Internet-Delivered Cognitive Behavioural Therapy for Adults with Mild to Moderate Depression and High Cardiovascular Disease Risks: A Randomised Attention-Controlled Trial
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BACKGROUND AND AIM: Mild to moderate depression is common in those with cardiovascular disease and undertreated. We aimed to evaluate the effectiveness of internet-delivered Cognitive Behaviour Therapy (iCBT) on depressive symptom severity and adherence to medical advice and lifestyle interventions in adults with mild to moderate depression and high cardiovascular disease (CVD) risks. METHODS: Randomised double-blind, 12 week attention-controlled trial comparing an iCBT programme (E-couch) with an internet-delivered attention control health information package (HealthWatch, n = 282). The primary outcome was depression symptom level on the nine-item Patient Health Questionnaire (PHQ-9) (trial registration: ACTRN12610000085077). RESULTS: 487/562 (88%) participants completed the endpoint assessment. 383/562 (70%) were currently treated for cardiovascular disease and 314/562 (56%) had at least one other comorbid condition. In ITT analysis of 562 participants iCBT produced a greater decline in the mean PHQ-9 score compared to the attention control of 1.06 (95% CI: 0.23-1.89) points, with differences between the two arms increasing over the intervention period (time by treatment effect interaction p = .012). There were also larger improvements in adherence (2.16 points; 95% CI: 0.33-3.99), reductions in anxiety (0.96 points; 95% CI: 0.19-1.73), and a greater proportion engaging in beneficial physical activity (Odds Ratio 1.91, 95%CI: 1.01-3.61) in the iCBT participants but no effect upon disability, or walking time/day. There were no withdrawals due to study related adverse events. CONCLUSIONS: In people with mild to moderate depression and high levels of CVD risk factors, a freely accessible iCBT programme (http://www.ecouch.anu.edu.au) produced a small, but robust, improvement in depressive symptoms, adherence and some health behaviours. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12610000085077.
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Preliminary evidence suggests that iCBT may reduce symptoms of depression and anxiety for adults with high cardiovascular risk.
“Furthermore, preliminary evidence suggests that iCBT may reduce symptoms of depression and anxiety for adults with high cardiovascular risk [14].”
Psychotherapy may lead to increased engagement in lifestyle behaviors that positively influence physical health.
“Psychotherapy may also lead to increased engagement in lifestyle behaviors that positively influence physical health327,335.”
From Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management (2023) · cites this paper as [335]
The recruitment process may be seen as valid because it corresponds to what is common in iCBT studies.
“In general terms, our recruitment process may be seen as valid as it corresponds to what is common in iCBT studies [38,39,43].”
From An Internet-Based Cognitive Behavioral Therapy Program Adapted to Patients With Cardiovascular Disease and Depression: Randomized Controlled Trial (2019) · cites this paper as [38]
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- Authors
- Glozier, N., Christensen, H., Naismith, S., Cockayne, N., Donkin, L., Neal, B., Mackinnon, A., & Hickie, I.
- Affiliations
- Black Dog Institute (AU)
- The University of Sydney (AU)
- The University of Melbourne (AU)
- ORCID
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2013-03-26
- Volume
- 8
- Issue
- 3
- Pages
- e59139
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3608590
- OpenAlex
- W2025841958
- Cited by
- 129
- References
- 40
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 7 · 2023: 18 · 2022: 10 · 2021: 10 · 2020: 9 · 2019: 9 · 2018: 15 · 2017: 9 · 2016: 9 · 2015: 14 · 2014: 5 · 2013: 1 · 2012: 1
- FWCI
- 14.77
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- The Sydney eScholarship Repository (The University of Sydney) (submittedVersion)
- UNSWorks (UNSW Sydney) (submittedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- National Heart Foundation of Australia (G08S 4048)
- NSW Ministry of Health
- Cancer Council NSW
- 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 › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- internet-based cognitive behavioral therapy, mild to moderate depression, cardiovascular risk, adherence to medical advice, lifestyle intervention, physical activity, anxiety, PHQ-9, health information interventions
- MeSH terms
- Attention, Cardiovascular Diseases, Depression, Double-Blind Method, Female, Humans, Male, Middle Aged, Quality of Life, Surveys and Questionnaires, Risk, Severity of Illness Index, Cognitive Behavioral Therapy, Treatment Outcome, Telemedicine, Internet
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