Internet-Based CBT for Depression with and without Telephone Tracking in a National Helpline: Randomised Controlled Trial

Louise Farrer,Helen Christensen,Kathleen M Griffiths,Andrew Mackinnon,Katharina Domschke

doi:10.1371/journal.pone.0028099

Louise Farrer, Helen Christensen + Show 3 more

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https://doi.org/10.1371/journal.pone.0028099

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Abstract

BackgroundTelephone helplines are frequently and repeatedly used by individuals with chronic mental health problems and web interventions may be an effective tool for reducing depression in this population.AimTo evaluate the effectiveness of a 6 week, web-based cognitive behaviour therapy (CBT) intervention with and without proactive weekly telephone tracking in the reduction of depression in callers to a helpline service.Method155 callers to a national helpline service with moderate to high psychological distress were recruited and randomised to receive either Internet CBT plus weekly telephone follow-up; Internet CBT only; weekly telephone follow-up only; or treatment as usual.ResultsDepression was lower in participants in the web intervention conditions both with and without telephone tracking compared to the treatment as usual condition both at post intervention and at 6 month follow-up. Telephone tracking provided by a lay telephone counsellor did not confer any additional advantage in terms of symptom reduction or adherence.ConclusionsA web-based CBT program is effective both with and without telephone tracking for reducing depression in callers to a national helpline.Trial Registration Controlled-Trials.com ISRCTN93903959

Highlights

Telephone helplines provide 24 hour, non-directive crisis and counselling services to large numbers of callers in the community using a volunteer workforce
Our study aimed to evaluate the effectiveness of a webbased cognitive behaviour therapy (CBT) program delivered within a helpline, and to examine the benefit of weekly telephone contact on efficacy, adherence and dropout
The most common reasons for ineligibility were a score of less than 22 on the K10 (138; 40.9%), a diagnosis of schizophrenia or bipolar disorder (89; 26.4%), or no Internet access (67; 19.9%). 370 people were eligible for inclusion in the trial, and of these, 155 completed informed consent procedures and baseline assessments, and were randomised to trial conditions, resulting in a 42% acceptance rate. 107 (69%) returned post intervention surveys, and 92 (59%) completed the 6 month follow up

Summary

Introduction

Telephone helplines provide 24 hour, non-directive crisis and counselling services to large numbers of callers in the community using a volunteer workforce. In Australia, over 850,000 calls are answered annually by the large telecounselling providers, with 20% of callers referred by healthcare providers. Designed primarily to provide immediate crisis intervention, these services are frequently used by callers experiencing chronic mental health problems. In addition to providing non-directive counselling, telephone helpline agencies refer callers to mainstream mental health services [5]. Mental health services are often difficult to access because of cost, structured consultation times, waiting list length, and location. Mainstream mental health services may not inspire trust. Telephone helplines are frequently and repeatedly used by individuals with chronic mental health problems and web interventions may be an effective tool for reducing depression in this population

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