Internet psychotherapy for depression in primary care shows effectiveness

September 10, 2009

Patients suffering from depression who participated in online cognitive-behavioral therapy sessions were nearly 2.5 times more likely to recover from depression than their standard care counterparts.

Patients suffering from depression who participated in online cognitive-behavioral therapy (CBT) sessions were nearly 2.5 times more likely to recover from depression than their standard care counterparts, according to results of a study published in the August 22, 2009, issue of the Lancet.

Researchers from the University of Bristol randomized 297 patients diagnosed with depression (defined as a score of 14 or more on the Beck depression inventory [BDI]), recruited from 55 general practices in three U.K. locations, to either online CBT in addition to usual care or to usual care alone from a primary care physician. Patients receiving usual care alone qualified for online therapy but were placed on a waiting list to begin therapy after follow-up so that they could serve as the control.

The online therapy consisted of up to 10 CBT sessions, each 55 minutes long, completed within 16 weeks of randomization when possible. Participants were assigned to one therapist for the duration of the study. Sessions were conducted via online instant messaging in real time, secured by individual passwords. Each entire session was recorded and available to the participant to review at any time.

The primary outcome was the BDI score at four months, where a score of less than 10 indicated recovery. Primary data were analyzed for 210 participants. Patients were followed for four months and eight months after completion of the sessions.

At four months, 38 percent of the patients who received the online therapy were considered recovered from depression compared with 24 percent in the control group. At the eight-month follow-up, 42 percent and 26 percent of the online-therapy and control patients were recovered, respectively, showing that therapeutic gains at four months were maintained.

Researchers concluded from the results of the study that online delivery of CBT is effective. They speculated that the online delivery method enhanced the effect of CBT by encouraging reflection, because thoughts and feelings were written rather than spoken, and therapist advice was available for review. They also concluded that the number of patients using online CBT sessions should grow because it is available in areas where access to treatment is limited and can be offered discreetly to people whose symptoms are severe.