Diminishing Effects After Recurrent Use of Self-Guided Internet-Based Interventions in Depression: Randomized Controlled Trial.

Lara Bücker,Steffen Moritz,Stefan Westermann,Patricia Schnakenberg,Eirini Karyotaki

doi:10.2196/14240

Abstract

BackgroundSelf-guided internet-based interventions have several advantages over guided interventions and are generally effective in treating psychiatric symptoms.ObjectiveWe aimed to investigate whether the use of a new self-guided internet-based intervention (MOOD) would lead to a significant reduction in depressive symptoms compared with a care-as-usual (CAU) control group in a sample of individuals with depressive symptoms, most of whom had already used a different self-guided internet-based intervention in a previous trial.MethodsA total of 125 individuals were randomized to the intervention condition (MOOD) and received access to the intervention for a period of six weeks or a CAU group. After six weeks, all participants were invited to take part in the post assessment. The Beck Depression Inventory-II served as the primary outcome.ResultsBoth intention-to-treat as well as per-protocol analyses indicated that the depressive symptomatology decreased in both conditions but showed no advantage for those who had used MOOD. Subsequent moderation analyses suggested that those individuals who had less experience with psychotherapy benefitted to a greater extent compared with those with more experience.ConclusionsSelf-guided internet-based interventions are deemed a suitable first-step approach to the treatment of depression. However, our results indicate that they are more efficacious in those with less psychotherapy experience.Trial RegistrationClinicalTrials.gov NCT03795480; http://clinicaltrials.gov/ct2/show/NCT03795480

Highlights

Major depression (MD) is one of the most common mental disorders, with more than 300 million people affected worldwide [1]
We aimed to investigate whether the use of a new self-guided internet-based intervention called MOOD over a period of 6 weeks would lead to a significant reduction in depressive symptoms compared with a CAU group in a sample of individuals who had previously and/or currently received therapy
The efficacy of unguided internet-based interventions has been proven in various trials. It is unclear whether internet-based interventions are beneficial for individuals with a long history of depression and greater experience with psychotherapy and for those who have already undergone a different unguided Web-based intervention

Summary

Introduction

Background Major depression (MD) is one of the most common mental disorders, with more than 300 million people affected worldwide [1]. 1 (page number not for citation purposes) depression is 56.3% [8] This means that a large number of individuals suffering from depressive symptoms remain untreated. This treatment gap can be attributed to several different causes. Presentation of lists of possible positive activities and exercises aimed at integrating positive activities into everyday life on a regular basis and planning them in a meaningful and realistic way; setting short- and long-term goals Self-esteem. Presentation of a list of concrete actions to increase self-esteem in everyday life (eg, joy diary). Self-guided internet-based interventions have several advantages over guided interventions and are generally effective in treating psychiatric symptoms

Methods

Results

Discussion

Conclusion