title: Combining imagination and reason in the treatment of depression: a randomized controlled trial of internet-based cognitive-bias modification and internet-CBT for depression.
abstract: OBJECTIVE
  Computerized cognitive-bias modification (CBM) protocols are rapidly evolving in experimental medicine yet might best be combined with Internet-based cognitive behavioral therapy (iCBT). No research to date has evaluated the combined approach in depression. The current randomized controlled trial aimed to evaluate both the independent effects of a CBM protocol targeting imagery and interpretation bias (CBM-I) and the combined effects of CBM-I followed by iCBT.
  
  
  METHODS
  Patients diagnosed with a major depressive episode were randomized to an 11-week intervention (1 week/CBM-I + 10 weeks/iCBT; n = 38) that was delivered via the Internet with no face-to-face patient contact or to a wait-list control (WLC; n = 31).
  
  
  RESULTS
  Intent-to-treat marginal models using restricted maximum likelihood estimation demonstrated significant reductions in primary measures of depressive symptoms and distress corresponding to medium-large effect sizes (Cohen's d = 0.62-2.40) following CBM-I and the combined (CBM-I + iCBT) intervention. Analyses demonstrated that the change in interpretation bias at least partially mediated the reduction in depression symptoms following CBM-I. Treatment superiority over the WLC was also evident on all outcome measures at both time points (Hedges gs = .59-.98). Significant reductions were also observed following the combined intervention on secondary measures associated with depression: disability, anxiety, and repetitive negative thinking (Cohen's d = 1.51-2.23). Twenty-seven percent of patients evidenced clinically significant change following CBM-I, and this proportion increased to 65% following the combined intervention.
  
  
  CONCLUSIONS
  The current study provides encouraging results of the integration of Internet-based technologies into an efficacious and acceptable form of treatment delivery. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
authors.affiliation: School of Psychiatry.
authors.forename: Alishia D
authors.initials: AD
authors.lastname: Williams
authors.forename: Simon E
authors.initials: SE
authors.lastname: Blackwell
authors.forename: Anna
authors.initials: A
authors.lastname: Mackenzie
authors.forename: Emily A
authors.initials: EA
authors.lastname: Holmes
authors.forename: Gavin
authors.initials: G
authors.lastname: Andrews
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007092:Imagination / Q000502:physiology; D020407:Internet / Q000706:statistics & numerical data; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D017216:Telemedicine / Q000379:methods*; D016896:Treatment Outcome; D014850:Waiting Lists