The more I got, the less I need?: Efficacy of Internet-based guided self-help compared to online psychoeducation for major depressive disorder

Jo Annika Reins; Leif Boß; Dirk Lehr; Matthias Berking; David Daniel Ebert

doi:10.1016/j.jad.2018.12.065

The more I got, the less I need? Efficacy of Internet-based guided self-help compared to online psychoeducation for major depressive disorder

Jo Annika Reins
, Leif Boß
, Dirk Lehr
, Matthias Berking
, David Daniel Ebert

Clinical, Neuro- & Developmental Psychology

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

BACKGROUND: This study's aims were to compare the efficacy and negative effects of guided Internet-based cognitive behavior therapy (iCBT) and online psychoeducation (OPE) in people with major depression.

METHODS: A total of 131 individuals were randomized. Assessments took place at baseline (T1), six weeks (T2), and three months (T3). The primary endpoint was change in observer-based depression severity from T1 to T2. Potential negative effects were analyzed in terms of suicidal ideations, symptom deterioration, attitudes toward seeking further help, and other adverse events.

RESULTS: iCBT (n = 65) and OPE (n = 66) both reduced depressive symptoms from T1 to T2, with large changes observed for iCBT and medium for OPE (iCBT: Cohen's d = 1.09; OPE: d = 0.60). Differences between groups were significant at the primary endpoint (d = 0.36, p = 0.028). OPE continued to have a positive effect from post-treatment to follow-up, while the effect of iCBT remained stable, with differences between groups not being significant anymore at follow-up. Participants who had undergone prior psychotherapy benefited from both treatments; but for those without prior psychotherapy, iCBT was superior also at follow-up. In the iCBT group 26.2% of the participants reported at least one side-effect.

LIMITATIONS: The history of psychotherapy was imbalanced between the groups. Some negative effects were assessed in the iCBT group only.

CONCLUSIONS: Both iCBT and OPE were effective in reducing depressive symptoms, but with iCBT having a more rapid effect. iCBT was specifically superior in those with no prior history of psychotherapy. Negative effects occurred frequently and should be considered when implementing iCBT.

TRIAL REGISTRATION: German clinical trials register: DRKS00005025.

Original language	English
Pages (from-to)	695-705
Number of pages	11
Journal	Journal of Affective Disorders
Volume	246
DOIs	https://doi.org/10.1016/j.jad.2018.12.065
Publication status	Published - 1 Mar 2019

Bibliographical note

Funding

Mr. Ebert, Mr. Lehr, and Mr. Berking hold shares of the GET.ON Institute for Online Health Training, which aims to transfer scientific knowledge related to the present research into routine mental health care in Germany. The foundation of such an institute to disseminate findings and products from the research project was the primary aim of the European Union for funding the currently-presented research. Mr. Berking has received research grants from the German Ministry of Research and the German Research Association and personal fees from various institutions providing ongoing training for psychotherapists. Mr. Ebert has received funds from the German Ministry of Research and the German Research Association, the European Union, the SVLFG and consultancy fees from Schoen Kliniken, Agaplesion Kliniken, Sanofi, Novartis, BARMER, Techniker Krankenkasse. No other disclosures are reported. All procedures involved in the study were consistent with the generally-accepted standards of ethical practice approved by the University of Marburg ethics committee (No. 2013–08 K). The trial is registered in the German clinical trials register under DRKS00005025., Mr. Ebert, Mr. Lehr, and Mr. Berking hold shares of the GET.ON Institute for Online Health Training, which aims to transfer scientific knowledge related to the present research into routine mental health care in Germany. The foundation of such an institute to disseminate findings and products from the research project was the primary aim of the European Union for funding the currently-presented research. Mr. Berking has received research grants from the German Ministry of Research and the German Research Association and personal fees from various institutions providing ongoing training for psychotherapists. Mr. Ebert has received funds from the German Ministry of Research and the German Research Association, the European Union, the SVLFG and consultancy fees from Schoen Kliniken, Agaplesion Kliniken, Sanofi, Novartis, BARMER, Techniker Krankenkasse. No other disclosures are reported.

Funders	Funder number
Agaplesion Kliniken
German Ministry of Research
Schoen Kliniken
Novartis
Sanofi
Philipps-Universität Marburg	2013–08 K
European Commission
Deutsche Forschungsgemeinschaft

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Adult
Cognitive Behavioral Therapy/methods
Depressive Disorder, Major/psychology
Female
Humans
Internet
Male
Middle Aged
Patient Education as Topic/methods
Psychotherapy/statistics & numerical data
Self Care/methods
Suicidal Ideation
Treatment Outcome

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10.1016/j.jad.2018.12.065

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Cite this

@article{98c20a1368f94f0ea1eadb215a138ade,

title = "The more I got, the less I need?: Efficacy of Internet-based guided self-help compared to online psychoeducation for major depressive disorder",

abstract = "BACKGROUND: This study's aims were to compare the efficacy and negative effects of guided Internet-based cognitive behavior therapy (iCBT) and online psychoeducation (OPE) in people with major depression.METHODS: A total of 131 individuals were randomized. Assessments took place at baseline (T1), six weeks (T2), and three months (T3). The primary endpoint was change in observer-based depression severity from T1 to T2. Potential negative effects were analyzed in terms of suicidal ideations, symptom deterioration, attitudes toward seeking further help, and other adverse events.RESULTS: iCBT (n = 65) and OPE (n = 66) both reduced depressive symptoms from T1 to T2, with large changes observed for iCBT and medium for OPE (iCBT: Cohen's d = 1.09; OPE: d = 0.60). Differences between groups were significant at the primary endpoint (d = 0.36, p = 0.028). OPE continued to have a positive effect from post-treatment to follow-up, while the effect of iCBT remained stable, with differences between groups not being significant anymore at follow-up. Participants who had undergone prior psychotherapy benefited from both treatments; but for those without prior psychotherapy, iCBT was superior also at follow-up. In the iCBT group 26.2\% of the participants reported at least one side-effect.LIMITATIONS: The history of psychotherapy was imbalanced between the groups. Some negative effects were assessed in the iCBT group only.CONCLUSIONS: Both iCBT and OPE were effective in reducing depressive symptoms, but with iCBT having a more rapid effect. iCBT was specifically superior in those with no prior history of psychotherapy. Negative effects occurred frequently and should be considered when implementing iCBT.TRIAL REGISTRATION: German clinical trials register: DRKS00005025.",

keywords = "Adult, Cognitive Behavioral Therapy/methods, Depressive Disorder, Major/psychology, Female, Humans, Internet, Male, Middle Aged, Patient Education as Topic/methods, Psychotherapy/statistics \& numerical data, Self Care/methods, Suicidal Ideation, Treatment Outcome",

author = "Reins, \{Jo Annika\} and Leif Bo{\ss} and Dirk Lehr and Matthias Berking and Ebert, \{David Daniel\}",

note = "Copyright {\textcopyright} 2018. Published by Elsevier B.V.",

year = "2019",

month = mar,

day = "1",

doi = "10.1016/j.jad.2018.12.065",

language = "English",

volume = "246",

pages = "695--705",

journal = "Journal of Affective Disorders",

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TY - JOUR

T1 - The more I got, the less I need?

T2 - Efficacy of Internet-based guided self-help compared to online psychoeducation for major depressive disorder

AU - Reins, Jo Annika

AU - Boß, Leif

AU - Lehr, Dirk

AU - Berking, Matthias

AU - Ebert, David Daniel

PY - 2019/3/1

Y1 - 2019/3/1

N2 - BACKGROUND: This study's aims were to compare the efficacy and negative effects of guided Internet-based cognitive behavior therapy (iCBT) and online psychoeducation (OPE) in people with major depression.METHODS: A total of 131 individuals were randomized. Assessments took place at baseline (T1), six weeks (T2), and three months (T3). The primary endpoint was change in observer-based depression severity from T1 to T2. Potential negative effects were analyzed in terms of suicidal ideations, symptom deterioration, attitudes toward seeking further help, and other adverse events.RESULTS: iCBT (n = 65) and OPE (n = 66) both reduced depressive symptoms from T1 to T2, with large changes observed for iCBT and medium for OPE (iCBT: Cohen's d = 1.09; OPE: d = 0.60). Differences between groups were significant at the primary endpoint (d = 0.36, p = 0.028). OPE continued to have a positive effect from post-treatment to follow-up, while the effect of iCBT remained stable, with differences between groups not being significant anymore at follow-up. Participants who had undergone prior psychotherapy benefited from both treatments; but for those without prior psychotherapy, iCBT was superior also at follow-up. In the iCBT group 26.2% of the participants reported at least one side-effect.LIMITATIONS: The history of psychotherapy was imbalanced between the groups. Some negative effects were assessed in the iCBT group only.CONCLUSIONS: Both iCBT and OPE were effective in reducing depressive symptoms, but with iCBT having a more rapid effect. iCBT was specifically superior in those with no prior history of psychotherapy. Negative effects occurred frequently and should be considered when implementing iCBT.TRIAL REGISTRATION: German clinical trials register: DRKS00005025.

AB - BACKGROUND: This study's aims were to compare the efficacy and negative effects of guided Internet-based cognitive behavior therapy (iCBT) and online psychoeducation (OPE) in people with major depression.METHODS: A total of 131 individuals were randomized. Assessments took place at baseline (T1), six weeks (T2), and three months (T3). The primary endpoint was change in observer-based depression severity from T1 to T2. Potential negative effects were analyzed in terms of suicidal ideations, symptom deterioration, attitudes toward seeking further help, and other adverse events.RESULTS: iCBT (n = 65) and OPE (n = 66) both reduced depressive symptoms from T1 to T2, with large changes observed for iCBT and medium for OPE (iCBT: Cohen's d = 1.09; OPE: d = 0.60). Differences between groups were significant at the primary endpoint (d = 0.36, p = 0.028). OPE continued to have a positive effect from post-treatment to follow-up, while the effect of iCBT remained stable, with differences between groups not being significant anymore at follow-up. Participants who had undergone prior psychotherapy benefited from both treatments; but for those without prior psychotherapy, iCBT was superior also at follow-up. In the iCBT group 26.2% of the participants reported at least one side-effect.LIMITATIONS: The history of psychotherapy was imbalanced between the groups. Some negative effects were assessed in the iCBT group only.CONCLUSIONS: Both iCBT and OPE were effective in reducing depressive symptoms, but with iCBT having a more rapid effect. iCBT was specifically superior in those with no prior history of psychotherapy. Negative effects occurred frequently and should be considered when implementing iCBT.TRIAL REGISTRATION: German clinical trials register: DRKS00005025.

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KW - Humans

KW - Internet

KW - Male

KW - Middle Aged

KW - Patient Education as Topic/methods

KW - Psychotherapy/statistics & numerical data

KW - Self Care/methods

KW - Suicidal Ideation

KW - Treatment Outcome

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