The Clinical Effectiveness of Web-Based Cognitive Behavioral Therapy With Face-to-Face Therapist Support for Depressed Primary Care Patients: Randomized Controlled Trial

“The SWLS measures global life satisfaction as a cognitive-judgemental process, in which individuals assess their quality of life according to their own criteria [77].”

“The inventory possesses high internal consistency and reliability, as well as robust convergent and discriminant validity [64-66].”

“The Alcohol Use Disorders Identification Test (AUDIT) is a screening instrument consisting of 10 questions about alcohol use in the past 12 months, alcohol dependence symptoms, and alcohol-related problems [83].”

“Most factor analyses confirm a 2-factor solution comprising a depression and an anxiety subscale [69].”

“Clinically significant changes on the BDI-II were assessed using the criteria for reliable change and cutoff points developed for the BDI by Seggar et al [97], based on the definition by Jacobson and Truax [98].”

“For the 5 dimensions, a scoring algorithm (the MVH_A1 tariff) based on preference weights was used to aggregate an index score (EQ Index) [73].”

“Several studies confirm the scale’s unidimensional structure and support its sound psychometric properties, including internal consistency, test-retest reliability, as well as convergent and discriminant construct validity [78-80].”

“Cognitive behavioral therapy (CBT) has proven to be as effective as pharmacotherapy in treating mild to moderate depression, with the benefit of reduced rates of relapse [10,11].”

“For the ITT analyses, calculations were based on pooled standard deviations calculated from the square root of each group’s variance parameters from the mixed models analysis: the single variance estimate of the procedure with a random intercept, and the sum of the variance estimates at each time point of interest min…”

“Trial information to participants as requested in CONSORT-EHEALTH [53].”

“Still, an increasing amount of research has pointed to the importance of support in Internet-based interventions, with interventions offering some degree of support from a professional during treatment generally showing substantially larger treatment effects than interventions involving little or no professional suppo…”

“Studies consistently support the BDI-II as a reliable, internally consistent, and valid scale for assessing depression both in psychiatric outpatients, the general population, and in primary care settings [56-58].”

“Most patients with psychological problems will receive most or all of their mental health care in primary care, and findings suggest that many patients prefer to consult their GP for treatment of depression [2,38-40].”

“A large body of research confirms the favorable internal consistency, reliability, and criterion validity [83-85].”

“This is in good accordance with the core symptoms of the Goldberg Anxiety Scale [104], which has been used in several studies with MoodGYM.”

“The rates of adherence are also comparable to those seen in other psychotherapy research and in regular clinical practice [105-107].”

“There was also substantial comorbidity with anxiety disorders, although lower than rates found in population-based studies [108,109].”

“There exist several effective psychological and pharmacological treatments for depression [7].”

“The Drug Use Disorders Identification Test (DUDIT) is an 11-item screening instrument measuring patterns of substance use during the past 12 months, as well as various drug-related problems [86].”

“Studies have demonstrated the effectiveness of MoodGYM in reducing symptoms of depression and anxiety among public registrants, trial participants, callers to a national helpline service, users of the UK National Health Service portal, adolescent school-based populations, and in Australian and Norwegian student sample…”

“There was also substantial comorbidity with anxiety disorders, although lower than rates found in population-based studies [108,109].”

“Since linear mixed-models analysis can handle incomplete data, no procedure for imputation of missing data was utilized in the analysis [92].”

“However, since the role of the clinician was mainly supportive and facilitative and the main therapeutic input was delivered through a standardized treatment package, the intervention was regarded conceptually as a guided self-help intervention [31].”

“The inventory possesses high internal consistency and reliability, as well as robust convergent and discriminant validity [64-66].”

“Studies consistently support the BDI-II as a reliable, internally consistent, and valid scale for assessing depression both in psychiatric outpatients, the general population, and in primary care settings [56-58].”

“A median dropout rate between 17% and 19% has been reported for computerized or Web-based treatment programs [54,55].”

“Depression is a highly prevalent disorder that often causes substantial functional impairment in daily life, reduction in quality of life, and increased medical service utilization [1-6].”

“Depression is a highly prevalent disorder that often causes substantial functional impairment in daily life, reduction in quality of life, and increased medical service utilization [1-6].”

“The adherence rate in the present study is comparable to that observed in other online guided interventions, in which adherence varied between 55% and 75% [13,14,23,30,99].”

“range, but somewhat below average, whereas the effects on SWLS and on depression and anxiety measured with HADS were commensurable to effects found previously for similar measures [12-14,27,99,100].”

“Several studies confirm the scale’s unidimensional structure and support its sound psychometric properties, including internal consistency, test-retest reliability, as well as convergent and discriminant construct validity [78-80].”

“Clinical practice guidelines primarily recommend treating mild to moderate depression using psychosocial interventions [41,42], and this is also in accordance with reported patient preferences [43-45].”

“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].”

“Clinical practice guidelines primarily recommend treating mild to moderate depression using psychosocial interventions [41,42], and this is also in accordance with reported patient preferences [43-45].”

“The adherence rate in the present study is comparable to that observed in other online guided interventions, in which adherence varied between 55% and 75% [13,14,23,30,99].”

“Research also suggests that such interventions are cost-effective compared to face-to-face treatments because they result in symptom reduction and reduced burden of disease for patients and alleviate demands on clinician time and resources [16-18].”

“Cognitive behavioral therapy (CBT) has proven to be as effective as pharmacotherapy in treating mild to moderate depression, with the benefit of reduced rates of relapse [10,11].”

“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].”

“Studies have demonstrated the effectiveness of MoodGYM in reducing symptoms of depression and anxiety among public registrants, trial participants, callers to a national helpline service, users of the UK National Health Service portal, adolescent school-based populations, and in Australian and Norwegian student sample…”

“Equivalent psychometric properties have been shown across paper-and-pencil and online formats of the questionnaire, and the 2 formats are highly correlated [59,67].”

“The inventory possesses high internal consistency and reliability, as well as robust convergent and discriminant validity [64-66].”

“The results of the present trial are also consistent with research suggesting that MoodGYM, despite its main focus on depressive thought content, can have significant positive effects on anxiety symptoms [29,35,103].”

“Still, an increasing amount of research has pointed to the importance of support in Internet-based interventions, with interventions offering some degree of support from a professional during treatment generally showing substantially larger treatment effects than interventions involving little or no professional suppo…”

“The adherence rate in the present study is comparable to that observed in other online guided interventions, in which adherence varied between 55% and 75% [13,14,23,30,99].”

“A substantive body of research shows that Internet-based CBT can be an efficacious treatment of depression (eg, [12-15]).”

“The demand for mental health treatment is higher than what can be met by the current number of trained clinicians [113].”

“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].”

“However, data from individuals who used the English version of the program has shown that most users were aged 25 to 44 years, and that the users’ average depression and anxiety scores were elevated compared to the general population [91].”

“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].”

“The adherence rate in the present study is comparable to that observed in other online guided interventions, in which adherence varied between 55% and 75% [13,14,23,30,99].”

“Clinical practice guidelines primarily recommend treating mild to moderate depression using psychosocial interventions [41,42], and this is also in accordance with reported patient preferences [43-45].”

“Research also suggests that such interventions are cost-effective compared to face-to-face treatments because they result in symptom reduction and reduced burden of disease for patients and alleviate demands on clinician time and resources [16-18].”

“range, but somewhat below average, whereas the effects on SWLS and on depression and anxiety measured with HADS were commensurable to effects found previously for similar measures [12-14,27,99,100].”

“Equivalent psychometric properties have been shown across paper-and-pencil and online formats of the questionnaire, and the 2 formats are highly correlated [59,67].”

“Research indicates that Internet data on this measure is as reliable and valid as paper-and-pencil data [81].”

“The rates of adherence are also comparable to those seen in other psychotherapy research and in regular clinical practice [105-107].”

“range, but somewhat below average, whereas the effects on SWLS and on depression and anxiety measured with HADS were commensurable to effects found previously for similar measures [12-14,27,99,100].”

“Positive effects have been shown to be sustained over 12 months [36].”

“The adherence rate in the present study is comparable to that observed in other online guided interventions, in which adherence varied between 55% and 75% [13,14,23,30,99].”

“Several studies have found high correlations between the paper-and-pencil and the computerized/online versions of the BDI-II [59-62].”

“Paper-and-pencil and Internet administration of the measure yields comparable psychometric properties, but Internet administration may overestimate scores [70,71].”

“Nevertheless, structured psychological interventions are infrequently delivered in general practice [46-48] because of time constraints [49-51] and a lack of knowledge and competence among GPs in the delivery of evidence-based psychological interventions [51,52].”

“Clinically significant changes on the BDI-II were assessed using the criteria for reliable change and cutoff points developed for the BDI by Seggar et al [97], based on the definition by Jacobson and Truax [98].”

“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].”

“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].”

“Studies have demonstrated the effectiveness of MoodGYM in reducing symptoms of depression and anxiety among public registrants, trial participants, callers to a national helpline service, users of the UK National Health Service portal, adolescent school-based populations, and in Australian and Norwegian student sample…”

“The adherence rate in the present study is comparable to that observed in other online guided interventions, in which adherence varied between 55% and 75% [13,14,23,30,99].”

“Several studies confirm the scale’s unidimensional structure and support its sound psychometric properties, including internal consistency, test-retest reliability, as well as convergent and discriminant construct validity [78-80].”

“The instrument has been demonstrated to discriminate between subgroups of patients with differing severities of mental illness and to capture changes in quality of life associated with improved mental health over time [74].”

“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].”

“For the ITT analyses, calculations were based on pooled standard deviations calculated from the square root of each group’s variance parameters from the mixed models analysis: the single variance estimate of the procedure with a random intercept, and the sum of the variance estimates at each time point of interest min…”

“The results of the present trial are also consistent with research suggesting that MoodGYM, despite its main focus on depressive thought content, can have significant positive effects on anxiety symptoms [29,35,103].”

“No significant differences have been found between scores obtained using paper and computerized modes of administration [75,76].”

“Previous studies of nonclinical samples have indicated that scores on the BDI tend to decrease with repeated administration [111,112].”

“Several studies have found high correlations between the paper-and-pencil and the computerized/online versions of the BDI-II [59-62].”

“Almost half of the sample did not fulfill the criteria for a major depressive episode on enrollment in the trial, and previous studies of minor depression have shown high rates of placebo response in primary care patients [101] and substantial likelihood of spontaneous remission in the general population [102].”

“Effect sizes (Cohen’s d) were calculated for withinand between-group changes based on estimated means or beta coefficients [93].”

“Nevertheless, structured psychological interventions are infrequently delivered in general practice [46-48] because of time constraints [49-51] and a lack of knowledge and competence among GPs in the delivery of evidence-based psychological interventions [51,52].”

“Nevertheless, structured psychological interventions are infrequently delivered in general practice [46-48] because of time constraints [49-51] and a lack of knowledge and competence among GPs in the delivery of evidence-based psychological interventions [51,52].”

“Despite this limitation, the results should not be considered weakened for most measures because the direction of differences has generally suggested that online versions tend to inflate estimations of symptom severity and lower ratings of quality of life [59,71,76], with the exception of BAI, for which Carlbring et a…”

“Previous studies of nonclinical samples have indicated that scores on the BDI tend to decrease with repeated administration [111,112].”

“The general content of the questions was influenced by patient satisfaction questionnaires used in other studies [87-89].”

“These findings are consistent with previous research in which favorable outcomes have been shown for treatments combining MoodGYM and face-to-face support from a professional [29,37].”

“However, a large proportion of those suffering from this disorder receive inadequate treatment or no treatment at all [8,9].”

“The general content of the questions was influenced by patient satisfaction questionnaires used in other studies [87-89].”

“No significant differences have been found between scores obtained using paper and computerized modes of administration [75,76].”

“Nevertheless, structured psychological interventions are infrequently delivered in general practice [46-48] because of time constraints [49-51] and a lack of knowledge and competence among GPs in the delivery of evidence-based psychological interventions [51,52].”

“Nevertheless, structured psychological interventions are infrequently delivered in general practice [46-48] because of time constraints [49-51] and a lack of knowledge and competence among GPs in the delivery of evidence-based psychological interventions [51,52].”

“Depression is a highly prevalent disorder that often causes substantial functional impairment in daily life, reduction in quality of life, and increased medical service utilization [1-6].”

“In fact, studies show that guidance may be delivered effectively not only by trained clinicians, but also by mental health workers with limited experience and by computer technicians [114,115].”

“Using blended interventions to improve the delivery of evidence-based treatment in primary care has been successful in acceptability and in reducing symptomatology [31,48,50,65,72].”

“[35] investigated the effect of a guided web-based intervention with face-to-face support, with positive results on depression and anxiety symptoms.”

“…prevalent function of depression apps was offering behavior training or therapy, with most apps focusing on CBT. Internet-based CBT (ICBT) has shown to be an effective treatment for depression [85], with the magnitude of effects depending on level of support and content of the intervention [86].”