title: Internet-based treatment of depression: a randomized controlled trial comparing guided with unguided self-help.
abstract: Internet-delivered self-help for depression with therapist guidance has shown efficacy in several trials. Results from meta-analyses suggest that guidance is important and that self-help programs without support are less effective. However, there are no direct experimental comparisons between guided and unguided internet-based treatments for depression. The present study compared the benefits of a 10-week web-based unguided self-help treatment with the same intervention complemented with weekly therapist support via e-mail. A waiting-list control group was also included. Seventy-six individuals meeting the diagnostic criteria of major depression or dysthymia were randomly assigned to one of the three conditions. The Beck Depression Inventory (BDI-II) was used as the primary outcome measure. Secondary outcomes included general psychopathology, interpersonal problems, and quality of life. Sixty-nine participants (91%) completed the assessment at posttreatment and 59 (78%) at 6-month follow-up. Results showed significant symptom reductions in both treatment groups compared to the waiting-list control group. At posttreatment, between-group effect sizes on the BDI-II were d = .66 for unguided self-help versus waiting-list and d = 1.14 for guided self-help versus waiting-list controls. In the comparison of the two active treatments, small-to-moderate, but not statistically significant effects in favor of the guided condition were found on all measured dimensions. In both groups, treatment gains were maintained at 6-month follow-up. The findings provide evidence that internet-delivered treatments for depression can be effective whether support is added or not. However, all participants were interviewed in a structured diagnostic telephone interview before inclusion, which prohibits conclusions regarding unguided treatments that are without any human contact.
authors: Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland. thomas.berger@ptp.unibe.ch
authors: Thomas
authors: T
authors: Berger
authors: Katja
authors: K
authors: Hämmerli
authors: Nina
authors: N
authors: Gubser
authors: Gerhard
authors: G
authors: Andersson
authors: Franz
authors: F
authors: Caspar
mesh_terms: D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods* / Q000706:statistics & numerical data; D003865:Major Depressive Disorder / Q000628:therapy*; D037001:Directive Counseling / Q000379:methods* / Q000706:statistics & numerical data; D019263:Dysthymic Disorder / Q000628:therapy*; D034742:Electronic Mail; D005260:Female; D006801:Humans; D020407:Internet; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011788:Quality of Life / Q000523:psychology; D012648:Self Care / Q000379:methods* / Q000523:psychology; D013813:Therapy, Computer-Assisted / Q000379:methods*; D014850:Waiting Lists