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Internet-based self-help for depression: randomised controlled trial
Örebro University, Department of Clinical Medicine. (Psykiatriskt forskningscentrum)ORCID iD: 0000-0001-9500-7763
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2005 (English)In: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 187, p. 456-461Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Major depression can be treated by means of cognitive-behavioural therapy, but as skilled therapists are in short supply there is a need for self-help approaches. Many individuals with depression use the internet for discussion of symptoms and to share their experience.

AIMS:

To investigate the effects of an internet-administered self-help programme including participation in a monitored, web-based discussion group, compared with participation in web-based discussion group only.

METHOD:

A randomised controlled trial was conducted to compare the effects of internet-based cognitive-behavioural therapy with minimal therapist contact (plus participation in a discussion group) with the effects of participation in a discussion group only.

RESULTS:

Internet-based therapy with minimal therapist contact, combined with activity in a discussion group, resulted in greater reductions of depressive symptoms compared with activity in a discussion group only (waiting-list control group). At 6 months' follow-up, improvement was maintained to a large extent.

CONCLUSIONS:

Internet-delivered cognitive cognitive-behavioural therapy should be pursued further as a complement or treatment alternative for mild-to-moderate depression.

Place, publisher, year, edition, pages
2005. Vol. 187, p. 456-461
Keywords [en]
Adult, Cognitive Therapy/*methods, Depressive Disorder/*therapy, Female, Follow-Up Studies, Humans, Internet, Male, Middle Aged, Patient Compliance, Psychiatric Status Rating Scales, Self Care/*methods, Self-Help Groups, Telemedicine/*methods, Treatment Outcome
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-3578DOI: 10.1192/bjp.187.5.456PubMedID: 16260822OAI: oai:DiVA.org:oru-3578DiVA, id: diva2:137876
Available from: 2008-12-09 Created: 2008-12-09 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Managing depression via the Internet: self-report measures, treatment & relapse prevention
Open this publication in new window or tab >>Managing depression via the Internet: self-report measures, treatment & relapse prevention
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Cognitive behaviour therapy (CBT) is an effective treatment for depression but access is limited. One way of increasing access is to offer CBT via the Internet. In Study I, guided Internet-based CBT was found to have a large effect on depressive symptoms compared to taking part in an online discussion group. Approximately two hours were spent on guiding each patient and the large effect found differs from previous studies that showed smaller effects, probably due to lack of guidance. The intervention had no effect on the participants’ quality of life but significantly decreased their level of anxiety.

Internet-based versions of self-report measures can be more practical and efficient than paper versions. However, before implementation, evidence of psychometrical equivalence to the paper versions should be available. This was tested in Studies II and III for the Montgomery-Åsberg Depression Rating Scale – Self-rated (MADRS-S) and the Beck Depression Inventory – Second Edition (BDI-II). When the full scales were investigated, equivalent psychometric properties were found in the two versions of the MADRS-S and BDI-II. However, in the Internet-version of the BDI-II, a lower score was found for the question about suicidality and the difference was statistically significant. Although the difference was small, this indicates that suicidality might be underestimated when using the Internet-based BDI-II.

As the long-term prognosis after treatment for depression is poor, in Study IV we investigated the possibility of delivering CBT-based relapse prevention via the Internet. The results revealed that fewer participants in the intervention group experienced a relapse compared to the control group and that the time spent on guiding each participant was approximately 2.5 hours. A trend towards a higher remission rate was found in the CBT group at the six-month follow-up and a reduction of depressive symptoms was associated with a lowered risk of relapse. CBT-based relapse prevention via the Internet can potentially be made available to large numbers of patients, thus improving their prognosis.

The Internet increases the possibilities for health care providers in the management of depression.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2011. p. 88
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 56
Keywords
Internet, depression, cognitive behaviour therapy, self-report measures, relapse prevention
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-15734 (URN)978-91-7668-806-9 (ISBN)
Public defence
2011-09-23, Örebro universitet, Prismahuset, Hörsal P2, Fakultetsgatan 1, Örebro, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2011-05-27 Created: 2011-05-27 Last updated: 2017-10-17Bibliographically approved

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Holländare, Fredrik

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