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

• Published in: Journal of affective disorders 2019-03, Vol.246, p.695-705
• Main Authors: Reins, Jo Annika, Boß, Leif, Lehr, Dirk, Berking, Matthias, Ebert, David Daniel
• Format: Article
• Language: English
• Subjects: Active control; History of psychotherapy; Internet-based cognitive behavior therapy; Major depressive disorder; Negative effects of psychotherapy; Psychoeducation
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2018.12.065

•beneficial effects of iCBT compared to Internet-based psychoeducation•potential influence of psychotherapy experience on the success of iCBT•Participants who had undergone prior psychotherapy benefited from both treatments•for those without prior psychotherapy, iCBT was superior•no differences in negative effects between treatments 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. 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. 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. The history of psychotherapy was imbalanced between the groups. Some negative effects were assessed in the iCBT group only. 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. German clinical trials register: DRKS00005025