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Cited by 116Digital Mental Health InterventionsPsychological Well-being and Life SatisfactionAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

An Internet-Based Intervention to Promote Mental Fitness for Mildly Depressed Adults: Randomized Controlled Trial

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Bolier, Linda, Haverman, Merel, Kramer, Jeannet, Westerhof, Gerben J, Riper, Heleen, Walburg, Jan A, Boon, Brigitte, Bohlmeijer, Ernst·2013·Journal of Medical Internet Research
DOI 10.2196/jmir.2603PMC PMC3929047
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Abstract

BACKGROUND: Depression is a worldwide problem warranting global solutions to tackle it. Enhancing well-being has benefits in its own right and could be a good strategy for preventing depression. Providing well-being interventions via the Internet may have synergetic effects. OBJECTIVE: Psyfit ("mental fitness online") is a fully automated self-help intervention to improve well-being based on positive psychology. This study examines the clinical effects of this intervention. METHODS: We conducted a 2-armed randomized controlled trial that compared the effects of access to Psyfit for 2 months (n=143) to a waiting-list control condition (n=141). Mild to moderately depressed adults in the general population seeking self-help were recruited. Primary outcome was well-being measured by Mental Health Continuum-Short Form (MHC-SF) and WHO Well-being Index (WHO-5); secondary outcomes were depressive symptoms, anxiety, vitality, and general health measured by Center for Epidemiological Studies Depression Scale (CES-D), Hospital Anxiety and Depression Scale Anxiety subscale (HADS-A), and Medical Outcomes Study-Short Form (MOS-SF) vitality and general health subscales, respectively. Online measurements were taken at baseline, 2 months, and 6 months after baseline. RESULTS: The dropout rate was 37.8% in the Psyfit group and 22.7% in the control group. At 2-month follow-up, Psyfit tended to be more effective in enhancing well-being (nonsignificantly for MHC-SF: Cohen's d=0.27, P=.06; significantly for WHO-5: Cohen's d=0.31, P=.01), compared to the waiting-list control group. For the secondary outcomes, small but significant effects were found for general health (Cohen's d=0.14, P=.01), vitality (d=0.22, P=.02), anxiety symptoms (Cohen's d=0.32, P=.001), and depressive symptoms (Cohen's d=0.36, P=.02). At 6-month follow-up, there were no significant effects on well-being (MHC-SF: Cohen's d=0.01, P=.90; WHO-5: Cohen's d=0.26, P=.11), whereas depressive symptoms (Cohen's d=0.35, P=.02) and anxiety symptoms (Cohen's d=0.35, P=.001) were still significantly reduced compared to the control group. There was no clear dose-response relationship between adherence and effectiveness, although some significant differences appeared across most outcomes in favor of those completing at least 1 lesson in the intervention. CONCLUSIONS: This study shows that an online well-being intervention can effectively enhance well-being (at least in the short-term and for 1 well-being measure) and can help to reduce anxiety and depression symptoms. Further research should focus on increasing adherence and motivation, reaching and serving lower-educated people, and widening the target group to include people with different levels of depressive symptoms. TRIAL REGISTRATION: Netherlands Trial Register (NTR) number: NTR2126; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2126 (archived by WebCite at http://www.webcitation.org/6IIiVrLcO).

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  • One study reported that almost 60% of participants with depression were indifferent to, or dissatisfied with, an online intervention using components of positive psychology.

    “One study reported that almost 60% of participants with depression were indifferent to, or dissatisfied with, an online intervention using components of positive psychology however, did not collect data on reasons for dissatisfaction [3].”

    From What might affect acceptability of online positive psychology interventions for depression: A qualitative study on patient expectations' (2018) · cites this paper as [3]

    The Results (Participant Satisfaction; page unavailable) report that 57.0% of the 93 intervention-group respondents were indifferent and/or dissatisfied with Psyfit, supporting the quoted finding. The Discussion (Adherence and Acceptability; page unavailable) says the authors collected no information on reasons for quitting or not starting, but does not specifically say they collected no data on reasons for dissatisfaction, as the full citing sentence claims. (LLM, conf=0.84)

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  • Few studies have provided data to support the idea that positive psychology interventions are acceptable.

    “However, few studies have provided data to support the idea that positive psychology interventions are acceptable.”

    From What might affect acceptability of online positive psychology interventions for depression: A qualitative study on patient expectations' (2018) · cites this paper as [3]

    The Results > Participant Satisfaction section (page unavailable) provides acceptability-related data for one online positive psychology intervention: 43% of respondents were satisfied with Psyfit, while about 70% would recommend it. The paper does not establish that few studies have provided such data across positive psychology interventions; its review of prior studies concerns effectiveness, not the number assessing acceptability. (LLM, conf=0.78)

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  • Given the widespread interest in taking positive psychology online for clinical and subclinical populations, it is salient to ensure that interventions are not undermined by issues of acceptability.

    “Given the widespread interest in taking positive psychology online for clinical and subclinical populations, [3, 5, 6] it is salient to ensure that interventions are not undermined by issues of acceptability [8].”

    From What might affect acceptability of online positive psychology interventions for depression: A qualitative study on patient expectations' (2018) · cites this paper as [3]

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Research works printed but not linked: 2

  1. [29]Seligman ME Steen TA Park N Peterson C Positive psychology progress: empirical validation of interventions Am Psychol 2005 60 5 410 21 10.1037/0003-066X.60.5.410 16045394 16045394 · DOI · Paper page
  2. [57]Fogg BJ Persuasive Technology: Using Computers to Change What We Think and Do 2003 San Francisco Morgan Kaufmann

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Authors
Bolier, L., Haverman, M., Kramer, J., Westerhof, G. J., Riper, H., Walburg, J. A., Boon, B., & Bohlmeijer, E.
Affiliations
  • Trimbos Institute (NL)
  • University of Twente (NL)
  • Leuphana University of Lüneburg (DE)
Corresponding author
Bolier, Linda
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2013-09-07
Volume
15
Issue
9
Pages
e200
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/jmir.2603
PMC
PMC3929047
OpenAlex
W2099472083
Cited by
116
References
71
Citations by year
2026: 3 · 2025: 3 · 2024: 4 · 2023: 8 · 2022: 8 · 2021: 13 · 2020: 8 · 2019: 12 · 2018: 12 · 2017: 14 · 2016: 13 · 2015: 10 · 2014: 7
FWCI
15.41
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Medical Internet Research (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
  • VU Research Portal (publishedVersion, other-oa)
  • University of Twente Research Information (acceptedVersion, cc-by)
  • Pure Amsterdam UMC (submittedVersion)
  • Multilingual Matters (Channel View Publications) (submittedVersion, cc-by)
  • University of Twente Research Information (submittedVersion, cc-by)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
Ministerie van Volksgezondheid, Welzijn en Sport
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Social Psychology › Psychological Well-being and Life Satisfaction
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
mild depression, online intervention, self-help, positive psychology, well-being, mental fitness, automated intervention, depression prevention, anxiety, vitality, health status, depressive symptoms, dropout
MeSH terms
Adult, Aged, Aged, 80 and over, Depression, Female, Humans, Male, Mental Health, Middle Aged, Netherlands, Patient Compliance, Self Care, Therapy, Computer-Assisted, Patient Satisfaction, Telemedicine, Internet, Young Adult

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