Internet-based CBT for Depression

A 12-month follow-up of a randomized controlled trial

CBT study

BACKGROUND: In this study we investigated whether an Internet-based computerized cognitive behavioral therapy (iCBT) program can decrease the risk of DSM-IV-TR major depressive episodes (MDE) during a 12-month follow-up of a randomized controlled trial of Japanese workers.

METHOD: Participants were recruited from one company and three departments of another company. Those participants who did not experience MDE in the past month were randomly allocated to intervention or control groups (n = 381 for each). A 6-week, six-lesson iCBT program was provided to the intervention group. While the control group only received the usual preventive mental health service for the first 6 months, the control group was given a chance to undertake the iCBT program after a 6-month follow-up. The primary outcome was a new onset of DSM-IV-TR MDE during the 12-month follow-up, as assessed by means of the web version of the WHO Composite International Diagnostic Interview (CIDI), version 3.0 depression section.

RESULTS: The intervention group had a significantly lower incidence of MDE at the 12-month follow-up than the control group (Log-rank ?2 = 7.04, p < 0.01). The hazard ratio for the intervention group was 0.22 (95% confidence interval 0.06–0.75), when estimated by the Cox proportional hazard model.

CONCLUSIONS: The present study demonstrates that an iCBT program is effective in preventing MDE in the working population. However, it should be noted that MDE was measured by self-report, while the CIDI can measure the episodes more strictly following DSM-IV criteria.

Imamura, K., Kawakami, N., Furukawa, T. A., Matsuyama, Y., Shimazu, A., Umanodan, R., Kawakami, S., … Kasai, K. (2015). Does Internet-based cognitive behavioral therapy (iCBT) prevent major depressive episode for workers? A 12-month follow-up of a randomized controlled trial. Psychological Medicine, 1-11.

Internet-Based CBT is Effective for Panic Disorder

OBJECTIVE: Guided Internet-based cognitive behaviour therapy (ICBT) for panic disorder has been shown to be efficacious in several randomized controlled trials. However, the effectiveness of the treatment when delivered within routine psychiatric care has not been studied. The aim of this study was to investigate the effectiveness of ICBT for panic disorder within the context of routine psychiatric care.

METHOD: We conducted a cohort study investigating all patients (n = 570) who had received guided ICBT for panic disorder between 2007 and 2012 in a routine care setting at an out-patient psychiatric clinic providing Internet-based treatment. The primary outcome measure was the Panic Disorder Severity Scale-Self-report (PDSS-SR).

RESULTS: Participants made large improvements from screening and pretreatment assessments to posttreatment (Cohen’s d range on the PDSS-SR = 1.07-1.55). Improvements were sustained at 6-month follow-up.

CONCLUSIONS: This study suggests that ICBT for panic disorder is as effective when delivered in a routine care context as in the previously published randomized controlled trials.

Hedman, E., Ljo?tsson, B., Ru?ck, C., Bergstro?m, J., Andersson, G., Kaldo, V., Jansson, L., … Lindefors, N. (January 01, 2013). Effectiveness of internet-based cognitive behaviour therapy for panic disorder in routine psychiatric care. Acta Psychiatrica Scandinavica, 128, 6, 457-67.

Tailored Internet-Based CBT is Effective for Depression

According to a recent study published in Plos One, tailored internet-based cognitive behavior therapy (CBT) may be helpful in the treatment of depression. In the current study, researchers compared individually tailored, internet-based self-help CBT to standardized (non-tailored) internet-based CBT and an active control (a monitored online discussion group). Participants included 121 individuals diagnosed with major depressive disorder and a range of comorbid symptoms. The standardized CBT (non-tailored) group received 8 self-help downloadable chapters with material on behavioral activation, cognitive restructuring, sleep management, general health advice and relapse prevention. The tailored CBT group received 25 self-help downloadable chapters with material on depression, panic, social anxiety, worrying and additional material (e.g., information on stress management and problem solving strategies) and each participant received an individual 10-week treatment plan. Both CBT groups (tailored and non-tailored) received email support from a therapist. At post-treatment and at a 6 month follow-up, both groups improved on measures of depression, anxiety, and quality of life. Subgroup analyses showed that the tailored CBT group had greater recovery rates as well as greater reductions in depressive symptoms among participants who presented with higher levels of depression and comorbidity at baseline. These results suggest that tailoring guided self-help treatments for depression may help make them more effective than standardized approaches.

Johansson, R., Sjoberg, E., Sjogren, M., Johnsson, E., Carlbring, P., Andersson, T., Rousseau, A., Andersson, G.  (2012).   Tailored vs. Standard Internet-Based Cognitive Behavior Therapy for Depression and Comorbid Symptoms: A Randomized Controlled Trial.  Plos ONE, 7(5) : e36905.  doi:  10.1371/journal.pone.0036905

Erectile Dysfunction benefits from Internet-based CBT

A study in the International Journal of Impotence Research reported that men with erectile dysfunction (ED) benefited from Internet-based cognitive behavioral therapy (CBT). An important aspect of this approach was that it removed much of the anxiety and embarrassment associated with face-to-face discussions of sexual problems. The CBT protocol included the men and their partners, and focused on psychological and relationship factors related to ED.

Designed as a 10-week program, couples participated in communication exercises, sensate focus activities, and email contact with therapists when needed. Improvements in ED were significantly greater among men who completed the program compared to those who received no treatment, and these findings were consistent with face-to-face psychological treatments. Additionally, the positive treatment effects remained stable during the 3-month follow-up period.

Study authors: M. P. McCabe, E. Price, L. Piterman, D. Lording