Tailored vs. Standardized Internet-Based Cognitive Behavior Therapy for Depression and Comorbid Symptoms: A Randomized Controlled Trial
Open accessAbstract
BACKGROUND AND AIMS: Major depression can be treated by means of cognitive behavior therapy, delivered via the Internet as guided self-help. Individually tailored guided self-help treatments have shown promising results in the treatment of anxiety disorders. This randomized controlled trial tested the efficacy of an Internet-based individually tailored guided self-help treatment which specifically targeted depression with comorbid symptoms. The treatment was compared both to standardized (non-tailored) Internet-based treatment and to an active control group in the form of a monitored online discussion group. Both guided self-help treatments were based on cognitive behavior therapy and lasted for 10 weeks. The discussion group consisted of weekly discussion themes related to depression and the treatment of depression. METHODS: A total of 121 participants with diagnosed major depressive disorder and with a range of comorbid symptoms were randomized to three groups. The tailored treatment consisted of a prescribed set of modules targeting depression as well as comorbid problems. The standardized treatment was a previously tested guided self-help program for depression. RESULTS: From pre-treatment to post-treatment, both treatment groups improved on measures of depression, anxiety and quality of life. The results were maintained at a 6-month follow-up. Subgroup analyses showed that the tailored treatment was more effective than the standardized treatment among participants with higher levels of depression at baseline and more comorbidity, both in terms of reduction of depressive symptoms and on recovery rates. In the subgroup with lower baseline scores of depression, few differences were seen between treatments and the discussion group. CONCLUSIONS: This study shows that tailored Internet-based treatment for depression is effective and that addressing comorbidity by tailoring may be one way of making guided self-help treatments more effective than standardized approaches in the treatment of more severe depression. TRIAL REGISTRATION: Clinicaltrials.gov NCT01181583.
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This could increase knowledge on how to tailor blended care to individual patients, related to the severity of their symptoms and their characteristics.
“This could increase our knowledge on how to tailor blended care to individual patients, related to the severity of their symptoms and their characteristics [41,42].”
There are few indications of differential efficacy between active ICBT treatments.
“This study is one of the few that provides some indications of differential efficacy between active treatments.”
From Internet-based psychological treatments for depression (2012) · cites this paper as [26]
Individually tailored ICBT has proven efficacy compared with control for mixed anxiety and for depression with high comorbid anxiety.
“Recent results exist proving the efficacy compared with control for mixed anxiety [25,27] and in the treatment of depression with a high amount of comorbid anxiety [26].”
From Internet-based psychological treatments for depression (2012) · cites this paper as [26]
With the exception of the study by Johansson et al., no study exists where differences in efficacy between ICBT treatments are observed.
“With the exception of study by Johansson et al., no study exists where differences in efficacy between ICBT treatments are observed [26].”
From Internet-based psychological treatments for depression (2012) · cites this paper as [26]
Tailored ICBT is superior to nontailored ICBT for patients with more severe forms of depression.
“The study by Johansson et al. included a comparison between tailored and nontailored treatment for depression and provided data that indicate that tailored treatment is superior to nontailored treatment for patients with more severe forms of depression [26].”
From Internet-based psychological treatments for depression (2012) · cites this paper as [26]
Tailored internet-delivered cognitive-behavioral therapy (ICBT) may work better than nontailored treatment for more severely depressed patients.
“Table: that tailored ICBT may work better than nontailored treatment for more severely depressed patients.”
From Internet-based psychological treatments for depression (2012) · cites this paper as [26]
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“Versions of the modules used in this trial were evaluated in two earlier studies [34, 35] as well as in a more recent study evaluating self-selected tailoring as compared to clinician-selected tailoring, with a somewhat more positive outcome for the self-selected procedure [25].”
MethodSelf-citationOnline self-help for suicidal thoughts: 3-month follow-up results and participant evaluation
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- Authors
- Johansson, R., Sjöberg, E., Sjögren, M., Johnsson, E., Carlbring, P., Andersson, T., Rousseau, A., & Andersson, G.
- Affiliations
- Linköping University (SE)
- Umeå University (SE)
- Linköping University Hospital (SE)
- Corresponding author
- Johansson, Robert
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2012-05-15
- Volume
- 7
- Issue
- 5
- Pages
- e36905
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3352859
- OpenAlex
- W2018731632
- Cited by
- 268
- References
- 37
- Citations by year
- 2026: 10 · 2025: 6 · 2024: 14 · 2023: 15 · 2022: 16 · 2021: 22 · 2020: 14 · 2019: 19 · 2018: 20 · 2017: 28 · 2016: 27 · 2015: 24 · 2014: 28 · 2013: 20 · 2012: 5
- FWCI
- 34.76
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DiVA (Linkoping University) (submittedVersion, other-oa)
- DiVA at Umeå University (Umeå University) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- 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
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- major depressive disorder, internet-based cognitive behavioral therapy, guided self-help, tailored treatment, comorbid symptoms, anxiety comorbidity, treatment efficacy, quality of life
- MeSH terms
- Adult, Aged, Anxiety, Depression, Depressive Disorder, Major, Major Depressive Disorder, Female, Follow-Up Studies, Humans, Male, Middle Aged, Quality of Life, Self Care, Therapy, Computer-Assisted, Comorbidity, Cognitive Behavioral Therapy, Treatment Outcome, Internet, Young Adult
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