Standardized Web-Based CBT of Mild to Moderate Depression: An RCT with a Long-Term Follow-Up (2009)

Ruwaard, J., B. Schrieken, M. Schrijver, J. Broeksteeg, J. Dekker, H. Vermeulen and A. Lange (2009). Standardized Web-Based Cognitive Behavioural Therapy of Mild to Moderate Depression: A Randomized Controlled Trial with a Long-Term Follow-Up. Cognitive Behaviour Therapy 38(4): 206-221.

ABSTRACT Background: Depression is common but undertreated. Web-based self-help provides a widely accessible treatment alternative for mild to moderate depression. However, the lack of therapist guidance may limit its efficacy. Objective: To assesses the efficacy of therapist-guided web-based Cognitive Behavioural Treatment (Web-CBT) of mild to moderate depression. Design: A randomised waiting-list controlled trial, with an 18-month follow-up. Participants: The study included a community sample of 54 participants with chronic, moderate depression (immediate treatment: n = 36, waiting-list control: n = 18). Outcome Measures: Primary outcome measures were the Beck Depression Inventory (BDI-IA) and the Depression scale of the Symptom Check List – Revised (SCL 90-R DEP). Secondary outcome measures were the Depression Anxiety Stress Scales (DASS-42) and the Well-being Questionnaire (W-BQ12). Results: In the RCT, 5 participants (9%) dropped out. Intention-to-treat ANCOVA’s revealed that participants in the treatment condition improved significantly more than the participants in the waiting-list control condition (.011 < p < .015). With regard to the primary measures, between-group effects were d = 0.7 (BDI-IA) and d = 1.1 (SCL-90-R DEP). Post-test SCL90-R DEP scores indicated recovery of 49% of the participants in the treatment group, compared to 6% in the control group (Odds Ratio = 14.5; p < .004). On average, the effects were stable up to 18 months (n = 39), although medication was a strong predictor of relapse. Conclusion: The results demonstrate the efficacy of Web-CBT of mild to moderate depression, and the importance of therapist guidance in psychological interventions.