Abstract
BackgroundNotwithstanding a high expectation for internet-based cognitive behavioral therapy (iCBT) for reducing depressive symptoms, many of iCBT programs have limitations such as temporary effects and high drop-out rates, possibly due to their complexity. We examined the effects of a free, simplified, 5-minute iCBT program by comparing it with a simplified emotion-focused mindfulness (sEFM) exercise and with a waiting list control group.MethodsA total of 974 participants, who were recruited using the website of a market research company, were randomly assigned to the iCBT group, the sEFM group, and the control group. Those in the intervention arms performed each exercise for 5 weeks. The primary outcome measure was the Center for Epidemiological Studies Depression scale (CES-D) at postintervention. Secondary outcome measures were the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 scale (GAD-7). Intention-to-treat analyses were conducted.ResultsDuring postintervention assessment, there were no significant differences between the intervention arms and the control group in the CES-D, although the difference between the iCBT arm and control group was close to significance (p = 0.05) in favor of iCBT. There was a significant difference in the PHQ-9 in favor of the sEFM group compared with the control group. There were no significant differences in outcome measures between the three groups at the 6-week follow-up.ConclusionsAlthough both iCBT and sEFM have the potential to temporarily reduce depressive symptoms, substantial improvements are required to enhance and maintain their effects.Trial registrationThis trial is registered with the UMIN Clinical Trial Registry (UMIN-CTR) (ID: UMIN000015097) on 1 October 2014.
Highlights
Notwithstanding a high expectation for internet-based cognitive behavioral therapy for reducing depressive symptoms, many of iCBT programs have limitations such as temporary effects and high drop-out rates, possibly due to their complexity
The participants were divided into the following groups: 326 people in the iCBT arm, 323 in the simplified emotion-focused mindfulness (sEFM) arm, and 325 in the waiting list arm
There were no significant differences between the three groups in terms of sex, age, marital status, educational attainment, employment status, Center for Epidemiological Studies Depression scale (CES-D) score at T0, Patient Health Questionnaire-9 (PHQ-9) score at T0, and Generalized Anxiety Disorder-7 scale (GAD-7) score at T0
Summary
Notwithstanding a high expectation for internet-based cognitive behavioral therapy (iCBT) for reducing depressive symptoms, many of iCBT programs have limitations such as temporary effects and high drop-out rates, possibly due to their complexity. From December 2015, Japan went to the extent of obliging companies with 50 or more employees to perform stress checks, which are an annual examination of employees’ stress levels, including symptoms of depression and anxiety [2]. Such a trend for general checks for depression may result in the more frequent identification of people suffering from depression and more people seeking treatment for it. The development of other delivery methods for CBT is necessary for the effective prevention and treatment of depression To deal with this problem, internet-based CBT (iCBT) has gained attention and numerous studies have analyzed the effects of iCBT on depression. The potential effects of iCBT in reducing depressive symptoms have been shown in meta-analyses [3, 4], the effects were observed to be transient and the participants’ drop-out rate was high [5]
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