Abstract
BackgroundThere are evidence-based interventions for depression that include different components. However, the efficacy of their therapeutic components is unknown. Another important issue related to depression interventions is that, up to now, their therapeutic components have only focused on reducing negative symptoms rather than on improving positive affect and well-being. Because the low levels of positive affect are more strongly linked to depression than to other emotional disorders, it is important to include this variable as an important treatment target. Positive psychotherapeutic strategies (PPs) could help in this issue. The results obtained so far are consistent and promising, showing that Internet-based interventions are effective in treating depression. However, most of them are also multi-component, and it is important to make progress in investigating what each component contributes to the intervention.MethodsThe current study will be a three-armed, simple-blinded, randomized controlled clinical trial with a dismantling design. 192 participants will be randomly assigned to: a) an Internet-based Global Protocol condition, which includes traditional therapeutic components of evidence-based treatments for depression (Motivation for change, Psychoeducation, Cognitive Therapy, Behavioral Activation (BA), Relapse Prevention) and PPs component, offering strategies to enhance positive mood and promote psychological strengths; b) an Internet-based BA Protocol condition (without the PPs component), and c) an Internet-based PPs Protocol condition (without the BA component). Primary outcome measures will be the BDI-II and PANAS. Secondary outcomes will include other variables such as depression, anxiety and stress, quality of life, resilience, and wellbeing related measures. Treatment acceptance and usability will also be measured. Participants will be assessed at pre-, post-treatment, 3-, 6- and 12- month follow- ups. The data will be analyzed based on the Intention-to-treat principle. Per protocol analyses will also be performed.DiscussionTo the best of our knowledge, this is the first randomized dismantling intervention study for depression with the aim of exploring the contribution of a PPs component and the BA component in an Internet-based intervention. The three protocols are online interventions, helping to reach many people who need psychological treatments and otherwise would not have access to them.Trial registrationClinicalstrials.gov as NCT03159715. Registered 19 May 2017.
Highlights
There are evidence-based interventions for depression that include different components
The US Institute of Medicine indicated that a key step in being able to offer evidence-based interventions in clinical settings is the identification of the core elements of psychological interventions [21]
One of the main aims of this study is to evaluate the efficacy of a complete Internet-based intervention for depressive symptoms, the same Internet-based intervention without the psychotherapeutic strategies (PPs) component, and the same Internet-based intervention without the behavioral activation (BA) component, all of them administered over the Internet to patients with mild to moderate depressive symptoms
Summary
There are evidence-based interventions for depression that include different components. The efficacy of their therapeutic components is unknown Another important issue related to depression interventions is that, up to now, their therapeutic components have only focused on reducing negative symptoms rather than on improving positive affect and well-being. We have evidence-based interventions for depression, including cognitive behavior therapy (CBT) [5, 6] and behavioral activation (BA) [7, 8], as well as interpersonal [3, 9] or problem-solving therapy [10]. The effect sizes found for CBT have been large compared to waiting list, placebo, or no-treatment conditions [14] It usually consists of applied cognitive techniques to change thought patterns and behavioral techniques to activate behaviors [13]. It has been pointed out that component studies are the best design to examine these core elements [15]
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