August 24, 2009
Therapist-delivered Internet Psychotherapy For Depression
According to a study in this month's Lancet, CBT seems to be effective for depression in primary care when delivered online in real time by a therapist, with benefits maintained over 8 months.
A research team at the University of Bristol in the United Kingdom, conducted a multicenter, randomized controlled trial, 297 individuals with a score of 14 or more on the Beck depression inventory (BDI) and a confirmed diagnosis of depression were recruited from 55 general practices. Participants were randomly assigned, by a computer-generated code, to online CBT in addition to usual care (intervention; n=149) or to usual care from their general practitioner while on an 8-month waiting list for online CBT (control; n=148)
The online treatment, consisted of 10 weekly 55-minute sessions, primarily using instant messaging. About two-thirds of the participants "showed up" for five or more sessions. After four months of follow-up, 38 percent of patients in the CBT group recovered from depression compared with 24 percent in the control group.
At eight months, recovery rates were 42 percent in the intervention group and 26 percent in the control group. That is a higher recovery rate than generally seen in conventional therapy for depression. The authors hypothesized that the heightened success rate might be due to the fact that people are writing rather than speaking their feelings and thoughts. "This approach could enhance metacognitive awareness, a term applied to changing the patient's relationship with negative thoughts and feelings, rather than changing their belief in the content of the negative thoughts."
The authors comment that "computerised CBT programs, although effective, are inflexible, can be difficult to tailor to individual patient needs, and are associated with low rates of adherence. However, individual CBT can be offered by a therapist online, with instant messaging in which client and therapist communicate in real time with typewritten responses. Possible benefits from this approach include flexibility and optimum use of patient and therapist time, reaching client groups for whom travel to treatment centres is difficult for reasons of geography or disability, and access to foreign language therapists. Some evidence suggests that writing about traumatic events can lead to improvements in health. This approach is acceptable to patients with depression, and therapy without face-to-face contact could encourage greater disclosure."
The Lancet, Volume 374, Issue 9690, Pages 628 - 634, 22 August 2009