title: Internet-based treatment for adults with depressive symptoms: randomized controlled trial.
abstract: BACKGROUND
  Many depressed people do not receive help for their symptoms, and there are various barriers that impede help-seeking. The Internet may offer interesting alternatives for reaching and helping people with depression. Depression can be treated effectively with Internet-based cognitive behavioral therapy (CBT), but a short intervention based on problem solving therapy (PST) could constitute a worthwhile alternative to CBT.
  
  
  OBJECTIVE
  In this study we evaluated the effectiveness of Internet-based CBT and Internet-based PST in comparison to a waiting list control group (WL), and we determined the differences between the two treatments.
  
  
  METHODS
  We conducted a 3-arm randomized controlled trial to compare CBT, PST, and WL. The main inclusion criterion was presence of depressive symptoms (>or= 16 on the Center for Epidemiological Studies Depression scale). CBT and PST consisted of eight and five weekly lessons respectively. Participants were supported by email. Self-report measures of depression, anxiety, and quality of life were completed at pretest and after 5, 8, and 12 weeks.
  
  
  RESULTS
  A total of 263 participants were randomized to the three conditions (CBT: n=88; PST: n=88; WL: n=87). Of the 263 participants, 184 (70%) completed questionnaires after 5 weeks, 173 (66%) after 8 weeks, and 151 (57%) after 12 weeks. Between-group effect sizes for depressive symptoms were 0.54 for CBT after 8 weeks (95% confidence interval (CI): 0.25 - 0.84) and 0.47 for PST after 5 weeks (95% CI: 0.17 - 0.77). These effects were further improved at 12 weeks (CBT: 0.69, 95% CI: 0.41 - 0.98; PST: 0.65, 95% CI: 0.36 - 0.95). For anxiety, effect sizes were also at a medium level. Effect sizes for quality of life were low. The number of participants showing clinically significant change at 12 weeks was significantly higher for CBT (n = 34, 38.6%) and PST (n = 30, 34.1%), compared to WL (n = 0).
  
  
  CONCLUSIONS
  Both Internet-based treatments are effective in reducing depressive symptoms, although the effect of PST is realized more quickly.
  
  
  BACKGROUND
  International Standard Randomized Controlled Trial Number (ISRCTN): 16823487; http://www.controlled-trials.com/ISRCTN16823487/16823487 (Archived by WebCite at http://www.webcitation.org/5cQsOj7xf).
authors.affiliation: Dept Clinical Psychology, VU University Amsterdam, FPP, Amsterdam, The Netherlands. eh.warmerdam@psy.vu.nl
authors.forename: Lisanne
authors.initials: L
authors.lastname: Warmerdam
authors.forename: Annemieke
authors.initials: A
authors.lastname: van Straten
authors.forename: Jos
authors.initials: J
authors.lastname: Twisk
authors.forename: Heleen
authors.initials: H
authors.lastname: Riper
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
mesh_terms: D000328:Adult; D000329:Advertising; D001008:Anxiety Disorders / Q000534:rehabilitation; D001521:Behavior Therapy / Q000379:methods; D003071:Cognition; D016001:Confidence Intervals; D003863:Depression / Q000534:rehabilitation*; D003866:Depressive Disorder / Q000534:rehabilitation*; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet; D009524:Newspapers as Topic; D018579:Patient Selection; D011340:Problem Solving; D011788:Quality of Life; D015203:Reproducibility of Results; D012657:Self-Help Groups / Q000458:organization & administration*; D013813:Therapy, Computer-Assisted / Q000379:methods*; D013997:Time Factors; D014850:Waiting Lists