyses of covariance revealed that participants in the treatment condition improved significantly more than those in the wait-list control condition (.011 < p < .015). With regard to the primary measures, between-group effects (d) were 0.7 for the BDI-IA and 1.1 for the SCL-90-R DEP. Posttest SCL-90- R DEP scores indicated recovery of 49% of the participants in the treatment group compared with 6% in the control group (odds ratio = 14.5; p < .004). On average, the effects were stable up to 18 months (n = 39), although medication was a strong predictor of relapse. The results demonstrate the efficacy of web-CBT for mild to moderate depression and the importance of therapist guidance in psychological interventions.

Keywords:

• adult
• cognitive behaviour therapy/methods
• computer-assisted protocol-directed therapy
• controlled clinical trials, randomized
• depression/psychology/therapy
• follow-up studies
• Internet intervention
• online therapy
• prediction of treatment
• psychotherapy/brief treatment outcome.

Acknowledgements

This project was initiated by a grant from the Dutch Foundation of Mental Health (NFGV) in Utrecht. The authors thank Paul Emmelkamp and Conor Dolan for their valuable suggestions and the graduate students who helped conducting the research, in particular Janine van Hinsberg, Romy Koch, Anne-Hilde Krips, Cornelie Renckens, Thea Wegner, and Asja Zandbergen.

 Jeroen Ruwaard, Bart Schrieken, Menno Schrijver, and Janneke Broeksteeg are employees of Interapy B.V. Alfred Lange is a consultant to this company.

 Hans Vermeulen is now affiliated with the Red Cross Hospital, Beverwijk, the Netherlands. Jack Dekker is now affiliated with the Department of Clinical Psychology, Vrije Universiteit, Amsterdam, the Netherlands.