title: Internet-based versus face-to-face cognitive-behavioral intervention for depression: a randomized controlled non-inferiority trial.
abstract: OBJECTIVE
  In the past decade, a large body of research has demonstrated that internet-based interventions can have beneficial effects on depression. However, only a few clinical trials have compared internet-based depression therapy with an equivalent face-to-face treatment. The primary aim of this study was to compare treatment outcomes of an internet-based intervention with a face-to-face intervention for depression in a randomized non-inferiority trial.
  
  
  METHODS
  A total of 62 participants suffering from depression were randomly assigned to the therapist-supported internet-based intervention group (n=32) and to the face-to-face intervention (n=30). The 8 week interventions were based on cognitive-behavioral therapy principles. Patients in both groups received the same treatment modules in the same chronological order and time-frame. Primary outcome measure was the Beck Depression Inventory-II (BDI-II); secondary outcome variables were suicidal ideation, anxiety, hopelessness and automatic thoughts.
  
  
  RESULTS
  The intention-to-treat analysis yielded no significant between-group difference (online vs. face-to-face group) for any of the pre- to post-treatment measurements. At post-treatment both treatment conditions revealed significant symptom changes compared to before the intervention. Within group effect sizes for depression in the online group (d=1.27) and the face-to-face group (d=1.37) can be considered large. At 3-month follow-up, results in the online group remained stable. In contrast to this, participants in the face-to-face group showed significantly worsened depressive symptoms three months after termination of treatment (t=-2.05, df=19, p<.05).
  
  
  CONCLUSIONS
  Due to the small sample size, it will be important to evaluate these outcomes in adequately-powered trials.
  
  
  CONCLUSIONS
  This study shows that an internet-based intervention for depression is equally beneficial to regular face-to-face therapy. However, more long term efficacy, indicated by continued symptom reduction three months after treatment, could be only be found for the online group.
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstr. 10, 04103 Leipzig, Germany. Electronic address: birgit.wagner@medizin.uni-leipzig.de.
authors.forename: Birgit
authors.initials: B
authors.lastname: Wagner
authors.forename: Andrea B
authors.initials: AB
authors.lastname: Horn
authors.forename: Andreas
authors.initials: A
authors.lastname: Maercker
mesh_terms: D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011569:Psychiatric Status Rating Scales; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: CBT; Depression; Face-to-face; Internet