@Article{info:doi/10.2196/jmir.1094,
author="Warmerdam, Lisanne
and van Straten, Annemieke
and Twisk, Jos
and Riper, Heleen
and Cuijpers, Pim",
title="Internet-Based Treatment for Adults with Depressive Symptoms: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2008",
month="Nov",
day="20",
volume="10",
number="4",
pages="e44",
keywords="Internet; depression; self-help; cognitive therapy; problem solving; randomized trial",
abstract="Background:  Many depressed people do not receive help for their symptoms, and there are various barriers that impede help-seeking. The Internet may offer interesting alternatives for reaching and helping people with depression. Depression can be treated effectively with Internet-based cognitive behavioral therapy (CBT), but a short intervention based on problem solving therapy (PST) could constitute a worthwhile alternative to CBT. Objective:  In this study we evaluated the effectiveness of Internet-based CBT and Internet-based PST in comparison to a waiting list control group (WL), and we determined the differences between the two treatments. Methods:  We conducted a 3-arm randomized controlled trial to compare CBT, PST, and WL. The main inclusion criterion was presence of 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. Results: A total of 263 participants were randomized to the three conditions (CBT: n=88; PST: n=88; WL: n=87). Of the 263 participants, 184 (70{\%}) completed questionnaires after 5 weeks, 173 (66{\%}) after 8 weeks, and 151 (57{\%}) after 12 weeks. Between-group effect sizes for depressive symptoms were 0.54 for CBT after 8 weeks (95{\%} confidence interval (CI): 0.25 - 0.84) and 0.47 for PST after 5 weeks (95{\%} CI: 0.17 - 0.77). These effects were further improved at 12 weeks (CBT: 0.69, 95{\%} CI: 0.41 - 0.98; PST: 0.65, 95{\%} CI: 0.36 - 0.95). For anxiety, effect sizes were also at a medium level. Effect sizes for quality of life were low. The number of participants showing clinically significant change at 12 weeks was significantly higher for CBT (n = 34, 38.6{\%}) and PST (n = 30, 34.1{\%}), compared to WL (n = 0). Conclusions:  Both Internet-based treatments are effective in reducing depressive symptoms, although the effect of PST is realized more quickly. Trial Registration:  International Standard Randomized Controlled Trial Number (ISRCTN): 16823487; http://www.controlled-trials.com/ISRCTN16823487/16823487  (Archived by WebCite at http://www.webcitation.org/5cQsOj7xf). ",
issn="1438-8871",
doi="10.2196/jmir.1094",
url="http://www.jmir.org/2008/4/e44/",
url="https://doi.org/10.2196/jmir.1094",
url="http://www.ncbi.nlm.nih.gov/pubmed/19033149"
}