Effectiveness of a Web-Based Self-Help Intervention for Symptoms of Depression, Anxiety, and Stress: Randomized Controlled Trial
Open accessAbstract
BACKGROUND: Self-help therapies are often effective in reducing mental health problems. We developed a new Web-based self-help intervention based on problem-solving therapy, which may be used for people with different types of comorbid problems: depression, anxiety, and work-related stress. OBJECTIVE: The aim was to study whether a Web-based self-help intervention is effective in reducing depression, anxiety, and work-related stress (burnout). METHODS: A total of 213 participants were recruited through mass media and randomized to the intervention (n = 107) or a waiting list control group (n = 106). The Web-based course took 4 weeks. Every week an automated email was sent to the participants to explain the contents and exercises for the coming week. In addition, participants were supported by trained psychology students who offered feedback by email on the completed exercises. The core element of the intervention is a procedure in which the participants learn to approach solvable problems in a structured way. At pre-test and post-test, we measured the following primary outcomes: depression (CES-D and MDI), anxiety (SCL-A and HADS), and work-related stress (MBI). Quality of life (EQ-5D) was measured as a secondary outcome. Intention-to-treat analyses were performed. RESULTS: Of the 213 participants, 177 (83.1%) completed the baseline and follow-up questionnaires; missing data were statistically imputed. Of all 107 participants in the intervention group, 9% (n = 10) dropped out before the course started and 55% (n = 59) completed the whole course. Among all participants, the intervention was effective in reducing symptoms of depression (CES-D: Cohen's d = 0.50, 95% confidence interval (CI) 0.22-0.79; MDI: d = 0.33, 95% CI 0.03-0.63) and anxiety (SCL-A: d = 0.42, 95% CI 0.14-0.70; HADS: d = 0.33, 95% CI 0.04-0.61) as well as in enhancing quality of life (d = 0.31, 95% CI 0.03-0.60). Moreover, a higher percentage of patients in the intervention group experienced a significant improvement in symptoms (CES-D: odds ratio [OR] = 3.5, 95% CI 1.9-6.7; MDI: OR = 3.7, 95% CI 1.4-10.0; SCL-A: OR = 2.1, 95% CI 1.0-4.6; HADS: OR = 3.1, 95% CI 1.6-6.0). Patients in the intervention group also recovered more often (MDI: OR = 2.2; SCL-A: OR = 2.0; HADS < 8), although these results were not statistically significant. The course was less effective for work-related stress, but participants in the intervention group recovered more often from burnout than those in the control group (OR = 4.0, 95% CI 1.2-13.5). CONCLUSIONS: We demonstrated statistically and clinically significant effects on symptoms of depression and anxiety. These effects were even more pronounced among participants with more severe baseline problems and for participants who fully completed the course. The effects on work-related stress and quality of life were less clear. To our knowledge, this is the first trial of a Web-based, problem-solving intervention for people with different types of (comorbid) emotional problems. The results are promising, especially for symptoms of depression and anxiety. Further research is needed to enhance the effectiveness for work-related stress. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN) 14881571.
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Computer-assisted programs have been evaluated in many countries in general, student, and corporate populations.
“They have been evaluated in many countries in general, student, and corporate populations [24-36].”
From Efficacy of Seren@ctif, a computer-based stress management program for patients with adjustment disorder with anxiety: Protocol for a controlled trial (2017) · cites this paper as [29]
Several studies categorized participants into adherent or not, or usage categories such as low, medium, and high, while others used continuous variables or a combination of these.
“Several studies categorized participants into adherent or not [49,54,57,75], or usage categories such as low, medium, and high [60], while others used continuous variables [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].”
From A Systematic Review of the Impact of Adherence on the Effectiveness of e-Therapies (2011) · cites this paper as [57]
The desired integration of multiple strategies, or practice elements, into BITs has led to the development of feature-rich applications designed mainly for use on a computer.
“The desired integration of multiple strategies, or practice elements, into BITs has led to the development of feature-rich applications (Titov et al., 2011, van Straten et al., 2008, Whitton et al., 2015) designed mainly for use on a computer.”
From Uptake and usage of IntelliCare: A publicly available suite of mental health and well-being apps (2016) · cites this paper as van Straten et al., 2008
The large reduction in depressive symptoms in the CAU group between baseline and posttreatment was unforeseen and sustained at the follow-up assessments.
“The large reduction in depressive symptoms in the CAU group between baseline and posttreatment was unforeseen and sustained at the follow-up assessments [34,67,68].”
From Long-Term Results of a Web-Based Guided Self-Help Intervention for Employees With Depressive Symptoms: Randomized Controlled Trial (2014) · cites this paper as [68]
When used correctly, Internet-delivered mental health (eMental Health) interventions produce treatment effects similar to those observed in face-to-face treatment.
“When used correctly, Internet-delivered mental health (eMental Health) interventions produce treatment effects similar to those observed in face-to-face treatment [1-4].”
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 [3]
Within-group improvement in depression in the intervention condition is comparable with other studies that examined the effects of Web-based PST in the general population.
“Within-group improvement in depression in the intervention condition is comparable with other studies that examined the effects of Web-based PST in the general population [38,62].”
From Short-Term Effects of a Web-Based Guided Self-Help Intervention for Employees With Depressive Symptoms: Randomized Controlled Trial (2014) · cites this paper as [62]
These studies did not show such large improvements on depression in the control group.
“However, these studies did not show such large improvements on depression in the control group.”
From Short-Term Effects of a Web-Based Guided Self-Help Intervention for Employees With Depressive Symptoms: Randomized Controlled Trial (2014) · cites this paper as [62]
These studies showed equal improvement scores on the CES-D, but baseline scores were higher compared to this study.
“Furthermore, these studies showed equal improvement scores on the CES-D, but baseline scores were higher compared to this study.”
From Short-Term Effects of a Web-Based Guided Self-Help Intervention for Employees With Depressive Symptoms: Randomized Controlled Trial (2014) · cites this paper as [62]
Completion of the intervention in this study was low compared with several other studies.
“Second, completion of the intervention in this study was low compared with several other studies [38,62,75,76].”
From Short-Term Effects of a Web-Based Guided Self-Help Intervention for Employees With Depressive Symptoms: Randomized Controlled Trial (2014) · cites this paper as [62]
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- Authors
- van Straten, A., Cuijpers, P., & Smits, N.
- Affiliations
- Vrije Universiteit Amsterdam (NL)
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2008-03-25
- Volume
- 10
- Issue
- 1
- Pages
- e7
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC2483843
- OpenAlex
- W1989138436
- Cited by
- 297
- References
- 34
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 8 · 2023: 8 · 2022: 8 · 2021: 7 · 2020: 7 · 2019: 11 · 2018: 14 · 2017: 20 · 2016: 27 · 2015: 25 · 2014: 29 · 2013: 28 · 2012: 25
- FWCI
- 29.76
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- TSpace (University of Toronto) (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Vrije Universiteit Amsterdam
- 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
- problem-solving therapy, depression, anxiety, occupational stress, burnout, quality of life, psychology students, digital mental health interventions, psychiatric comorbidity, intervention effectiveness, waiting list control group, participant satisfaction, treatment acceptability
- MeSH terms
- Adult, Anxiety, Burnout, Professional, Depression, Female, Humans, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Netherlands, Patient Education as Topic, Patient Participation, Professional-Patient Relations, Referral and Consultation, Self-Help Groups, Social Support, Therapy, Computer-Assisted, Program Evaluation, Comorbidity, Confidence Intervals, Odds Ratio, Internet
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