Are Digitally Delivered Psychological Interventions for Depression the Way Forward? A Review

  • Evgenia Stefanopoulou
  • David Lewis
  • Matthew Taylor
  • James Broscombe
  • Javid Ahmad
  • Jan Larkin
Review Article
  • 15 Downloads

Abstract

Digitally delivered interventions aim to make psychological treatments more widely accessible and minimize clinician input. Although their clinical efficacy against wait-list, control conditions is well established, comparative outcome studies are a much better way to examine if psychotherapies are equally effective. Such reviews are still relatively lacking. The aim of this review was therefore to evaluate the effectiveness of digitally delivered psychological therapies over traditionally delivered (face-to-face) ones to alleviate symptoms in adults experiencing sub-threshold and clinical depression. Findings showed that digital interventions produced consistently clinically significant improvements in depressive symptoms. Moreover, the level of therapist contact or expertise did not affect much treatment effectiveness. Future research is pertinent to investigate further the influence of therapist input, the reasons for dropout, how to improve users’ experience and therapeutic engagement and maintain improvements at post-treatment.

Keywords

Depression Review Digital Online Interventions 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors.

References

  1. 1.
    World Health Organization (WHO). Facts sheet No 369. In Depression. WHO, 2017 http://www.who.int/mediacentre/factsheets/fs369/en/ Accessed 5th of November 2017.
  2. 2.
    Milanovic SM, Erjavec K, Poljicanin T, Vrabec B, Brecic P. Prevalence of depression symptoms and associated socio-demographic factors in primary health care patients. Psychiatr Danub. 2015;27(1):31–7.PubMedGoogle Scholar
  3. 3.
    National Collaborating Centre for Mental Health. The NICE guideline on the treatment and management of depression in adults: 1–707. 2016. http://www.nice.org.uk/nicemedia/live/12329/45896/45896.pdf. Accessed 5th of November 2017.
  4. 4.
    Sudak DM. Cognitive behavioral therapy for depression. Psychiatric.Clinics. 2012;35(1):99–110.PubMedGoogle Scholar
  5. 5.
    Ekers D, Webster L, Van Straten A, Cuijpers P, Richards D, Gilbody S. Behavioural activation for depression; an update of meta-analysis of effectiveness and sub group analysis. PLoS One. 2014;9(6):e100100.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Van Hees ML, Rotter T, Ellermann T, Evers SM. The effectiveness of individual interpersonal psychotherapy as a treatment for major depressive disorder in adult outpatients: a systematic review. BMC Psychiatry. 2013;13(1):22–5.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Cuijpers P, Donker T, Weissman MM, Ravitz P, Cristea IA. Interpersonal psychotherapy for mental health problems: a comprehensive meta-analysis. Am J Psychiatr. 2016;173(7):680–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Fischer MS, Baucom DH, Cohen MJ. Cognitive-behavioral couple therapies: review of the evidence for the treatment of relationship distress, psychopathology, and chronic health conditions. Fam Process. 2016;55(3):423–42.CrossRefPubMedGoogle Scholar
  9. 9.
    Driessen E, Hegelmaier LM, Abbass AA, Barber JP, Dekker JJ, Van HL, et al. The efficacy of short-term psychodynamic psychotherapy for depression: a meta-analysis update. Clin Psychol Rev. 2015;42:1–15.CrossRefPubMedGoogle Scholar
  10. 10.
    Bower P, Knowles S, Coventry PA, Rowland N. Counselling for mental health and psychosocial problems in primary care. Cochrane Database Syst Rev. 2011;9:CD001025.Google Scholar
  11. 11.
    Cuijpers P, Kleiboer A, Karyotaki E, Riper H. Internet and mobile interventions for depression: opportunities and challenges. Depress Anxiety. 2017;34:596–602.CrossRefPubMedGoogle Scholar
  12. 12.
    Williams C, McClay CA, Martinez R, Morrison J, Haig C, Jones R, et al. Online CBT life skills programme for low mood and anxiety: study protocol for a pilot randomized controlled trial. Trials. 2016;17(1):220–5.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    World Health Organization. mhGAP training manuals for the mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings-version 2.0. 2017.Google Scholar
  14. 14.
    Schmidt U, Wykes T. E-mental health–a land of unlimited possibilities. J Ment Health. 2012;21(4):327–31.CrossRefPubMedGoogle Scholar
  15. 15.
    Foroushani PS, Schneider J, Assareh N. Meta-review of the effectiveness of computerised CBT in treating depression. BMC Psychiatry. 2011;11(1):131–6.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Musiat P, Tarrier N. Collateral outcomes in e-mental health: a systematic review of the evidence for added benefits of computerized cognitive behavior therapy interventions for mental health. Psychol Med. 2014;44(15):3137–50.CrossRefPubMedGoogle Scholar
  17. 17.
    Andersson G, Cuijpers P. Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cogn Behav Ther. 2009;38(4):196–205.CrossRefPubMedGoogle Scholar
  18. 18.
    Griffiths KM, Farrer L, Christensen H. The efficacy of internet interventions for depression and anxiety disorders: a review of randomised controlled trials. Med J Aust. 2010;192(11):S4.PubMedGoogle Scholar
  19. 19.
    Cuijpers P, Koole SL, van Dijke A, Roca M, Li J, Reynolds CF. Psychotherapy for subclinical depression: meta-analysis. Br J Psychiatry. 2014;205(4):268–74.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Richards D, Richardson T. Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev. 2012;32(4):329–42.CrossRefPubMedGoogle Scholar
  21. 21.
    Cuijpers P, Donker T, Johansson R, Mohr DC, van Straten A, Andersson G. Self-guided psychological treatment for depressive symptoms: a meta-analysis. PLoS One. 2011;6(6):e21274.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Wagner B, Horn AB, Maercker A. Internet-based versus face-to-face cognitive-behavioral intervention for depression: a randomized controlled non-inferiority trial. J Affect Disord. 2014;152:113–21.CrossRefPubMedGoogle Scholar
  23. 23.
    Wright JH, Wright AS, Albano AM, Basco MR, Goldsmith LJ, Raffield T, et al. Computer-assisted cognitive therapy for depression: maintaining efficacy while reducing therapist time. Am J Psychiatr. 2005;162(6):1158–64.CrossRefPubMedGoogle Scholar
  24. 24.
    Selmi PM, Klein MH, Greist JH, Sorrell SP, Erdman HP. Computer-administered cognitive-behavioral therapy for depression. Am J Psychiatry. 1990;147(1):51. 56CrossRefPubMedGoogle Scholar
  25. 25.
    Berger T, Hämmerli K, Gubser N, Andersson G, Caspar F. Internet-based treatment of depression: a randomized controlled trial comparing guided with unguided self-help. Cogn Behav Ther. 2011;40(4):251–66.CrossRefPubMedGoogle Scholar
  26. 26.
    Farrer L, Christensen H, Griffiths KM, Mackinnon A. Internet-based CBT for depression with and without telephone tracking in a national helpline: randomised controlled trial. PLoS One. 2011;6(11):e28099.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Clarke G, Kelleher C, Hornbrook M, DeBar L, Dickerson J, Gullion C. Randomized effectiveness trial of an internet, pure self-help, cognitive behavioral intervention for depressive symptoms in young adults. Cogn Behav Ther. 2009;38(4):222–34.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Clarke G, Eubanks D, Reid CK, O'Connor E, DeBar LL, Lynch F, et al. Overcoming Depression on the Internet (ODIN)(2): a randomized trial of a self-help depression skills program with reminders. J Med Internet Res. 2005:7(2).Google Scholar
  29. 29.
    Santucci LC, McHugh RK, Elkins RM, Schechter B, Ross MS, Landa CE, et al. Pilot implementation of computerized cognitive behavioural therapy in a university health setting. Adm Policy Ment Health Ment Health Serv Res. 2014;41(4):514–21.CrossRefGoogle Scholar
  30. 30.
    Vernmark K, Lenndin J, Bjärehed J, Carlsson M, Karlsson J, Öberg J, et al. Internet administered guided self-help versus individualized e-mail therapy: A randomized trial of two versions of CBT for major depression. Behav Res Ther. 2010;48(5):368–76.CrossRefPubMedGoogle Scholar
  31. 31.
    Andersson G, Bergström J, Holländare F, Carlbring PER, Kaldo V, Ekselius L. Internet-based self-help for depression: randomised controlled trial. Br J Psychiatry. 2005;187(5):456–61.CrossRefPubMedGoogle Scholar
  32. 32.
    Titov N, Andrews G, Davies M, McIntyre K, Robinson E, Solley K. Internet treatment for depression: a randomized controlled trial comparing clinician vs. technician assistance. PLoS One. 2010;5(6):e10939.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Watts S, Mackenzie A, Thomas C, Griskaitis A, Mewton L, Williams A, et al. CBT for depression: a pilot RCT comparing mobile phone vs. computer. BMC Psychiatry. 2013;13(1):49–55.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Andersson G, Hesser H, Hummerdal D, Bergman-Nordgren L, Carlbring P. A 3.5-year follow-up of internet-delivered cognitive behavior therapy for major depression. J Ment Health. 2013;22(2):155–64.CrossRefPubMedGoogle Scholar
  35. 35.
    Blom K, Jernelöv S, Kraepelien M, Bergdahl MO, Jungmarker K, Ankartjärn L, et al. Internet treatment addressing either insomnia or depression, for patients with both diagnoses: a randomized trial. Sleep. 2015;38(2):267–77.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Christensen H, Griffiths KM, Mackinnon AJ, Brittliffe K. Online randomized controlled trial of brief and full cognitive behaviour therapy for depression. Psychol Med. 2006;36(12):1737–46.CrossRefPubMedGoogle Scholar
  37. 37.
    Johansson R, Sjöberg E, Sjögren M, Johnsson E, Carlbring P, Andersson T, et al. Tailored vs. standardized internet-based cognitive behavior therapy for depression and comorbid symptoms: a randomized controlled trial. PLoS One. 2012;7(5):e36905.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Kleiboer A, Donker T, Seekles W, van Straten A, Riper H, Cuijpers P. A randomized controlled trial on the role of support in internet-based problem solving therapy for depression and anxiety. Behav Res Ther. 2015;72:63–71.CrossRefPubMedGoogle Scholar
  39. 39.
    Mackinnon, A., Griffiths, K. M., & Christensen, H. (2008). Comparative randomised trial of online cognitive–behavioural therapy and an information website for depression: 12-month outcomes. The British Journal of Psychiatry, 192(2), 130–134.CrossRefPubMedGoogle Scholar
  40. 40.
    Santucci, L. C., McHugh, R. K., Elkins, R. M., Schechter, B., Ross, M. S., Landa, C. E., & Barlow, D. H. (2014). Pilot implementation of computerized cognitive behavioral therapy in a university health setting. Administration and Policy in Mental Health and Mental Health Services Research, 41(4), 514–521.CrossRefPubMedGoogle Scholar
  41. 41.
    Vernmark, K., Lenndin, J., Bjärehed, J., Carlsson, M., Karlsson, J., Öberg, J., & Andersson, G. (2010). Internet administered guided self-help versus individualized e-mail therapy: A randomized trial of two versions of CBT for major depression. Behaviour research and therapy, 48(5), 368-376.Google Scholar
  42. 42.
    Andersson G, Hesser H, Veilord A, Svedling L, Andersson F, Sleman O. … & Lamminen, M. Randomised controlled non-inferiority trial with 3-year follow-up of internet-delivered versus face-to-face group cognitive behavioural therapy for depression. J Affect Disord. 2013;151(3):986–94.CrossRefPubMedGoogle Scholar
  43. 43.
    Mackinnon A, Griffiths KM, Christensen H. Comparative randomised trial of online cognitive–behavioural therapy and an information website for depression: 12-month outcomes. Br J Psychiatry. 2008;192(2):130–4.CrossRefPubMedGoogle Scholar
  44. 44.
    Ly KH, Trüschel A, Jarl L, Magnusson S, Windahl T, Johansson R, et al. Behavioural activation versus mindfulness-based guided self-help treatment administered through a smartphone application: a randomised controlled trial. BMJ open. 2014;4(1):e003440.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Warmerdam L, van Straten A, Twisk J, Riper H, Cuijpers P. Internet-based treatment for adults with depressive symptoms: randomized controlled trial. J Med Internet Res. 2008;10(4):e44.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Kenter RMF, Cuijpers P, Beekman A, van Straten A. Effectiveness of a web-based guided self-help intervention for outpatients with a depressive disorder: short-term results from a randomized controlled trial. J Med Internet Res. 2016;18(3):e80.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Christensen H, Griffiths KM, Jorm AF. Delivering interventions for depression by using the internet: randomised controlled trial. BMJ. 2004;328(7434):265. 260CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Mohr DC, Duffecy J, Ho J, Kwasny M, Cai X, Burns MN, et al. A randomized controlled trial evaluating a manualized TeleCoaching protocol for improving adherence to a web-based intervention for the treatment of depression. PloS one. 2013;8(8):e70086.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Blackwell SE, Browning M, Mathews A, Pictet A, Welch J, Davies J, et al. Positive imagery-based cognitive bias modification as a web-based treatment tool for depressed adults: a randomized controlled trial. Clinical Psychological Science. 2015;3(1):91–111.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Williams AD, O’Moore K, Blackwell SE, Smith J, Holmes EA, Andrews G. Positive imagery cognitive bias modification (CBM) and internet-based cognitive behavioral therapy (iCBT): a randomized controlled trial. J Affect Disord. 2015;178:131–41.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Johansson R, Ekbladh S, Hebert A, Lindström M, Möller S, Petitt E, et al. Psychodynamic guided self-help for adult depression through the internet: a randomised controlled trial. PLoS One. 2012;7(5):e38021.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Kelders SM, Bohlmeijer ET, Pots WT, van Gemert-Pijnen JE. Comparing human and automated support for depression: fractional factorial randomized controlled trial. Behav Res Ther. 2015;72:72–80.CrossRefPubMedGoogle Scholar
  53. 53.
    Spek V, Nyklı’cek I, Smits N, Cuijpers P. riper, H., Keyzer, J., et al. internet-based cognitive behavioural therapy for subthreshold depression in people over 50 years old: a randomized controlled clinical trial. Psychol Med. 2007;37:1797–806.PubMedGoogle Scholar
  54. 54.
    Lewinsohn PM, Munoz RF, Youngren MA, Zeiss AM. Control Your Depression. New York: Fireside; 1992.Google Scholar
  55. 55.
    Imamura K, Kawakami N, Furukawa TA, Matsuyama Y, Shimazu A, Umanodan R, et al. Effects of an internet-based cognitive behavioral therapy (iCBT) program in manga format on improving subthreshold depressive symptoms among healthy workers: a randomized controlled trial. PLoS One. 2014;9(5):e97167.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Buntrock C, Ebert D, Lehr D, Riper H, Smit F, Cuijpers P, et al. Effectiveness of a web-based cognitive behavioural intervention for subthreshold depression: pragmatic randomised controlled trial. Psychother Psychosom. 2015;84(6):348–58.CrossRefPubMedGoogle Scholar
  57. 57.
    Josephine K, Josefine L, Philipp D, David E, Harald B. Internet-and mobile-based depression interventions for people with diagnosed depression: a systematic review and meta-analysis. J Affect Disord. 2017;223:28–40.CrossRefPubMedGoogle Scholar
  58. 58.
    Baumeister H, Reichler L, Munzinger M, Lin J. The impact of guidance on internet-based mental health interventions – a systematic review. Internet Interv. 2014;1(4):205–15.CrossRefGoogle Scholar
  59. 59.
    Titov N. Internet-delivered psychotherapy for depression in adults. Curr Opin Psychiatry. 2011;24(1):18–23.CrossRefPubMedGoogle Scholar
  60. 60.
    Proudfoot D, Goldberg A, Mann B, Everitt I, Marks IA, Gray. Computerised, interactive, multimedia cognitive-behavioural program for anxiety and depression in general practice. Psychol Med. 2003;33:217–27.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Turning Point, Registered CharityLondonUK

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