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Internet-Based Psychotherapy for Depression: Does it Work and What to Look For?

There are several internet-based psychological treatments available for treating depression. Most of the commercially available treatments are based on the principles of cognitive-behavioral therapy (Titov et al., 2014). Studies comparing internet-based therapy with face-to-face therapy demonstrate that internet-based treatments are as effective as face-to-face therapy (Andrews et al., 2010).
Similar to other evidence-based therapies for depression, internet-based cognitive-behavioral therapy is a structured program divided into modules with assigned reading, worksheets, self-assessments, and homework. This may not be suitable for individuals who prefer a less structured therapy. In addition, like traditional face-to-face therapy, internet-based approaches may take time to be effective. If you don’t see any effect within 3 to 4 weeks after starting an internet-based depression intervention, it may be time to discuss potential barriers to using the program or other treatment options with the therapist or clinician assigned to you through the program. Internet-based self-guided programs are not geared for crisis situations and shouldn’t be undertaken if one is at risk for harming self or others.

What to look for in an internet-based psychological treatment?


Internet-based psychological treatments come in various formats and some are freely accessible while others require a fee or an activation code. Some programs are self-guided while others are therapist-guided. Below are few questions that may help you evaluate these programs (Renton et al., 2014):

  • Is there a fee or physician referral required to access the program?

  • Has the program been evaluated for efficacy with at least one randomized controlled trial? Go to the research section of the program and look for the words “randomized” and “controlled” in the cited research as randomized controlled trials afford the highest level of evidence to support the effectiveness of an intervention.

  • What therapies/treatment approach(es) does the program offer? Research mostly supports cognitive-behavioral therapy approaches as being effective for depression with some evidence to support the efficacy of behavioral activation, interpersonal psychotherapy, and acceptance-based treatment (Carlbring et al., 2013; Titov et al., 2014).  

  • Who is the program designed for? The program should be designed for individuals with depression with or without anxiety.

  • Is the program interactive or only provides education about depression? Although education about depression may increase your knowledge about this condition, it is not a substitute for therapy-based interventions that interactive programs offer.

  • Does the program allow users to monitor their progress/modules completion and mood over time? A key ingredient for self-management of depression is monitoring your symptoms to gauge if the treatment is effective.

  • Does the program offer linking with a clinician or therapist (either your own clinician or a program-specific clinician)? What is the type of linkage (e.g., telephone, secure email, text message, etc.)? Research shows that clinician-guided programs have better outcomes and retention.

  • Does the program offer worksheets, either printable for offline use or integrated throughout the program? Are these worksheets mandatory or optional?

  • Does the program offer crisis or emergency contacts?

  • Does the program offer an assessment at the beginning?

  • Does the program offer additional features such as e-mail or text reminders?

  • Does the program offer peer-support (e.g., forum, personal story sharing, or blogs)?

  • Is the program available in the language of your choice?

  • How is the content delivered: size of text, audio or video inputs, use of character examples, and case scenarios?

  • What kind of personal or mental health information is required by the program and how is it kept confidential?

These questions will help you find a program that tailors to your needs in terms of accessibility, affordability, type of intervention being sought, and the extent of support desired. You may find answers to majority of these questions in the “Frequently Asked Questions” section on the program website. Besides affordability and accessibility, the other key factor in choosing the right program for yourself is that it needs to be evidence-based and documents the research supporting its beneficial effects. Don’t waste your time on programs that don’t cite any research to support their effectiveness.


To learn more about what internet-based programs are evidence-based and other evidence-based self-management techniques for depression, please refer to the book The Complete Guide to Self-Management of Depression: Practical and Proven Methods. This comprehensive and easy-to-read book offers the reader a menu of options to self-manage depression that go above and beyond the traditional approaches to treat depression and includes complementary and alternative medicine approaches, exercise, mindfulness, role of social support, and bright light therapy. Besides therapy techniques, the book also provides an evidence-based overview of the role medications in treating depression - when to take them, how long to take them, when and how to stop them, and what to do when medications stop working.


HARPREET S. DUGGAL, MD, FAPA

REFERENCES

Andrews, G., Cuijpers, P., Craske, M. G., McEvoy, P., & Titov, N. (2010). Computer therapy for anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS ONE, 5(10), e13196. doi:10.1371/journal.pone.0013196

Carlbring, P., Hägglund, M., Luthström, A., Dahlin, M., Kadowaki, A., Vernmark, K., & Andersson, G. (2013). Internet-based behavioral activation and acceptance-based treatment for depression: a randomized controlled trial. Journal of Affective Disorders, 148, 331-337.

Renton, T., Tang, H., Ennis, N., Cusimano, M. D., Bhalerao, S., Schweizer, T. A., & Topolovec-Vranic, J. (2014). Web-based intervention programs for depression: a scoping review and evaluation. Journal of Medical Internet Research, 16(9), e209. Doi:10.2196/jmir.3147.

Titov, N., Dear, B. F., & Andersson, G. (2014). Internet-delivered psychotherapy for anxiety disorders and depression. FOCUS, XII(3), 299-308.




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