Effects of an Internet-based cognitive behavioral therapy (iCBT) program in Manga format on improving subthreshold depressive symptoms among healthy workers: a randomized controlled trial.

Kotaro Imamura,Norito Kawakami,Kiyoto Kasai,Rino Umanodan,Yutaka Matsuyama,Toshi A Furukawa,Akihito Shimazu,Sonoko Kawakami,Susana Jiménez-Murcia

doi:10.1371/journal.pone.0097167

Kotaro Imamura, Norito Kawakami + Show 7 more

Open Access

https://doi.org/10.1371/journal.pone.0097167

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Journal: PloS one	Publication Date: May 20, 2014
Citations: 117	License type: CC BY 4.0

Affiliation: The University of Tokyo, Kyoto University

Abstract

ObjectiveThe purpose of this study was to develop a new Internet-based computerized cognitive behavior therapy (iCBT) program in Manga format, the Japanese cartoon, for workers and to examine the effects of the iCBT program on improving subthreshold depression using a randomized controlled trial (RCT) design among workers employed in private companies in Japan.MethodAll workers in a company (n = 290) and all workers in three departments (n = 1,500) at the headquarters of another large company were recruited by an invitation e-mail. Participants who fulfilled the inclusion criteria were randomly allocated to intervention or control groups (N = 381 for each group). A six-week, six-lesson iCBT program using Manga (Japanese comic) story was developed. The program included several CBT skills: self-monitoring, cognitive restructuring, assertiveness, problem solving, and relaxation. The intervention group studied the iCBT program at a frequency of one lesson per week. Depression (Beck Depression Inventory II; BDI-II) was assessed as a primary outcome at baseline, and three- and six-month follow-ups for both intervention and control groups were performed.ResultsThe iCBT program showed a significant intervention effect on BDI-II (t = −1.99, p<0.05) with small effect sizes (Cohen's d: −0.16, 95% Confidence Interval: −0.32 to 0.00, at six-month follow-up).ConclusionsThe present study first demonstrated that a computerized cognitive behavior therapy delivered via the Internet was effective in improving depression in the general working population. It seems critical to improve program involvement of participants in order to enhance the effect size of an iCBT program.Trial RegistrationUMIN Clinical Trials Registry UMIN000006210

Highlights

Occupational stress has been considered a major risk factor for a wide range of health outcomes [1,2]
A growing body of literature has shown that stress management interventions (SMI) based on cognitive behavioral therapy (CBT) [4,5] and relaxation therapy [6] are effective in reducing work-related stress and improving depression and anxiety among workers
Another meta-analysis reported that the effect size of Internet-based computerized cognitive behavior therapy (iCBT) with therapist support was greater than the effect size of self-guided program without therapist support [15,17]

Summary

Conclusions

The present study first demonstrated that a computerized cognitive behavior therapy delivered via the Internet was effective in improving depression in the general working population. It seems critical to improve program involvement of participants in order to enhance the effect size of an iCBT program. Editor: Susana Jimenez-Murcia, University Hospital of Bellvitge-IDIBELL; CIBER Fisiopatologıa Obesidad y Nutricion (CIBERObn), Instituto Salud Carlos III; Department of Clinical Sciences, School of Medicine, University of Barcelona, Spain, Spain. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript This does not alter the authors’ adherence to all the PLoS ONE policies on sharing data and materials

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