An Internet-based program for depression using activity and physiological sensors: efficacy, expectations, satisfaction, and ease of use
Open accessAbstract
PURPOSE: Computerized cognitive behavioral therapy (CCBT) has been shown to be efficacious. Moreover, CCBT can be enhanced by using physiological and activity sensors, but there is no evidence about the acceptability of all these tools. The objective of this study is to examine the efficacy, expectations, satisfaction, and ease of use of an Internet-based CCBT program for preventing depression, with and without sensors (electroencephalography, electrocardiograhpy ECG, and actigraphy), in a high-risk population (unemployed men). PATIENTS AND METHODS: Sixty participants at risk of depression (unemployed men) were randomly assigned to three experimental conditions: 1) intervention program (N=22), 2) intervention program plus sensors (N=19), and 3) control group (N=19). Participants completed depression, anxiety, positive and negative affect, and perceived stress measures. Furthermore, they also completed the measures for expectation, satisfaction, and the ease of use of the program. RESULTS: Results showed that the two intervention groups improved significantly more than the control group on the clinical variables, and the improvements were greater in the group that used sensors than in the group that did not use them. Furthermore, participants in both intervention groups scored high on expectations and satisfaction with the CCBT program (with and without sensors). The mean score for usability was 88 out of 100 (standard deviation =12.32). No significant differences were found between groups on any of these variables. CONCLUSION: This is the first study to analyze the efficacy, expectations, satisfaction, and ease of use of an Internet-based program using physiological and activity sensors. These results suggest that an Internet program for depression with or without physiological and activity sensors is effective, satisfactory, and easy to use.
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Few studies have focused on the assessment of treatment acceptability in terms of IBIs and its relationship with effectiveness.
“the importance of treatment acceptability is known, and few studies have focused on its assessment in terms of IBIs and its relationship with effectiveness (29, 35, 42, 43, 45, 52).”
From Exploring the relationship between the acceptability of an internet-based intervention for depression in primary care and clinical outcomes: Secondary analysis of a randomized controlled trial (2019) · cites this paper as [43]
The Introduction says little is known about acceptability in Internet-based computerized cognitive behavioral therapy and that most studies do not measure it directly. It also says acceptability can help optimize effectiveness, but does not establish that few studies have assessed the relationship between acceptability and effectiveness. The indexed passages provide no page numbers. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe aforementioned ICTs have been shown to be well supported in terms of acceptability issues.
“Even though few studies have addressed this topic (Anderson et al., 2007; Botella et al., 2016; Campos et al., 2018), the aforementioned ICTs have been shown to be well supported in terms of acceptability issues.”
From Enhancing In Vivo Exposure in the Treatment of Panic Disorder and Agoraphobia Using Location-Based Technologies: A Case Study (2020) · cites this paper as Botella et al., 2016
This intervention has shown its efficacy in different RCTs.
“It has shown its efficacy in different RCTs [51–53].”
Some variables related to treatment acceptability are expectations and satisfaction.
“Some variables related to treatment acceptability are expectations and satisfaction (42–45).”
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“In any case, the importance of treatment acceptability is known, and few studies have focused on its assessment in terms of IBIs and its relationship with effectiveness (29, 35, 42, 43, 45, 52).”
BackgroundResultSelf-citationWang, M., Chen, H., Yang, F., Xu, X., & Li, J. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.06.057 · Cited by 25 · see citing works
Rachyla, I., Pérez-Ara, M., Molés, M., Campos, D., Mira, A., Botella, C., & Quero, S. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1751-6 · Cited by 22 · see citing works
Self-citationPositive Technologies for Improving Health and Well-Being
Botella, C., Baños, R., & Guillén, V. (2017) · Springer eBooks · doi:10.1007/978-3-319-51787-2_13 · Cited by 19 · see citing works
Self-citationQuero, S., Rachyla, I., Molés, M., Mor, S., Tur, C., Cuijpers, P. J., López-Montoyo, A., & Botella, C. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16203842 · Cited by 18 · see citing works
Self-citationMiralles, I., Granell, C., García-Palacios, A., Castilla, D., González-Pérez, A., Casteleyn, S., & Bretón-López, J. (2020) · Clinical Case Studies · doi:10.1177/1534650119892900 · Cited by 11 · see citing works
“Even though few studies have addressed this topic (Anderson et al., 2007; Botella et al., 2016; Campos et al., 2018), the aforementioned ICTs have been shown to be well supported in terms of acceptability issues.”
BackgroundSelf-citationThree Questions to Consider Before Applying Ecological Momentary Interventions (EMI) in Psychiatry
Gründahl, M., Deckert, J., & Hein, G. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00333 · Cited by 11 · see citing works
“(40) investigated the feasibility and efficacy of an internet-based CBT-EMI for the prevention and treatment of”
BackgroundDiaz-Sanahuja, L., Campos, D., Mira, A., Castilla, D., García-Palacios, A., & Bretón-López, J. M. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100466 · Cited by 10 · see citing works
Self-citationMira, A., Díaz-García, A., Castilla, D., Campos, D., Romero, S., Bretón-López, J., García-Palacios, A., Baños, R., & Botella, C. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2099-2 · Cited by 9 · see citing works
Self-citationGómez-Cambronero, Á., Casteleyn, S., Bretón-López, J., García-Palacios, A., & Mira, A. (2023) · Internet Interventions · doi:10.1016/j.invent.2023.100624 · Cited by 9 · see citing works
“The Spanish version has been used in previous studies Botella et al. (2016); Mira et al. (2019).”
MethodSelf-citationQuiñonez-Freire, C., Vara, M. D., Herrero, R., Mira, A., García‐Palacios, A., Botella, C., & Baños, R. (2020) · Internet Interventions · doi:10.1016/j.invent.2020.100352 · Cited by 8 · see citing works
Self-citationMira, A., Farfallini, L., Baños, R., Bretón-López, J. M., & Botella, C. (2016) · Psicodebate · doi:10.18682/pd.v16i2.597 · Cited by 8 · see citing works
Self-citation„iFightDepression“ im stationären Setting
Schwarz, J., Mauche, N., Oehler, C., Rummel-Kluge, C., Hegerl, U., & Strauss, M. (2021) · Der Nervenarzt · doi:10.1007/s00115-021-01214-w · Cited by 4 · see citing works
Opozda, M. J., Oxlad, M., Turnbull, D. A., Gupta, H., Vincent, A. D., Ziesing, S., Nankivell, M. E., & Wittert, G. (2023) · Current Psychology · doi:10.1007/s12144-023-04968-5 · Cited by 5 · see citing works
“Participant recruitment occurred in clinical (Nolte et al., 2021; Rice et al., 2020), community (Botella et al., 2016; Davidson et al., 2020; Deady et al., 2018; Fogarty et al., 2017; Nolte et al., 2021), and workplace settings (Davidson et al., 2020; Deady et al., 2018; Geraedts et al., 2014).”
InfluentialDíaz-Sanahuja, L., Suso‐Ribera, C., Lucas, I., Jiménez‐Múrcia, S., Tur, C., Gual-Montolio, P., Paredes-Mealla, M., García‐Palacios, A., & Bretón-López, J. M. (2024) · Journal of Gambling Studies · doi:10.1007/s10899-024-10318-2 · Cited by 4 · see citing works
“The Spanish adaptation of the Treatment Expectations questionnaire has been used in previous research (Botella et al., 2016; Mira et al., 2019a, b, c; Tortella-Feliu et al., 2011). c) Usability and acceptability of the technology.”
MethodSelf-citationLorente-Català, R., Gili, M., del Hoyo, Y. L., Mayoral, F., Pérez‐Aranda, A., Castro, A., Moreno, E. V., Baños, R., Roca, M., Monreal‐Bartolomé, A., et al. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100581 · Cited by 4 · see citing works
““Smiling is Fun” (“Sonreír es divertido” in Spanish) is a manualized intervention protocol of ICBT using multimedia material in an interactive and self-administered way for the prevention and treatment of depression and adjustment disorders (Botella et al., 2016).”
BackgroundSelf-citationDíaz-Sanahuja, L., Miralles, I., Granell, C., Mira, A., González-Pérez, A., Casteleyn, S., García-Palacios, A., & Bretón-López, J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19073769 · Cited by 3 · see citing works
“Even though few studies have addressed this topic [46,52,53], the aforementioned ICT system-driven examples have shown to be well-supported regarding acceptability.”
BackgroundSelf-citationMiralles, I., Granell, C., & Huerta, J. (2016) · Lecture notes in computer science · doi:10.1007/978-3-319-48799-1_48 · Cited by 2 · see citing works
Self-citationRomero, S., Mira, A., Bretón-López, J. M., Díaz‐García, A., Díaz-Sanahuja, L., García‐Palacios, A., & Botella, C. (2019) · Lecture notes of the Institute for Computer Sciences, Social Informatics and Telecommunications Engineering · doi:10.1007/978-3-030-25872-6_10 · Cited by 2 · see citing works
Self-citationRachyla, I., Mor, S., Botella, C., Castilla, D., & Quero, S. (2022) · Frontiers in Virtual Reality · doi:10.3389/frvir.2022.931366 · Cited by 1 · see citing works
“As for expectations with regard to the ICBT for AjD, results were similar to those found in the literature for other disorders, such as depression (Botella et al., 2016) or specific phobia (Campos et al.”
BackgroundResultSelf-citationHuman-Centred Robotics and AI for Trustworthy Human-Robot Interaction
Cangelosi, A., Adikari, M., Maharjan, R. S., Raggioli, L., Semeraro, F., Stoican, R., Tavella, F., Zhu, H., & Romeo, M. (2025) · Culture in policy making · doi:10.1007/978-3-031-97673-5_9 · Cited by 1 · see citing works
Lorente-Català, R., Castro, A., Fernández‐Martínez, S., Moreno, E. V., Guerrero-Pertiñez, G., Forteza-Rey, I., Gili, M., del Hoyo, Y. L., Mayoral, F., García‐Campayo, J., et al. (2026) · BMC Public Health · doi:10.1186/s12889-026-27573-0 · Cited by 1 · see citing works
“In this study, self-guided online interventions are proposed as a solution to address this issue in PC in Spain [25, 26], with the program “Smiling is fun” (in Spanish: “ Sonreír es divertido” ).”
Self-citationCabanel, N., Schmidt, A.-M., Fockenberg, S., Brückmann, K. F., Müller, M. J., Kundermann, B., & Haag, A. (2021) · Chronobiology International · doi:10.1080/07420528.2021.1994583 · Cited by 1 · see citing works
“Using actigraphy as a (self)-control feedback for activity in combination with an online CBT program for volunteers at the risk of depression reduced subclinical depression and anxiety better than online CBT alone (Botella et al. 2016).”
BackgroundMethodInfluentialDíaz-García, A., González-Robles, A., Fernández-Álvarez, J., Castilla, D., Mira, A., Bretón, J., García-Palacios, A., & Botella, C. (2019) · International Symposium on Pervasive Computing Paradigms for Mental Health · doi:10.1007/978-3-030-25872-6_11 · Cited by 1 · see citing works
Self-citationDroegemueller, B., Mielke, C., Haux, R., & Diehl, A. (2020) · Studies in health technology and informatics · doi:10.3233/shti200694
“Not only the assumption after a predominant acceptance could be substantiated here [6, 7, 8], but also the fear about an intrusion into intimacy and privacy, which is also described in a previous study [9].”
BackgroundResultRewards in Mental Health Applications for Aiding with Depression: A Meta-analysis
Six, S., Harris, M. W., Winterlind, E. L., & Byrne, K. A. (2021) · Communications in computer and information science · doi:10.1007/978-3-030-90179-0_26
Tur, C., & Tur Domenech, C. (2023) · doi:10.6035/14109.2023.433029
Opozda, M. J., Oxlad, M., Turnbull, D. A., Gupta, H., Vincent, A. D., Ziesing, S., Nankivell, M. E., & Wittert, G. (2022) · Journal of Medical Internet Research · doi:10.2196/40854
Lorente-Català, R., Font-Furnieles, P., Escriva-Sanchis, R., Bertó-García, C., Vera-Albero, P., & García‐Palacios, A. (2024) · Internet Interventions · doi:10.1016/j.invent.2024.100742
“Through diverse RCTs, the intervention has demonstrated efficacy and effectiveness in the prevention and treatment of depression (e.g., Botella et al., 2016; Mira et al., 2019; Mira et al., 2016).”
BackgroundSelf-citationiCCBT, an Interactive Approach of CBT for Online Psychological Intervention
Liao, Y., Liu, F., Lin, L., Hou, M., She, Y., Wu, H., Hu, B., & Wu, Q. (2024) · International Conference on Computer Supported Cooperative Work in Design (CSCWD) · doi:10.1109/cscwd61410.2024.10580063 · Cited by 1 · see citing works
“Besides, CCBT is also effective for stress management [14], depression prevention [15], and happiness improvement [16] in the general population.”
BackgroundTur, C., Campos, D., Díaz-Sanahuja, L., Fernández-Buendía, S., Grimaldos, J., la Coba-Cañizares, L. D., Kazlauskas, E., & Quero, S. (2025) · Behavioral Sciences · doi:10.3390/bs15101312
“These results are consistent with other studies that have observed high expectations before treatment (Botella et al., 2016; Campos et al., 2018; Mor et al., 2022) and satisfaction after treatment (Botella et al., 2016; Campos et al., 2018; McGoron et al., 2019; Mor et al., 2022; Palacios et al.,…”
InfluentialSelf-citationElia, F. L., García‐Palacios, A., Botella, C., Penedo, J. M. G., Holtforth, M. G., Berger, T., & Fernández‐Álvarez, J. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1918892
“Used in Spanish clinical trials with good results (116).”
Self-citation
- Authors
- Botella, C., Mira, A., Moragrega, I., García-Palacios, A., Bretón-López, J., Castilla, D., Riera López del Amo, A., Soler, C., Molinari, G., Quero, S., Guillén, V., Miralles, I., Nebot, S., Serrano, B., Majoe, D., Alcañiz, M., & Baños, R. M.
- Affiliations
- Universitat Jaume I (ES)
- Universitat de València (ES)
- ETH Zurich (CH)
- Corresponding author
- Botella, Cristina
- ORCID
- Venue
- Neuropsychiatric Disease and Treatment
- Publisher
- Informa UK Limited
- Published
- 2016-02
- Volume
- 12
- Pages
- 393
- ISSN
- 1176-6328 (ISSN-L)
- 1178-2021
- PMC
- PMC4770071
- OpenAlex
- W2282455080
- Cited by
- 42
- References
- 59
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 3 · 2023: 5 · 2022: 5 · 2021: 6 · 2020: 5 · 2019: 7 · 2018: 3 · 2017: 2 · 2016: 2
- FWCI
- 7.19
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Neuropsychiatric Disease and Treatment (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Repositori UJI (Universitat Jaume I) (acceptedVersion, cc-by-nc)
- Repository of Digital Objects for Teaching Research and Culture (University of Valencia) (submittedVersion, cc-by-nc)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by-nc)
- Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
- Repository for Publications and Research Data (ETH Zurich) (submittedVersion, cc-by-nc)
- ETH Zürich Research Collection
- Funders
- European Commission (248544)
- Ministerio de Ciencia e Innovación
- Instituto de Salud Carlos III
- 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 › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- depression prevention, computerized cognitive behavioral therapy, online intervention, physiological sensors, wearable activity trackers, EEG, electrocardiogram, actigraphy, unemployed men, vulnerable populations, acceptability, user satisfaction, perceived ease of use, expectations, anxiety, positive and negative affect, perceived stress
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