Internet-based behavioral activation and acceptance-based treatment for depression: a randomized controlled trial.
BACKGROUND
Internet-based cognitive behavior therapy for depression has been tested in several trials but there are no internet studies on behavioral activation (BA), and no studies on BA over the internet including components of acceptance and commitment therapy (ACT). The aim of this study was to develop and test the effects of internet-delivered BA combined with ACT against a waiting list control condition as a first test of the effects of treatment.


METHODS
Selection took place with a computerized screening interview and a subsequent semi-structured telephone interview. A total of 80 individuals from the general public were randomized to one of two conditions. The treatment lasted for 8 weeks after which both groups were assessed. We also included a 3 month follow-up. The treatment included interactive elements online and a CD-ROM for mindfulness and acceptance exercises. In addition, written support and feedback was given by a therapist every week.


RESULTS
Results at posttreatment showed a large between group effect size on the Beck Depression inventory II d=0.98 (95%CI=0.51-1.44). In the treated group 25% (10/40) reached remission defined as a BDI score ≤ 10 vs. 5% (2/40) in the control group. Results on secondary measures were smaller. While few dropped out from the study (N=2) at posttreatment, the average number of completed modules was M=5.1 out of the seven modules.


CONCLUSIONS
The study only included a waiting-list comparison and it is not possible to determine which treatment components were the most effective.


CONCLUSIONS
We conclude that there is initial evidence that BA with components of ACT can be effective in reducing symptoms of depression.
Department of Psychology, Stockholm University, Stockholm, Sweden. per@carlbring.se
Per
P
Carlbring
Malin
M
Hägglund
Anne
A
Luthström
Mats
M
Dahlin
Åsa
Å
Kadowaki
Kristofer
K
Vernmark
Gerhard
G
Andersson
D064869:Acceptance and Commitment Therapy / Q000379:methods*; D000328:Adult; D003865:Major Depressive Disorder / Q000523:psychology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D036301:Qualitative Research; D012720:Severity of Illness Index; D013813:Therapy, Computer-Assisted; D016896:Treatment Outcome