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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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In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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].”
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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].”
In the citing paper
“Some online programs, such as Deprexis, use patient feedback to select specific content presented to patients [35].”
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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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“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
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
“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
“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
Self-citation
Metadata
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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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