RCPsych: Cognitive behavioural therapy website versus information website for depression
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Friday, 01, Feb 2008 12:00
CBT more effective after 6 months; both still effective after 1 year
A comparison of a cognitive behavioural therapy (CBT) website with an information website for depression has found that after 6 months only the CBT website was significantly effective in reducing symptoms. After 1 year, both interventions were significantly better than no intervention (control condition).
Research has shown that internet-delivered brief CBT may be effective in reducing depression, but it has not been clear whether these gains are maintained over time.
The aim of this Australian study, published in the February 2008 issue of the British Journal of Psychiatry, was to see whether the benefits of internet-delivered brief psychoeducation and CBT were still there 6 and 12 months later, compared with a control condition, in which participants were asked questions about their lifestyle.
525 people with depression living in the community were randomised to one of the three conditions, and followed up at 6 and 12 months.
The CBT intervention comprised 5 interactive modules, including cognitive restructuring, pleasant activities, assertiveness training, problem-solving and downloadable relaxation sessions.
The psychoeducation website provided information about the symptoms of depression and its diagnosis, including evidence-based information about medical, psychological, alternative and lifestyle interventions, depression resources and sources of help, and a search engine to explore depression websites worldwide.
Interviewers maintained weekly telephone contact with all three groups over the period of the intervention - a total of six 10-minute contacts. Participants were telephoned up to three times to remind them to complete post-intervention questionnaires.
There was no other contact with participants over the 12-month period following the intervention period, although the websites were still accessible to them.
At the end of the interventions (post-test), it was found that both had reduced depression symptoms to a greater extent than the control condition. No significant differences were found between the two interventions at this point.
After 6 months, the effects of both interventions had declined, but the benefits of the CBT intervention remained significant, whilst those of the information website did not.
After 12 months, the pattern of decline was maintained. There was a slight but significant increase in the benefits of the active interventions compared with controls. However, participants in all three conditions continued to show reductions in symptoms of depression after the post-test.
The findings of this study confirm the effectiveness of the two interventions. The researchers comment that although their effects were similar throughout the trial, it can be presumed that their mechanisms of action differed.
CBT is an established treatment for depression, and its effectiveness has been shown in a variety of methods of delivery. Methods by which psychoeducation is effective for depression have not been extensively explored.
Future research should look at the ways in which these self-managed early intervention programmes compare with conventional drug treatment or psychotherapy for depression.
There is also a need to determine which aspects of the interventions are associated with better outcomes. This is particularly critical for internet approaches as, in normal settings without telephone contact, many users persevere with websites for only brief periods.
Further community research should investigate the circumstances under which these interventions prevent or reduce symptoms of depression, reduce stigma, increase help-seeking, maintain treatment participation, and offer knowledge and self-help that is of value to people with depression.
For further information contact Dr. Andrew Mackinnon, Australian National University, Canberra.
Tel: + 61 (0) 403 129
E-mail: Andrew.Mackinnon@anu.edu.au
Reference
Mackinnon A, Griffiths KM and Christensen H (2008) Comparative randomised trial of online cognitive-behavioural therapy and an information website for depression: 12-month outcomes. British Journal of Psychiatry, 192, 130-134.
For further information, or a press copy of the full paper, please contact Deborah Hart or Thomas Kennedy in the External Affairs Department.
Telephone: 020 7235 2351 Extensions. 127 or 154
E-mail: dhart@rcpsych.ac.uk or tkennedy@rcpsych.ac.uk.