Web-based depression treatment: associations of clients' word use with adherence and outcome.
BACKGROUND
The growing number of web-based psychological treatments, based on textual communication, generates a wealth of data that can contribute to knowledge of online and face-to-face treatments. We investigated whether clients' language use predicted treatment outcomes and adherence in Master Your Mood (MYM), an online group course for young adults with depressive symptoms.


METHODS
Among 234 participants from a randomised controlled trial of MYM, we tested whether their word use on course application forms predicted baseline levels of depression, anxiety and mastery, or subsequent treatment adherence. We then analysed chat session transcripts of course completers (n=67) to investigate whether word use changes predicted changes in treatment outcomes.


RESULTS
Depression improvement was predicted by increasing use of 'discrepancy words' during treatment (e.g. should). At baseline, more discrepancy words predicted higher mastery level. Adherence was predicted by more words used at application, more social words and fewer discrepancy words.


CONCLUSIONS
Many variables were included, increasing the chance of coincidental results. This risk was constrained by examining only those word categories that have been investigated in relation to depression or adherence.


CONCLUSIONS
This is the first study to link word use during treatment to outcomes of treatment that has proven to be effective in an RCT. The results suggest that paying attention to the length of problem articulation at application and to 'discrepancy words' may be wise, as these seem to be psychological markers. To expand knowledge of word use as psychological marker, research on web-based treatment should include text analysis.
Trimbos Institute, Knowledge Centre of Mental Health and Addiction, Da Costakade 45, Post Office Box 727, 3500 Utrecht, The Netherlands. Electronic address: rzanden@trimbos.nl.
Rianne
R
Van der Zanden
Trimbos Institute, Knowledge Centre of Mental Health and Addiction, Da Costakade 45, Post Office Box 727, 3500 Utrecht, The Netherlands. Electronic address: keshiacurie@yahoo.com.
Keshia
K
Curie
Department of Social Sciences, Utrecht University, The Netherlands. Electronic address: m.vanlonden@uu.nl.
Monique
M
Van Londen
Trimbos Institute, Knowledge Centre of Mental Health and Addiction, Da Costakade 45, Post Office Box 727, 3500 Utrecht, The Netherlands.
Jeannet
J
Kramer
Department of Language and Communication, Network Institute, VU University Amsterdam, The Netherlands. Electronic address: g.j.steen@vu.nl.
Gerard
G
Steen
Department of Clinical Psychology, EMGO Institute for Health and Care Research, VU University Amsterdam, The Netherlands. Electronic address: p.cijpers@vu.nl.
Pim
P
Cuijpers
D001007:Anxiety; D003863:Depression / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet; D007802:Language; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D013813:Therapy, Computer-Assisted; D016896:Treatment Outcome; D055815:Young Adult
Depression; Linguistics; Text analysis; Web-based treatment; Word use; e-Mental health