Internet administered guided self-help versus individualized e-mail therapy: A randomized trial of two versions of CBT for major depression
Abstract
Internet-delivered psychological treatment of major depression has been investigated in several trials, but the role of personalized treatment is less investigated. Studies suggest that guidance is important and that automated computerized programmes without therapist support are less effective. Individualized e-mail therapy for depression has not been studied in a controlled trial. Eighty-eight individuals with major depression were randomized to two different forms of Internet-delivered cognitive behaviour therapy (CBT), or to a waiting-list control group. One form of Internet treatment consisted of guided self-help, with weekly modules and homework assignments. Standard CBT components were presented and brief support was provided during the treatment. The other group received e-mail therapy, which was tailored and did not use the self-help texts i.e., all e-mails were written for the unique patient. Both treatments lasted for 8 weeks. In the guided self-help 93% completed (27/29) and in the e-mail therapy 96% (29/30) completed the posttreatment assessment. Results showed significant symptom reductions in both treatment groups with moderate to large effect sizes. At posttreatment 34.5% of the guided self-help group and 30% of the e-mail therapy group reached the criteria of high-end-state functioning (Beck Depression Inventory score below 9). At six-month follow-up the corresponding figures were 47.4% and 43.3%. Overall, the difference between guided self-help and e-mail therapy was small, but in favour of the latter. These findings indicate that both guided self-help and individualized e-mail therapy can be effective.
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Internet-based psychological treatment is gaining momentum and showing positive effects for a range of clinical populations.
“in recent years, internet-based psychological treatment is gaining momentum and showing positive affects for a range of clinical populations (e.g., Hedman et al., 2011;Vernmark et al., 2010)”
From A review of cyberbullying and suggestions for online psychological therapy (2015) · cites this paper as Vernmark et al., 2010
Psychological therapies have been consistently shown to be effective in helping individuals of all ages deal with distress.
“Psychological therapies have been consistently shown as effective in helping individuals of all ages to deal with distress”
From A review of cyberbullying and suggestions for online psychological therapy (2015) · cites this paper as Vernmark et al., 2010
Previous studies comparing treatments while allowing stable medication find that medication status seems unrelated to change in depth of depression.
“Previous studies comparing treatments while allowing for stable medication find that medication status seem to be unrelated to change in depth of depression (Proudfoot et al., 2004; Vernmark et al., 2010).”
From Internet-Based Therapy for Mild to Moderate Depression in Swedish Primary Care: Short Term Results from the PRIM-NET Randomized Controlled Trial (2014) · cites this paper as Vernmark et al., 2010
The inclusion criteria allowed stable medication, and patients might have received other treatments for depression during the study period.
“Second, because the aim of the study was to assess the effectiveness in a real life primary care setting, our inclusion criteria allowed stable medication, which is common in similar studies (e.g., Carlbring et al., 2013; Vernmark et al., 2010) and our patients might have received other treatments for depression during the study period.”
From Internet-Based Therapy for Mild to Moderate Depression in Swedish Primary Care: Short Term Results from the PRIM-NET Randomized Controlled Trial (2014) · cites this paper as Vernmark et al., 2010
The attrition rates in this study were equal or lower compared with several similar studies on guided Web-based interventions for depression with long-term follow-up assessments.
“The attrition rates in this study were equal or lower compared with several similar studies on guided Web-based interventions for depression with long-term follow-up assessments [67,73,74].”
From Long-Term Results of a Web-Based Guided Self-Help Intervention for Employees With Depressive Symptoms: Randomized Controlled Trial (2014) · cites this paper as [74]
Pretreatment contact is often in the form of a structured diagnostic interview and probably results in more reliable diagnostic categories for inclusion in a trial.
“This pretreatment contact is often in the form of a structured diagnostic interview [20,21], and probably results in more reliable diagnostic categories for inclusion in a trial.”
From Internet-based psychological treatments for depression (2012) · cites this paper as [21]
Previous studies of online intervention for depression in the community using a CBT protocol similar to the current study reported post-treatment effect sizes averaging 1.29 and follow-up effects averaging 1.42, based on samples ranging from 45 to 300.
“An analysis of a number of previous studies of an online intervention for depression in the community and that have used a CBT protocol similar to the intervention in the current study have reported post-treatment effect sizes averaging 1.29, and follow-up effects averaging 1.42, based on samples ranging from 45 – 300 [39,42-48].”
Eighteen studies state that encouraging adherence is a task for the counselor.
“it is remarkable that 18 state that encouraging adherence is a task for the counselor [45-62]”
From Persuasive System Design Does Matter: a Systematic Review of Adherence to Web-based Interventions (2012) · cites this paper as [47]
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Establishing Guidelines for Executing and Reporting Internet Intervention Research
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Self-citationAndersson, G., Paxling, B., Wiwe, M., Vernmark, K., Felix, C. B., Lundborg, L., Furmark, T., Cuijpers, P., & Carlbring, P. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.05.003 · Cited by 202 · see citing works
Self-citationAndersson, G., Hesser, H., Veilord, A., Svedling, L., Andersson, F., Sleman, O., Mauritzson, L., Sarkohi, A., Claesson, E., Zetterqvist, V., et al. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.08.022 · Cited by 195 · see citing works
Self-citationTransdiagnostic Internet treatment for anxiety disorders: A randomized controlled trial
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Acceptability of Internet Treatment of Anxiety and Depression
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Self-citationMoberg, C., Niles, A., & Beermann, D. (2019) · Journal of Medical Internet Research · doi:10.2196/12556 · Cited by 157 · see citing works
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Internet-delivered psychotherapy for depression in adults
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Stubbings, D. R., Rees, C. S., Roberts, L. D., & Kane, R. T. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2564 · Cited by 162 · see citing works
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“However, in a previous trial by our group on depression, inexperienced therapist were found to be effective when the treatment was in the form of e-mail and not structured in advance [64].”
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“The latest studies indicate that increasing therapist contact time beyond a certain threshold may not facilitate further treatment gains [14].”
BackgroundEbert, D. D., Donkin, L., Andersson, G., Andrews, G., Berger, T., Carlbring, P., Rozenthal, A., Choi, I., Laferton, J. A. C., Johansson, R., et al. (2016) · Psychological Medicine · doi:10.1017/s0033291716001562 · Cited by 154 · see citing works
Self-citationEffect of psychotherapy for depression on quality of life: meta-analysis
Kolovos, S., Kleiboer, A., & Cuijpers, P. (2016) · British Journal of Psychiatry · doi:10.1192/bjp.bp.115.175059 · Cited by 153 · see citing works
Høifødt, R. S., Lillevoll, K. R., Griffiths, K. M., Wilsgaard, T., Eisemann, M., Waterloo, K., & Kolstrup, N. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2714 · Cited by 154 · see citing works
“range, but somewhat below average, whereas the effects on SWLS and on depression and anxiety measured with HADS were commensurable to effects found previously for similar measures [12-14,27,99,100].”
BackgroundResultOnline interventions for depression and anxiety – a systematic review
Saddichha, S., Al-Desouki, M., Lamia, A., Linden, I. A., & Krausz, M. (2014) · Health Psychology and Behavioral Medicine · doi:10.1080/21642850.2014.945934 · Cited by 133 · see citing works
“Study Sample Intervention Results Comments Spek, Nyklicek et al. (2007) In a sample of 301 participants aged above 50 years with sub-threshold depression diagnosed as a score of above 12 on the Edinburgh Depression Scale (EDS) were randomized into three groups: Internet-based CBT, group CBT and Wait-listed control gro…”
BackgroundMethodInfluentialNordgren, L. B., Hedman, E., Etienne, J., Bodin, J., Kadowaki, Å., Eriksson, S., Lindkvist, E., Andersson, G., & Carlbring, P. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.05.007 · Cited by 145 · see citing works
Self-citationPihlaja, S., Stenberg, J.-H., Joutsenniemi, K., Mehik, H., Ritola, V., & Joffe, G. (2018) · Internet Interventions · doi:10.1016/j.invent.2017.11.005 · Cited by 134 · see citing works
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Self-citationEfficacy of Personalized Psychological Interventions: A Systematic Review and Meta-Analysis
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“Venrnmark (2010) [46] community guided iCBT, 8 88 BDI, MADRS QOL WL 6 months 14% LOCF Sweden”
BackgroundInfluentialGuided internet-based CBT for common mental disorders
Andersson, G., Carlbring, P., Ljótsson, B., & Hedman, E. (2013) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-013-9237-9 · Cited by 119 · see citing works
Self-citationLong-term effects of internet-supported cognitive behaviour therapy
Andersson, G., Rozental, A., Shafran, R., & Carlbring, P. (2018) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2018.1400381 · Cited by 117 · see citing works
Self-citationMomMoodBooster Web-Based Intervention for Postpartum Depression: Feasibility Trial Results
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Smoktunowicz, E., Barak, A., Andersson, G., Baños, R., Berger, T., Botella, C., Dear, B. F., Donker, T., Ebert, D. D., Hadjistavropoulos, H. D., et al. (2020) · Internet Interventions · doi:10.1016/j.invent.2020.100331 · Cited by 108 · see citing works
Self-citationKaiser, J., Hanschmidt, F., & Kersting, A. (2020) · Computers in Human Behavior · doi:10.1016/j.chb.2020.106512 · Cited by 105 · see citing works
Effectiveness of Web-based Psychological Interventions for Depression: A Meta-analysis
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Internet-based cognitive—behavior therapy for procrastination: A randomized controlled trial.
Rozental, A., Forsell, E., Svensson, A., Andersson, G., & Carlbring, P. (2015) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000023 · Cited by 103 · see citing works
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Self-citationA review of cyberbullying and suggestions for online psychological therapy
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“The attrition rates in this study were equal or lower compared with several similar studies on guided Web-based interventions for depression with long-term follow-up assessments [67,73,74].”
Controversy clarified: an updated review of clinical psychology and tele-health
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Acceptance of Mobile Mental Health Treatment Applications
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The effects of psychotherapy for depression on anxiety symptoms: a meta-analysis
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Less Positive or More Negative? Future-Directed Thinking in Mild to Moderate Depression
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“Klara (66) General population SCID-I Depression Guided CBT (29), guided CBT via email (30) Wait-list (29) 7 modules/8 weeks BDI MADRS-S, BAI, QOLI 47 (83.”
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Self-citationA qualitative exploration of Internet-based treatment for comorbid depression and alcohol misuse
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“However, while amount of contact time correlates positively with efficacy [61], there are nevertheless diminishing gains in increasing contact time above a certain threshold [62,63].”
Internetbasierte Interventionen in der Behandlung psychischer Störungen
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Self-citationA 3.5-year follow-up of Internet-delivered cognitive behavior therapy for major depression
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Psicoterapia pela Internet: viável ou inviável?
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- Authors
- Vernmark, K., Lenndin, J., Bjärehed, J., Carlsson, M., Karlsson, J., Öberg, J., Carlbring, P., Eriksson, T., & Andersson, G.
- Affiliations
- Linköping University (SE)
- Corresponding author
- Andersson, Gerhard
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2010-05
- Volume
- 48
- Issue
- 5
- Pages
- 368-376
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W2085505243
- Semantic Scholar
- 5dfce7f4faac59fa38b806f1a06929dc66be9031
- Cited by
- 226
- References
- 61
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 9 · 2023: 15 · 2022: 13 · 2021: 11 · 2020: 13 · 2019: 12 · 2018: 9 · 2017: 13 · 2016: 19 · 2015: 17 · 2014: 19 · 2013: 21 · 2012: 23
- FWCI
- 32.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Funders
- Vetenskapsrådet
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- major depressive disorder, internet-based cognitive behavioral therapy, guided self-help, personalized treatment, therapist support, treatment completion, symptom relief, long-term follow-up
- MeSH terms
- Adaptation, Psychological, Adult, Aged, Analysis of Variance, Bibliotherapy, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Programmed Instructions as Topic, Self Care, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Treatment Outcome, Statistics, Nonparametric, Remote Consultation, Internet, Electronic Mail, Young Adult
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