Effectiveness of a novel integrative online treatment for depression (Deprexis): randomized controlled trial
Open accessAbstract
BACKGROUND: Depression is associated with immense suffering and costs, and many patients receive inadequate care, often because of the limited availability of treatment. Web-based treatments may play an increasingly important role in closing this gap between demand and supply. We developed the integrative, Web-based program Deprexis, which covers therapeutic approaches such as behavioral activation, cognitive restructuring, mindfulness/acceptance exercises, and social skills training. OBJECTIVE: To evaluate the effectiveness of the Web-based intervention in a randomized controlled trial. METHODS: There were 396 adults recruited via Internet depression forums in Germany, and they were randomly assigned in an 80:20 weighted randomization sequence to either 9 weeks of immediate-program-access as an add-on to treatment-as-usual (N = 320), or to a 9-week delayed-access plus treatment-as-usual condition (N = 76). At pre- and post-treatment and 6-month follow-up, we measured depression (Beck Depression Inventory) as the primary outcome measure and social functioning (Work and Social Adjustment Scale) as the secondary outcome measure. Complete analyses and intention-to-treat analyses were performed. RESULTS: Of 396 participants, 216 (55%) completed the post-measurement 9 weeks later. Available case analyses revealed a significant reduction in depression severity (BDI), Cohen's d = .64 (CI 95% = 0.33 - 0.94), and significant improvement in social functioning (WSA), Cohen's d = .64, 95% (CI 95% = 0.33 - 0.95). These improvements were maintained at 6-month follow-up. Intention-to-treat analyses confirmed significant effects on depression and social functioning improvements (BDI: Cohen's d = .30, CI 95% = 0.05 - 0.55; WSA: Cohen's d = .36, CI 95% = 0.10 - 0.61). Moreover, a much higher percentage of patients in the intervention group experienced a significant reduction of depression symptoms (BDI: odds ratio [OR] = 6.8, CI 95% = 2.90 - 18.19) and recovered more often (OR = 17.3, 95% CI 2.3 - 130). More than 80% of the users felt subjectively that the program had been helpful. CONCLUSIONS: This integrative, Web-based intervention was effective in reducing symptoms of depression and in improving social functioning. Findings suggest that the program could serve as an adjunctive or stand-alone treatment tool for patients suffering from symptoms of depression.
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Online treatment is clearly better than nothing, according to recent studies.
“online treatment is clearly better than nothing, according to recent studies. [17-19,32]”
From The more it is needed, the less it is wanted: Attitudes toward face-to-face intervention among depressed patients undergoing online treatment (2013) · cites this paper as [17]
The number of modules completed was found to correlate with outcomes in interventions that targeted cigarette smoking, depression, and anxiety disorders.
“The number of modules completed was found to correlate with outcomes in interventions that targeted cigarette smoking [42,46,47], depression [45,48-51], and anxiety disorders [52-57].”
From A Systematic Review of the Impact of Adherence on the Effectiveness of e-Therapies (2011) · cites this paper as [50]
Adding online sessions or modules to regular face-to-face psychotherapy can increase adherence and effectiveness but also increases costs and workload among professionals.
“While recent studies have shown that adding online sessions or modules to regular face-to-face psychotherapy can increase the adherence and effectiveness of a patients’ treatment, it also increases costs and workload among professionals [17-19].”
Deprexis, the treatment tested by Meyer et al. [23] and Berger et al. [16], is an example of a blend of cognitive-behavioral therapy (CBT) with non-CBT components, including positive psychology interventions, dreamwork, and emotion-focused interventions above more traditional cognitive and behavioral techniques.
“Deprexis, the treatment tested by Meyer et al. [23] and Berger et al. [16], is an example of such a blend as it includes positive psychology interventions, dreamwork and emotion-focused interventions above more traditional cognitive and behavioral techniques.”
From Internet-based psychological treatments for depression (2012) · cites this paper as [23]
The WSAS has sound psychometric properties when administered on the Internet.
“The WSAS has been shown to have sound psychometric properties when administered on the Internet [20]”
From Breaking open the black box: isolating the most potent features of a web and mobile phone-based intervention for depression, anxiety, and stress (2015) · cites this paper as [20]
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].”
Some online programs, such as Deprexis, use patient feedback to select specific content presented to patients.
“Some online programs, such as Deprexis, use patient feedback to select specific content presented to patients [35].”
A free-choice program in European countries had a higher completion rate and was more effective than a fixed order program.
“It has been reported that a free-choice program in European countries had a higher completion rate and was more effective than a fixed order program24.”
From Effect of smartphone-based stress management programs on depression and anxiety of hospital nurses in Vietnam: a three-arm randomized controlled trial (2021) · cites this paper as [24]
Program A (free-choice) showed non-significant effects on depression and anxiety symptoms at any follow-up, which were smaller than Program B (fixed-order), contrasting with previous findings in Europe.
“In addition, Program A (free-choice) showed non-significant effects on depression and anxiety symptoms at any follow-up, which were smaller than Program B (fixed-order), which is also contrast to previous finding in Europe24.”
From Effect of smartphone-based stress management programs on depression and anxiety of hospital nurses in Vietnam: a three-arm randomized controlled trial (2021) · cites this paper as [24]
Previous findings in European countries showed that a free-choice program had a higher completion rate than a fixed-order program.
“This is contradicted previous findings that a free-choice program showed a higher completion rate than a fixed order program in European countries24.”
From Effect of smartphone-based stress management programs on depression and anxiety of hospital nurses in Vietnam: a three-arm randomized controlled trial (2021) · cites this paper as [24]
A possible reason for the inconsistency is a difference in ways of tailoring between the previous study and the present study: the previous study used a navigation program to direct users to the most appropriate program based on pre-determined responses concerning their needs and preferences, while the present study simply asked users to select one of the free-choice modules.
“A possible reason is a difference in ways of tailoring between the previous study and the present study. While the previous study used a navigation program to direct users to the most appropriate program based on pre-determined responses concerning their needs and preferences, the present study simply asked users to select one of the free-choice modules.”
From Effect of smartphone-based stress management programs on depression and anxiety of hospital nurses in Vietnam: a three-arm randomized controlled trial (2021) · cites this paper as [24]
The finding that completion rates, satisfaction, and usefulness of the two programs were similar is inconsistent with a previous finding reporting more favorable adherence to a free-choice program than a fixed-order program in European countries.
“The completion rates, satisfaction, and usefulness of the two programs were similar. The finding is inconsistent with a previous finding reporting a more favorable adherence to a free-choice program than a fixed-order program in European countries24.”
From Effect of smartphone-based stress management programs on depression and anxiety of hospital nurses in Vietnam: a three-arm randomized controlled trial (2021) · cites this paper as [24]
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Wïttchen, H., Müller, N., Schmidtkunz, B., Winter, S., & Pfister, H. (2000) · Max Planck Institute for Plasma Physics · Cited by 22 · see citing works
Congruence between reasons for depression and motivations for specific interventions
Meyer, B., & Garcia‐Roberts, L. (2007) · Psychology and Psychotherapy: Theory, Research and Practice · doi:10.1348/147608306x169982 · Cited by 19 · see citing works
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- [16]16. Andersson G, Cuijpers P, Carlbring P, Lindefors N. Effects of Internet-delivered cognitive behaviour therapy for anxiety and mood disorders. Review Series Psychiatry 2007;9:9-14.
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Computer-based psychological treatments for depression: A systematic review and meta-analysis
Richards, D., & Richardson, T. (2012) · Clinical Psychology Review · doi:10.1016/j.cpr.2012.02.004 · Cited by 1,442 · see citing works
“For instance, Meyer et al. (2009) reported that 80% of users were generally satis fi ed with the online program (Deprexis).”
BackgroundMethodInfluentialPersuasive System Design Does Matter: a Systematic Review of Adherence to Web-based Interventions
Kelders, S. M., Kok, R. N., Ossebaard, H. C., & Van Gemert-Pijnen, J. E. (2012) · Journal of Medical Internet Research · doi:10.2196/jmir.2104 · Cited by 1,308 · see citing works
Advantages and limitations of Internet-based interventions for common mental disorders
Andersson, G., & Titov, N. (2014) · World Psychiatry · doi:10.1002/wps.20083 · Cited by 1,160 · see citing works
“The majority of studies of mood disorders have examined major depression and have evaluated different forms of CBT (35,63,64).”
BackgroundSelf-citationA Systematic Review of the Impact of Adherence on the Effectiveness of e-Therapies
Donkin, L., Christensen, H., Naismith, S. L., Neal, B., Hickie, I. B., & Glozier, N. (2011) · Journal of Medical Internet Research · doi:10.2196/jmir.1772 · Cited by 876 · see citing works
“Several studies categorized participants into adherent or not [49,54,57,75], or usage categories such as low, medium, and high [60], while others u s e d c o n t i n u o u s v a r i a b l e s [23,24,33-36,38-41,43-45,50-52,55,56,58,59,61,76] or a combination of these [42,46,53,64-66,77].”
Karyotaki, E., Efthimiou, O., Miguel, C., Maas genannt Bermpohl, F., Furukawa, T. A., Cuijpers, P., Individual Patient Data Meta-Analyses for Depression (IPDMA-DE) Collaboration, Riper, H., Patel, V., Mira, A., et al. (2021) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2020.4364 · Cited by 866 · see citing works
Self-citationKaryotaki, E., Riper, H., Twisk, J., Hoogendoorn, A., Kleiboer, A., Mira, A., Mackinnon, A., Meyer, B., Botella, C., Littlewood, E., et al. (2017) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2017.0044 · Cited by 691 · see citing works
“Four of the included trials provided support related to the technical aspects of the online platforms,(15,31,33,36) whereas 9 trials were purely self-guided.(12-14,30,32,34,35,37,38)The control conditionsusedwere attentionplacebo, no treatment, treatment as usual, orwaiting list.”
BackgroundSelf-citationHedman, E., Ljótsson, B., & Lindefors, N. (2012) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1586/erp.12.67 · Cited by 672 · see citing works
Internet-Delivered Psychological Treatments
Andersson, G. (2016) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-021815-093006 · Cited by 595 · see citing works
“2003) and Deprexis (Meyer et al. 2009)—or smartphone-based applications (so-called apps) with specific brand names (Donker et al.”
BackgroundSelf-citationInternet-based psychological treatments for depression
Johansson, R., & Andersson, G. (2012) · Expert Review of Neurotherapeutics · doi:10.1586/ern.12.63 · Cited by 509 · see citing works
“CAU 148 Meyer et al. (2009) Germany None None 1.”
Self-citationvan Ballegooijen, W., Cuijpers, P., van Straten, A., Karyotaki, E., Andersson, G., Smit, J. H., & Riper, H. (2014) · PLoS ONE · doi:10.1371/journal.pone.0100674 · Cited by 409 · see citing works
“[3–5].”
Self-citationMixing Online and Face-to-Face Therapy: How to Benefit From Blended Care in Mental Health Care
Wentzel, J., van der Vaart, R., Bohlmeijer, E. T., & van Gemert-Pijnen, J. E. W. C. (2016) · JMIR Mental Health · doi:10.2196/mental.4534 · Cited by 371 · see citing works
“Nevertheless, studies have shown that online and face-to-face treatments are often not integrated, but rather online components are used as an addition to regular therapy [3,10,11].”
Karyotaki, E., Kleiboer, A., Smit, F., Turner, D. T., Pastor, A. M., Andersson, G., Berger, T., Botella, C., Breton, J. M., Carlbring, P., et al. (2015) · Psychological Medicine · doi:10.1017/s0033291715000665 · Cited by 408 · see citing works
Self-citationBerger, T. (2017) · Psychotherapy Research · doi:10.1080/10503307.2015.1119908 · Cited by 364 · see citing works
Self-citationBerger, T., Hämmerli, K., Gubser, N., Andersson, G., & Caspar, F. (2011) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2011.616531 · Cited by 383 · see citing works
“high attrition and dropout rates found in the first study (only 55% of the participants completed the posttreatment assessment in the previous study; Meyer et al., 2009).”
BackgroundMethodResultInfluentialSelf-citationTitov, N., Dear, B. F., Johnston, L., Lorian, C., Zou, J., Wootton, B., Spence, J., McEvoy, P. M., & Rapee, R. M. (2013) · PLoS ONE · doi:10.1371/journal.pone.0062873 · Cited by 364 · see citing works
“However, the results parallel an extensive literature that indicates the benefits of minimal therapist contact added to self-help programs [39,40].”
Bower, P., Kontopantelis, E., Sutton, A., Kendrick, T., Richards, D. A., Gilbody, S., Knowles, S., Cuijpers, P., Andersson, G., Christensen, H., et al. (2013) · BMJ · doi:10.1136/bmj.f540 · Cited by 341 · see citing works
Self-citationCavanagh, K., Strauss, C., Forder, L., & Jones, F. (2014) · Clinical Psychology Review · doi:10.1016/j.cpr.2014.01.001 · Cited by 340 · see citing works
Behavioral activation interventions for well-being: A meta-analysis
Mazzucchelli, T. G., Kane, R. T., & Rees, C. S. (2010) · The Journal of Positive Psychology · doi:10.1080/17439760903569154 · Cited by 319 · see citing works
Interventions to improve return to work in depressed people
Nieuwenhuijsen, K., Faber, B., Verbeek, J. H. A. M., Neumeyer‐Gromen, A., Hees, H. L., Verhoeven, A. C., Feltz-Cornelis, C. M. V. D., & Bültmann, U. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006237.pub3 · Cited by 313 · see citing works
Griffiths, K. M., Farrer, L., & Christensen, H. (2010) · Medical Journal of Australia · doi:10.5694/j.1326-5377.2010.tb03685.x · Cited by 303 · see citing works
van der Vaart, R., Witting, M., Riper, H., Kooistra, L., Bohlmeijer, E. T., & van Gemert-Pijnen, L. J. (2014) · BMC Psychiatry · doi:10.1186/s12888-014-0355-z · Cited by 273 · see citing works
“While recent studies have shown that adding online sessions or modules to regular face-to-face psychotherapy can increase the adherence and effectiveness of a patients’ treatment, it also increases costs and workload among professionals [17-19].”
BackgroundProudfoot, J., Clarke, J., Birch, M.-R., Whitton, A. E., Parker, G., Manicavasagar, V., Harrison, V., Christensen, H., & Hadzi-Pavlovic, D. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-312 · Cited by 264 · see citing works
“[22] provide data supporting the psychometric adequacy of the WSAS when administered in an online format.”
MethodJohansson, R., Sjöberg, E., Sjögren, M., Johnsson, E., Carlbring, P., Andersson, T., Rousseau, A., & Andersson, G. (2012) · PLoS ONE · doi:10.1371/journal.pone.0036905 · Cited by 268 · see citing works
“for tinnitus [12], depression [13], panic [14] and anxiety disorders [15], it has to our knowledge never been directly compared to standardized (non-tailored) ICBT in a randomized controlled trial.”
ResultSelf-citationRogers, M. A., Lemmen, K., Kramer, R., Mann, J., & Chopra, V. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.7111 · Cited by 259 · see citing works
“Of these studies, there were 268 unique RCTs that were self-help Internet-based interventions; and of the 268 studies, there were 57 trials demonstrating a health benefit with a functional website [77-138].”
BackgroundSelf-guided psychological treatment for depressive symptoms: a meta-analysis
Cuijpers, P., Donker, T., Johansson, R., Mohr, D. C., van Straten, A., & Andersson, G. (2011) · PLoS ONE · doi:10.1371/journal.pone.0021274 · Cited by 250 · see citing works
“This resulted in removal of the study of Meyer and colleagues [11] (d = 0.”
BackgroundResultSelf-citationLayous, K., Nelson, S. K., & Lyubomirsky, S. (2012) · Journal of Happiness Studies · doi:10.1007/s10902-012-9346-2 · Cited by 250 · see citing works
“Feelings of need satisfaction have been associated with positive affect and (less) negative affect (Sheldon et al. 2001), and increases in need satisfaction have been shown to predict later increases in subjective well-being (Niemiec et al. 2009; Sheldon and Elliot 1999).”
BackgroundIndividually-tailored, internet-based treatment for anxiety disorders: a randomized controlled trial
Carlbring, P., Maurin, L., Törngren, C., Linna, E., Eriksson, T., Sparthan, E., Strååt, M., Marquez von Hage, C., Bergman-Nordgren, L., & Andersson, G. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2010.10.002 · Cited by 227 · see citing works
“While some degree of tailoring has beenpart of previous Internet trials, for example on depression (Meyer et al., 2009) and tinnitus (Kaldoetal.”
BackgroundSelf-citationTitov, N., Dear, B. F., Staples, L. G., Terides, M. D., Karin, E., Sheehan, J., Johnston, L., Gandy, M., Fogliati, V. J., Wootton, B. M., et al. (2015) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2015.08.002 · Cited by 223 · see citing works
“Another romising line of research has reported that self-guided delivery of D-CBT and DS-CBT can result in significant clinical improvements Meyer et al., 2009; Berger et al., 2011; Titov et al., 2013).”
ResultVernmark, K., Lenndin, J., Bjärehed, J., Carlsson, M., Karlsson, J., Öberg, J., Carlbring, P., Eriksson, T., & Andersson, G. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2010.01.005 · Cited by 226 · see citing works
“Indeed, one exception is a recent trial on unguided treatment which included a more comprehensive treatment programme and found a moderate effect size of d¼ .64 (Meyer et al., 2009).”
BackgroundSelf-citationO'Mahen, H. A., Richards, D. A., Woodford, J., Wilkinson, E., McGinley, J., Taylor, R. S., & Warren, F. C. (2014) · Psychological Medicine · doi:10.1017/s0033291713002092 · Cited by 201 · see citing works
“Online cognitive behavioural therapy (CBT) for depression has been demonstrated in a number of randomized controlled trials (e.g. Christensen et al. 2004; Warmerdam et al. 2008; Meyer et al. 2009; Perini et al. 2009) and systematic reviews (e.”
MethodInterventions to improve return to work in depressed people
Nieuwenhuijsen, K., Verbeek, J. H. A. M., Neumeyer‐Gromen, A., Verhoeven, A. C., Bültmann, U., & Faber, B. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006237.pub4 · Cited by 221 · see citing works
Theme issue on e-mental health: A growing field in internet research
Riper, H., Andersson, G., Christensen, H., Cuijpers, P., Lange, A., & Eysenbach, G. (2010) · Journal of Medical Internet Research · doi:10.2196/jmir.1713 · Cited by 200 · see citing works
“Looking through the “e-mental health” articles published in JMIR in the past 3 years, it becomes evident that depression remains a major public health issue and a primary target for Internet interventions [1-9].”
BackgroundSelf-citationCarlbring, P., Hägglund, M., Luthström, A., Dahlin, M., Kadowaki, Å., Vernmark, K., & Andersson, G. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.12.020 · Cited by 177 · see citing works
Self-citationLy, K. H., Topooco, N., Cederlund, H., Wallin, A., Bergström, J., Molander, O., Carlbring, P., & Andersson, G. (2015) · PLOS ONE · doi:10.1371/journal.pone.0126559 · Cited by 171 · see citing works
“We hypothesised that the new treatment would be non-inferior to the standard treatment and consequently, overcome the drawbacks that previous studies have suggested, namely that adding digital components also increases costs and workload among professionals [11,12,13].”
BackgroundSelf-citationMeyer, B., Bierbrodt, J., Schröder, J., Berger, T., Beevers, C. G., Weiss, M., Jacob, G., Späth, C., Andersson, G., Lutz, W., et al. (2015) · Internet Interventions · doi:10.1016/j.invent.2014.12.003 · Cited by 188 · see citing works
“It can be deployed both in an unsupported (Meyer et al., 2009; Moritz et al., 2012) or a supported version (Berger et al.”
BackgroundMethodResultInfluentialSelf-citationKaryotaki, E., Kemmeren, L., Riper, H., Twisk, J., Hoogendoorn, A., Kleiboer, A., Mira, A., Mackinnon, A., Meyer, B., Botella, C., et al. (2018) · Psychological Medicine · doi:10.1017/s0033291718000648 · Cited by 167 · see citing works
“…(Christensen et al. 2004; de Graaf et al. 2009; Berger et al. 2011; Farrer et al. 2011; Gilbody et al. 2015; Karyotaki et al. 2017 accepted, Spek et al. 2007; Meyer et al. 2009; Moritz et al. 2012; Phillips et al. 2014; Kleiboer et al. 2015; Meyer et al. 2015; Klein et al. 2016; Mira et al. 2017).”
BackgroundMethodSelf-citationInternet-delivered psychotherapy for depression in adults
Titov, N. (2011) · Current Opinion in Psychiatry · doi:10.1097/yco.0b013e32833ed18f · Cited by 158 · see citing works
Lim, S. M., Shiau, C. W. C., Cheng, L. J., & Lau, Y. (2022) · Behavior Therapy · doi:10.1016/j.beth.2021.09.007 · Cited by 163 · see citing works
Effectiveness of psychoeducation for depression: A systematic review
Tursi, M. F. D. S., Baes, C. V. W., Camacho, F. R. D. B., Tofoli, S. M. D. C., & Juruena, M. F. (2013) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867413491154 · Cited by 173 · see citing works
“The model of Meyer et al. (2009) evaluated the effectiveness of Internet-based intervention in a RCT.”
BackgroundMethodInfluentialA randomized controlled pilot study of a brief web-based mindfulness training
Glück, T. M., & Maercker, A. (2011) · BMC Psychiatry · doi:10.1186/1471-244x-11-175 · Cited by 168 · see citing works
“With its incorporation into cognitive behavioural manuals, mindfulness is now also used in some webbased interventions as component in cognitive-behavioural treatment programmes for a variety of conditions [16-20].”
BackgroundMethodResultInfluentialAllexandre, D., Bernstein, A. M., Walker, E., Hunter, J., Roizen, M. F., & Morledge, T. J. (2016) · Journal of Occupational & Environmental Medicine · doi:10.1097/jom.0000000000000680 · Cited by 157 · see citing works
“Beyond practical barriers to access, the progressive decrease in online participation over the course of the program suggests that there is a progressive disengagement over time, a constant findings in web-based interventions.(37) Model-based approaches such as the persuasive system design(36,47) may help guide effort…”
BackgroundFeasibility of an Online Mindfulness Program for Stress Management—A Randomized, Controlled Trial
Morledge, T. J., Allexandre, D., Fox, E., Fu, A. Z., Higashi, M. K., Kruzikas, D. T., Pham, S. V., & Reese, P. R. (2013) · Annals of Behavioral Medicine · doi:10.1007/s12160-013-9490-x · Cited by 159 · see citing works
“Although mindfulness interventions have been successfully delivered online or remotely, they have been mainly geared toward conditions other than stress, such as depression [19, 20], irritable bowel syndrome [21], and pain [22].”
BackgroundResultMood disorders and complementary and alternative medicine: a literature review
Qureshi, N. A., & Al-Bedah (2013) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s43419 · Cited by 155 · see citing works
“214 218”
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
“Studies generally show small to moderate effects of self-administered, unguided CBT in the treatment of depression [19-23], although in some studies unguided interventions have yielded large treatment effects [24,25].”
ResultBerger, T., Krieger, T., Sude, K., Meyer, B., & Maercker, A. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.11.021 · Cited by 153 · see citing works
Self-citationOnline 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
“…Christensen, Griffiths, &Mackinnon, 2011; Hollandare et al., 2011; Johansson et al., 2012, 2013; Kessler et al., 2009; Lintvedt et al., 2011; Meyer et al., 2009; O’Kearney et al., 2006; Perini, Titov, & Andrews, 2009; Ruwaard et al., 2009; Spek, Nyklicek et al., 2007; Spek et al., 2008;…”
BackgroundMethodInfluentialMorgan, A. J., Jorm, A. F., & Mackinnon, A. J. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2262 · Cited by 150 · see citing works
“Despite the growth in Internet-based interventions for mental health problems, such as computerized cognitive behavior therapy [12], Internet-based recruitment to mental health studies is uncommon [13,14].”
BackgroundClarke, J., Proudfoot, J., Birch, M.-R., Whitton, A. E., Parker, G., Manicavasagar, V., Harrison, V., Christensen, H., & Hadzi-Pavlovic, D. (2014) · BMC Psychiatry · doi:10.1186/s12888-014-0272-1 · Cited by 138 · see citing works
“[5] provide data supporting the psychometric adequacy of the WSAS when administered in an online format.”
BackgroundMethodKlein, J. P., Berger, T., Schröder, J., Späth, C., Meyer, B., Caspar, F., Lutz, W., Arndt, A., Greiner, W., Gräfe, V., et al. (2016) · Psychotherapy and Psychosomatics · doi:10.1159/000445355 · Cited by 145 · see citing works
“This contrasts with lower treatment adherence in previous trials [16, 20] and may be attributed to the fact that all participants had contact with clinicians during the telephone interview preceding the randomization.”
MethodResultInfluentialSelf-citationFischer, A., Schröder, J., Vettorazzi, E., Wolf, O. T., Pöttgen, J., Lau, S., Heesen, C., Moritz, S., & Gold, S. M. (2015) · The Lancet Psychiatry · doi:10.1016/s2215-0366(14)00049-2 · Cited by 143 · see citing works
Lappalainen, P., Granlund, A., Siltanen, S., Ahonen, S., Vitikainen, M., Tolvanen, A., & Lappalainen, R. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.07.006 · Cited by 138 · see citing works
Farrer, L., Christensen, H., Griffiths, K. M., & Mackinnon, A. (2011) · PLoS ONE · doi:10.1371/journal.pone.0028099 · Cited by 140 · see citing works
“Effects were also larger than any previous reported effect sizes across 11 RCTs comparing Internet interventions to waitlist, treatment as usual or placebo control conditions for depression [6,15,17,38,39, 40,41,42,43,44,45].”
ResultA randomized controlled trial of internet-based therapy in depression
Moritz, S., Schilling, L., Hauschildt, M., Schröder, J., & Treszl, A. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.04.006 · Cited by 140 · see citing works
“85) and larger, in fact, than in a previous, similar study (Meyer et al., 2009), the post-treatment difference in depression reduction between the treatment and control groups was only small to medium in magnitude (d 1⁄4 .”
BackgroundResultInfluentialYuan, P., Bare, M. G., Johnson, M. O., & Saberi, P. (2014) · Journal of Medical Internet Research · doi:10.2196/jmir.3229 · Cited by 138 · see citing works
“These venues have already been used to successfully recruit research participants from various groups, such as mothers of advanced maternal age [23], individuals with Klinefelter’s syndrome [24], those with active depression [25,26], and smokers [27,28].”
BackgroundZarski, A.-C., Lehr, D., Berking, M., Riper, H., Cuijpers, P., & Ebert, D. D. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.4493 · Cited by 114 · see citing works
“Low treatment adherence is a major concern because it has been associated with reduced efficacy of Internet interventions for physical and mental disorders and health promotion programs [8-13].”
Sztein, D. M., Koransky, C. E., Fegan, L., & Himelhoch, S. (2018) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x17717402 · Cited by 135 · see citing works
“(2012)) and therefore these are the values that were included in the final analysis.(31,33,34,36) The studies did not address length of depression symptoms prior to starting the program as part of their analyses.”
BackgroundThe responsiveness problem in psychotherapy: A review of proposed solutions.
Kramer, U., & Stiles, W. B. (2015) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12107 · Cited by 135 · see citing works
So, M., Yamaguchi, S., Hashimoto, S., Sado, M., Furukawa, T. A., & McCrone, P. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-113 · Cited by 129 · see citing works
“Meyer (2009) [41] community guided iCBT, 8 396 BDI WSAS WL 6 months 31% replaced by pretreatment scores German”
BackgroundWeb-Based Intervention Programs for Depression: A Scoping Review and Evaluation
Renton, T., Tang, H., Ennis, N., Cusimano, M. D., Bhalerao, S., Schweizer, T. A., & Topolovec-Vranic, J. (2014) · Journal of Medical Internet Research · doi:10.2196/jmir.3147 · Cited by 116 · see citing works
“Examining the existing literature, completion rates in RCTs of Web-delivered treatments for depression have primarily ranged from 55%-67% [49-54] with rates as low as 20% [55].”
Wahbeh, H., Svalina, M. N., & Oken, B. S. (2014) · Open Medicine Journal · doi:10.2174/1874220301401010066 · Cited by 116 · see citing works
The Working Alliance Inventory for guided Internet interventions (WAI‐I)
Gómez Penedo, J. M., Berger, T., grosse Holtforth, M., Krieger, T., Schröder, J., Hohagen, F., Meyer, B., Moritz, S., & Klein, J. P. (2020) · Journal of Clinical Psychology · doi:10.1002/jclp.22823 · Cited by 100 · see citing works
Self-citationThe association between adherence and outcome in an Internet intervention for depression
Fuhr, K., Schröder, J., Berger, T., Moritz, S., Meyer, B., Lutz, W., Hohagen, F., Hautzinger, M., & Klein, J. P. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.12.028 · Cited by 97 · see citing works
Self-citationSchröder, J., Berger, T., Meyer, B., Lutz, W., Hautzinger, M., Späth, C., Eichenberg, C., Klein, J. P., & Moritz, S. (2017) · Cognitive Therapy and Research · doi:10.1007/s10608-017-9850-0 · Cited by 113 · see citing works
Self-citationWildeboer, G., Kelders, S. M., & van Gemert-Pijnen, J. E. W. C. (2016) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2016.04.005 · Cited by 98 · see citing works
Berger, T., Urech, A., Krieger, T., Stolz, T., Schulz, A., Vincent, A., Moser, C. T., Moritz, S., & Meyer, B. (2017) · Psychological Medicine · doi:10.1017/s0033291716002270 · Cited by 98 · see citing works
“…was developed by Gaia AG, Hamburg, Germany, an e-Health company that has developed several previous Internet interventions, including ‘deprexis’, a depression-focused programme that has been tested in several RCTs (e.g. Meyer et al. 2009; Berger et al. 2011b; Moritz et al. 2012; Klein et al. 2016).”
Self-citationInternet interventions for depression: new developments
Schröder, J., Berger, T., Westermann, S., Klein, J. P., & Moritz, S. (2016) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2016.18.2/jschroeder · Cited by 105 · see citing works
Self-citationRichards, D., Timulak, L., O'Brien, E., Hayes, C., Vigano, N., Sharry, J., & Doherty, G. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.10.005 · Cited by 109 · see citing works
Zwerenz, R., Becker, J., Knickenberg, R. J., Siepmann, M., Hagen, K., & Beutel, M. E. (2017) · Psychotherapy and Psychosomatics · doi:10.1159/000481177 · Cited by 108 · see citing works
“Optional reminders via e-mail and SMS can be activated [33] .”
BackgroundEffectiveness of Web-based Psychological Interventions for Depression: A Meta-analysis
Cowpertwait, L., & Clarke, D. (2013) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-012-9416-z · Cited by 101 · see citing works
Digital therapeutics in neurology
Abbadessa, G., Brigo, F., Clerico, M., De Mercanti, S., Trojsi, F., Tedeschi, G., Bonavita, S., & Lavorgna, L. (2022) · Journal of Neurology · doi:10.1007/s00415-021-10608-4 · Cited by 116 · see citing works
“An example of DTx to manage depression is “Deprexis” [60].”
BackgroundResultTwomey, C., O’Reilly, G., & Meyer, B. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.06.081 · Cited by 103 · see citing works
Self-citationInternet-based randomized controlled trials: a systematic review
Mathieu, E., McGeechan, K., Barratt, A., & Herbert, R. (2013) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2012-001175 · Cited by 98 · see citing works
Cella, M., Sharpe, M., & Chalder, T. (2011) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2011.02.009 · Cited by 99 · see citing works
Schröder, J., Brückner, K., Fischer, A., Lindenau, M., Köther, U., Vettorazzi, E., & Moritz, S. (2014) · Epilepsia · doi:10.1111/epi.12833 · Cited by 96 · see citing works
“Interventions such as Deprexis may help to close the existing treatment gap due to their accessibility and efficacy.(14,23,29) It is also important to note that most Internet interventions that claim to reduce depressive symptoms have no evidence base at all and should be tested in independent randomized controlled tr…”
BackgroundKooistra, L. C., Wiersma, J. E., Ruwaard, J., Neijenhuijs, K., Lokkerbol, J., van Oppen, P., Smit, F., & Riper, H. (2019) · Journal of Medical Internet Research · doi:10.2196/14261 · Cited by 84 · see citing works
Enrique, A., Palacios, J. E., Ryan, H., & Richards, D. (2019) · Journal of Medical Internet Research · doi:10.2196/12775 · Cited by 81 · see citing works
“Similar criteria have been used in other studies of internet-delivered interventions for depression [19,32,33].”
Lauder, S., Chester, A., Castle, D. J., Dodd, S., Gliddon, E., Berk, L., Chamberlain, J. A., Klein, B., Gilbert, M., Austin, D., et al. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.08.008 · Cited by 91 · see citing works
“For both groups of the study, the non-usage attrition rate, a noted issue in online programs, (Eysenbach, 2005) was comparable to similar self-guided programs (Meyer et al., 2009).”
ResultLifestyle medicine for depression: A meta-analysis of randomized controlled trials
Wong, V. W.-H., Ho, F. Y., Shi, N.-K., Sarris, J. J., Chung, K., & Yeung, W. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.02.012 · Cited by 89 · see citing works
Close, S., Smaldone, A. M., Fennoy, I., Reame, N. K., & Grey, M. J. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2286 · Cited by 89 · see citing works
Salamanca-Sanabria, A., Richards, D., Timulak, L., Connell, S., Mojica Perilla, M., Parra-Villa, Y., & Castro-Camacho, L. (2020) · JMIR Mental Health · doi:10.2196/13392 · Cited by 83 · see citing works
“Internet-delivered interventions for depression have showed higher retention rates, for example, a study [93] reported 49% of participants providing data at posttreatment and 35% at follow-up.”
Maloni, J. A., Przeworski, A., & Damato, E. G. (2013) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2012.12.001 · Cited by 80 · see citing works
Wang, Z., Wang, J., & Maercker, A. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2690 · Cited by 84 · see citing works
“In recent years, the Internet has been adopted as a valuable tool to deliver mental health services to large populations [3-4].”
Titov, N., Dear, B. F., Johnston, L., McEvoy, P. M., Wootton, B., Terides, M. D., Gandy, M., Fogliati, V., Kayrouz, R., & Rapee, R. M. (2014) · PLoS ONE · doi:10.1371/journal.pone.0089591 · Cited by 81 · see citing works
“The magnitude of clinical benefits from this self-guided intervention at 12-month follow-up were larger than those reported at follow-up than other self-guided internet treatments for depression or anxiety [12,24].”
Twomey, C. D., O’Reilly, G., Bültmann, O., & Meyer, B. (2020) · PLoS ONE · doi:10.1371/journal.pone.0228100 · Cited by 75 · see citing works
“Several studies have shown longer term effects of deprexis [8, 9, 23, 29], but for the purposes of this meta-analysis there was still an insufficient amount of data to examine the stability of intervention effects over six months or beyond.”
BackgroundSelf-citationParticipating in Online Mental Health Interventions: Who Is Most Likely to Sign Up and Why?
Crisp, D. A., & Griffiths, K. M. (2014) · Depression Research and Treatment · doi:10.1155/2014/790457 · Cited by 76 · see citing works
Feasibility of an eHealth Service to Support Collaborative Depression Care: Results of a Pilot Study
Meglic, M., Furlan, M., Kuzmanic, M., Kozel, D., Baraga, D., Kuhar, I., Kosir, B., Iljaz, R., Novak Sarotar, B., Dernovsek, M. Z., et al. (2010) · Journal of Medical Internet Research · doi:10.2196/jmir.1510 · Cited by 71 · see citing works
Lintvedt, O., Griffiths, K. M., Eisemann, M. R., & Waterloo, K. K. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2422 · Cited by 74 · see citing works
“Several of these have been subjected to research evaluation or are in the test phase: Alles onder controle [15], Color your life [16], Deprexis [17], E-couch [18], HealthSteps for Depression [19], Interapy Depression [20], Living Life to The Full On-line [21], MoodCalmer [22], MoodHelper.”
BackgroundAndrews, G., & Williams, A. D. (2015) · Clinical Psychology Review · doi:10.1016/j.cpr.2014.05.006 · Cited by 80 · see citing works
“MDD; elevated depressi ve sympto ms www.deprexis.com Germa n, English , Swedis h Berger et al., 2011, Meyer et al., 2009, Moritz et al., 2012 Variable, based on factors such as patient number and clinical setting GAIA, Research and Developme nt Unit, Hamburg, Germany.”
BackgroundLy, K. H., Dahl, J., Carlbring, P., & Andersson, G. (2012) · SpringerPlus · doi:10.1186/2193-1801-1-11 · Cited by 69 · see citing works
“The current intervention is based on our previous experiences with Internet-based depression treatment (Cuijpers et al. 2010; Andersson et al. 2011; Andersson et al. 2005; Bendelin et al. 2011; Holländare et al. 2011; Meyer et al. 2009; Vernmark et al. 2010).”
MethodSelf-citationBeiwinkel, T., Eißing, T., Telle, N.-T., Siegmund-Schultze, E., & Rössler, W. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.6546 · Cited by 62 · see citing works
“Web-based interventions for depression have been studied among different clinical populations in Germany [25-29] but, to the best of our knowledge, no studies have yet focused on a Web-based intervention among a population with sick leave due to depression.”
Whitton, A. E., Proudfoot, J., Clarke, J., Birch, M.-R., Parker, G., Manicavasagar, V., & Hadzi-Pavlovic, D. (2015) · JMIR Mental Health · doi:10.2196/mental.3573 · Cited by 69 · see citing works
“Furthermore, Google Analytics data revealed an average site visit duration of 10 minutes and 37 seconds, which is in line with that shown in other trials of Internet-delivered interventions for anxiety and depression that report average site visit durations of between 7 and 13 minutes [23,24], indicating a high level…”
InfluentialBeevers, C. G., Pearson, R., Hoffman, J. S., Foulser, A. A., Shumake, J., & Meyer, B. (2017) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000171 · Cited by 69 · see citing works
Self-citationJabir, A. I., Lin, X., Martinengo, L., Sharp, G., Theng, Y. L., & Car, L. T. (2023) · Journal of Medical Internet Research · doi:10.2196/48168 · Cited by 70 · see citing works
Rosso, I. M., Killgore, W. D. S., Olson, E. A., Webb, C. A., Fukunaga, R., Auerbach, R. P., Gogel, H., Buchholz, J. L., & Rauch, S. L. (2016) · Depression and Anxiety · doi:10.1002/da.22590 · Cited by 65 · see citing works
“…may predict differential outcome in iCBT (Andersson et al., 2005; Button, Wiles, Lewis, Peters, & Kessler, 2012; de Graaf, Hollon, & Huibers, 2010; Meyer et al., 2009; Warmerdam, van Straten, Twisk, Riper, & Cuijpers, 2008; Warmerdam, van Straten, Twisk, & Cuijpers, 2013), we also tested for…”
BackgroundNobis, S., Lehr, D., Ebert, D. D., Berking, M., Heber, E., Baumeister, H., Becker, A., Snoek, F. J., & Riper, H. M. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-306 · Cited by 62 · see citing works
“As studies show, web-based interventions are mostly used by higher educated persons and females [32,104,105].”
BackgroundLy, K. H., Carlbring, P., & Andersson, G. (2012) · Trials · doi:10.1186/1745-6215-13-62 · Cited by 61 · see citing works
“treatment [15,16,19-23].”
Self-citationThe Implementation of Internet Interventions for Depression: A Scoping Review
Drozd, F., Vaskinn, L., Bergsund, H. B., Haga, S. M., Slinning, K., & Bjørkli, C. A. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.5670 · Cited by 60 · see citing works
“These found significant positive effects for factors such as marital status (van Straten, Cuijpers, & Smits, 2008), level of engagement with the program (Meyer et al., 2009) and older age (e.”
Richards, D., Murphy, T., Viganó, N., Timulak, L., Doherty, G., Sharry, J., & Hayes, C. (2016) · Internet Interventions · doi:10.1016/j.invent.2016.06.007 · Cited by 59 · see citing works
“One quarter ofthecurrentsampleweremale,typicalofthepredominanceoffemales presentingwith symptomsof depression (Meyer et al., 2009).”
Individualized Web-Based Exercise for the Treatment of Depression: Randomized Controlled Trial
Haller, N., Lorenz, S., Pfirrmann, D., Koch, C., Lieb, K., Dettweiler, U., Simon, P. D., & Jung, P. (2018) · JMIR Mental Health · doi:10.2196/10698 · Cited by 58 · see citing works
“To the best of our knowledge, this is the first Web-based exercise approach in the treatment of MDD. Previous Web-based trials on depression have focused on self-help and cognitive behavioral therapy (CBT) [11-13].”
InfluentialBuntrock, C., Ebert, D. D., Lehr, D., Cuijpers, P. J., Riper, H. M., Smit, F., & Berking, M. (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-25 · Cited by 57 · see citing works
“Web-based interventions have shown to be well accepted by participants [29,30] and to be effective in the acute treatment of MDD [12] as well as in reducing depressive symptoms both in adults and adolescents [31,32].”
Background
- Authors
- Meyer, B., Berger, T., Caspar, F., Beevers, C. G., Andersson, G., & Weiss, M.
- Affiliations
- University Medical Center Hamburg-Eppendorf (DE)
- University of Bern (CH)
- The University of Texas at Austin (US)
- Linköping University (SE)
- GAIA (Germany) (DE)
- Corresponding author
- Meyer, Björn
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2009-05-11
- Volume
- 11
- Issue
- 2
- Pages
- e15
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC2762808
- OpenAlex
- W2115531241
- Semantic Scholar
- 37b1f1ccf725c315bb299af7bb17a1f37a3fe471
- Cited by
- 363
- References
- 96
- Citations by year
- 2026: 12 · 2025: 12 · 2024: 10 · 2023: 15 · 2022: 13 · 2021: 28 · 2020: 24 · 2019: 25 · 2018: 25 · 2017: 28 · 2016: 30 · 2015: 25 · 2014: 33 · 2013: 32 · 2012: 24
- FWCI
- 19.99
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- other-oa
- Locations
- Journal of Medical Internet Research (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- BORIS (University Library Bern) (submittedVersion)
- 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
- depression, online therapy, online intervention, Deprexis, behavioral activation, cognitive restructuring, mindfulness, acceptance and commitment therapy, social skills training, integrative psychotherapy, social functioning, online forums, medication adherence, recovery from depression, digital mental health, treatment gap, user satisfaction
- MeSH terms
- Adult, Behavior, Behavior Therapy, Cognition, Depression, Depressive Disorder, Emotions, Female, Follow-Up Studies, Humans, Life Style, Male, Online Systems, Patient Education as Topic, Personality Inventory, Problem Solving, Psychiatric Status Rating Scales, Social Adjustment, Social Behavior, Social Support, Exercise, Internet
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