Internet therapy

For depression several self help treatment options are available. In short mutual self help groups, cognitive behavioral therapy and problem solving therapy are the most important
Mutual help groups provide limited but promising evidence that mutual help groups benefit people with three types of problems: chronic mental illness, depression/anxiety, and bereavement.

Cognitive behavioral therapy is very efficient as self help treatment, its structured format makes it very suitable for self-help purposes and it can be very efficacious for the treatment of depression. Problem solving therapy (PST) is another option for self help in depression. Recently, a new, generic, PST-based intervention for multiple mental health problems that could be applied through the Internet was developed.

What is Internet problem solving therapy?

The general idea of self-examination therapy is that subjects learn to regain control over their problems and lives by

• determining what really matters to them
• investing energy only in those problems that are related to what matters
• thinking less negatively about the problems that are unrelated
• accepting those situations that cannot be changed.

Self-examination therapy was exclusively designed to be a self-administered treatment and has been found to be effective in several studies in the United States [11-14]. In these studies, self-examination therapy was offered in book format, and it is not known whether it also works when given via the Internet.

How was this study done?
PST has a short duration of 5 weeks. CBT is an 8-week intervention, both can be administered on the Internet. These two forms of self help for depression were compared in a 3-arm randomized controlled trial to compare CBT, PST, and a waiting list group (WL). Patients had to have depressive symptoms (≥ 16 on the Center for Epidemiological Studies Depression scale). CBT and PST consisted of eight and five weekly lessons respectively. Participants were supported by email. Self-report measures of depression, anxiety, and quality of life were completed at pretest and after 5, 8, and 12 weeks.

Internet-based CBT and Internet-based PST are both effective in reducing depressive symptoms in comparison to a waiting list control group. These results were visible directly after treatment and 12 weeks after baseline. There is no indication that one is more effective than the other, although the effects are realized faster by PST than by CBT.

Mind you we’re talking about depressive symptoms not depressive disorder, this might also explain the high drop out rate.Overall the percentage of completers in this study was 38%. This is relatively low in comparison to other trials about Internet-based self-help for depression.

Of those participants assigned to CBT and PST, 8 (9.1%) versus 14 (15.9%) completed no lesson at all. Of those assigned to CBT, 63 (71.6%) participants completed at least four lessons and 34 (38.6%) completed all eight. Of those assigned to PST, 49 (55.7%) participants completed three or more sessions and 33 (37.5%) finished the whole course.

The advantage of this kind of therapies is the short duration until efficacy, low costs, prevents fear of stigmatization.

Lisanne Warmerdam, Annemieke van Straten, Jos Twisk, Heleen Riper, Pim Cuijpers (2008). Internet-Based Treatment for Adults with Depressive Symptoms: Randomized Controlled Trial Journal of Medical Internet Research, 10 (4) DOI: 10.2196/jmir.1094