Internet-Based Psychological Support for Depression

Overseen By Jay C Buckey, M.D

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: Dartmouth-Hitchcock Medical Center

No Placebo Group

Trial Summary

What is the purpose of this trial?

The investigators have developed interactive, multimedia-intensive, computer-based treatment programs that include depression (Problem-Solving Therapy), stress management, and conflict management. Together the three modules are called PATH. The problem-solving module is based on an evidence-based psychotherapy called Problem-Solving Therapy in which depressed patients identify problems in their lives and work through a structured format for solving these problems. We have subjected the problem-solving module to Phase 1-3 feasibility, acceptability and efficacy trials which have been positive and without adverse events. The conflict program uses a cognitive-behavioral-therapy-based approach. The program includes a conflict briefing, an interactive conflict simulation, a conflict assessment tool, an interactive training exercise in interest-based negotiation, and a cognitive restructuring exercise. The stress program also uses a cognitive behavioral therapy (CBT) approach. In the program, the mentor introduces the "stress pyramid", which demonstrates how stress triggers can lead to different feelings, actions and thoughts, which are analogs to the CBT realms of dysfunctional emotions, maladaptive behaviors, and faulty cognitive processes. The stress management content is delivered over 6 sessions, with each session including exercises in the 3 domains of thoughts, feelings, and actions. The program includes briefings, cognitive restructuring exercises, interactive scenarios, and self-assessments. This program has been evaluated with law and business students and was shown effective in reducing stress levels. The purpose of the current study is to make the problem-solving, stress, and the conflict modules available through the internet for any adult 18 or older in order to assess their feasibility, acceptability and effectiveness under naturalistic conditions.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It seems focused on psychological support, so you may not need to change your medication routine, but it's best to confirm with the trial organizers.

What data supports the effectiveness of the treatment Internet-based psychological support for depression?

Research shows that Internet-based treatments, especially those using cognitive behavioral therapy (CBT), are effective in reducing depression symptoms. These treatments can be as effective as in-person therapy, particularly when guided by a therapist. ^{1 2 3 4 5}

Is Internet-based psychological support safe for humans?

Internet-based psychological support, like problem-solving therapy, is generally considered safe for humans. Studies suggest that it can be effective for depression and anxiety, especially when combined with regular human support, and no specific safety concerns have been highlighted in the research. ^{1 4 6 7 8}

How is Internet-Based Psychological Support for Depression different from other treatments?

Internet-Based Psychological Support for Depression is unique because it offers a short, online intervention based on problem-solving therapy (PST), which can be a valuable alternative to traditional cognitive behavioral therapy (CBT). This approach is particularly beneficial for those who face barriers to accessing in-person therapy, providing a more accessible and flexible option for managing depression. ^{1 2 3 4 9}

Research Team

Jay Buckey, MD

Principal Investigator

Dartmouth-Hitchcock Medical Center

Eligibility Criteria

This trial is for adults aged 18 or older who are experiencing depression, stress, or need help with conflict resolution. It's specifically designed for employees and faculty attending the EAP programs of DHMC and Dartmouth College.

Inclusion Criteria

I am an adult working or teaching at DHMC or Dartmouth College and feel depressed.

I am 18 years old or older.

Exclusion Criteria

N/A

Trial Timeline

Enrollment

Participants are referred to the PATH program and sign up online, providing electronic consent.

Ongoing

Treatment

Participants engage with the PATH program modules, including problem-solving, stress management, and conflict management.

5 years

Online sessions

Data Collection

Automatic collection of usage data, PHQ-9 scores, PSS scores, and acceptability questionnaires during program use.

5 years

Follow-up

Participants' progress and effectiveness of the program are monitored through self-reported measures over time.

5 years

Treatment Details

Interventions

• Internet-based psychological support (Behavioral Intervention)

Trial Overview The trial tests an internet-based support program called PATH, which includes modules on problem-solving therapy for depression, stress management using CBT techniques, and conflict management through interactive simulations and exercises.

Participant Groups

Group I: Internet Based psychological support Experimental Treatment 1 Intervention

The internet-based psychological support intervention (PATH) is an internet based Problem Solving Therapy, stress management training and conflict management training program.

Who Is Running the Clinical Trial?

Dartmouth-Hitchcock Medical Center

Lead Sponsor

Trials

548

Recruited

2,545,000+

Findings from Research

Internet interventions based on cognitive behavioral therapy have been shown to effectively reduce symptoms of depression, with medium-to-large effect sizes (d=0.58-0.78) when guided by a therapist, and small-to-medium effect sizes (d=0.25-0.36) for self-help formats compared to usual care.

These interventions could help address the treatment gap for individuals with depression, as many do not receive adequate care, suggesting a promising avenue for integrating these tools into mental health care systems.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Internet interventions for depression: new developments. Schröder, J., Berger, T., Westermann, S., et al.[2022]

A pilot study involving 196 primary care patients found that 20% enrolled in an Internet-delivered cognitive behavioral therapy (CBT) program, indicating that integrating such programs into healthcare systems is feasible.

Participants who completed the program experienced a significant average reduction of 46% in depressive symptoms after four months, along with a decrease in suicidal thoughts, suggesting that Internet-delivered CBT can be an effective treatment for depression.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Online cognitive behavioral therapy for depressed primary care patients: a pilot feasibility project. Whiteside, U., Richards, J., Steinfeld, B., et al.[2021]

In a study involving 263 participants, both Internet-based cognitive behavioral therapy (CBT) and problem-solving therapy (PST) were effective in reducing depressive symptoms, with CBT showing a higher effect size at 12 weeks (0.69) compared to PST (0.65).

PST provided quicker results, with significant symptom reduction observed after just 5 weeks (effect size 0.47), making it a viable alternative to CBT for those seeking faster relief from depression.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Internet-based treatment for adults with depressive symptoms: randomized controlled trial. Warmerdam, L., van Straten, A., Twisk, J., et al.[2022]

Internet-based therapies for depression have been shown to be effective, with numerous randomized controlled trials confirming their efficacy and no significant differences in outcomes compared to traditional face-to-face treatments.

The future of mental health care may benefit from integrating these Internet-based interventions, especially with advancements in technology like smartphones and virtual reality, which could enhance treatment accessibility and effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Internet and mobile interventions for depression: Opportunities and challenges. Cuijpers, P., Kleiboer, A., Karyotaki, E., et al.[2018]

A study involving 525 participants found that both a cognitive-behavioral therapy (CBT) internet intervention and a depression information website led to significant reductions in depression scores compared to a placebo control, with benefits lasting up to 12 months.

While the CBT intervention maintained its effectiveness at the 6-month follow-up, the depression information website's benefits were not significant at that time, suggesting that the CBT may provide more sustained support for depression management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparative randomised trial of online cognitive-behavioural therapy and an information website for depression: 12-month outcomes. Mackinnon, A., Griffiths, KM., Christensen, H.[2022]

Internet-based cognitive-behavioral therapy (CBT) is an effective self-help program that allows patients to receive psychological support via the Internet, making therapy more accessible, especially for those unable to attend traditional sessions.

This form of therapy has shown particular effectiveness in treating conditions like panic disorder, social phobia, and depression, indicating its potential to reach and help a wider range of individuals in need of mental health support.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Internet-based cognitive-behavioral therapy in the treatment of psychiatric disorders]. Holmberg, N., Kähkönen, S.[2022]

A study involving 286 participants showed that four different therapist-supported internet treatments for depression significantly reduced depressive symptoms over a 12-week period, with a notable effect size (Hedges g = 1.01) compared to a control group.

The findings emphasize the importance of including psychoeducation in treatment, as it positively influences treatment outcomes and participant retention, suggesting that educational components should be integrated into future internet-based depression therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Behavioral activation versus physical activity via the internet: A randomized controlled trial. Nyström, MBT., Stenling, A., Sjöström, E., et al.[2018]

References

1. England pubmed.ncbi.nlm.nih.gov

Internet interventions for depression: new developments. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Online cognitive behavioral therapy for depressed primary care patients: a pilot feasibility project. [2021]

3. Canada pubmed.ncbi.nlm.nih.gov

Internet-based treatment for adults with depressive symptoms: randomized controlled trial. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Internet and mobile interventions for depression: Opportunities and challenges. [2018]

5. England pubmed.ncbi.nlm.nih.gov

Comparative randomised trial of online cognitive-behavioural therapy and an information website for depression: 12-month outcomes. [2022]

6. England pubmed.ncbi.nlm.nih.gov

A randomized controlled trial on the role of support in Internet-based problem solving therapy for depression and anxiety. [2022]

7. England pubmed.ncbi.nlm.nih.gov

Predicting outcome of Internet-based treatment for depressive symptoms. [2022]

8. Finland pubmed.ncbi.nlm.nih.gov

[Internet-based cognitive-behavioral therapy in the treatment of psychiatric disorders]. [2022]

9. Netherlands pubmed.ncbi.nlm.nih.gov

Behavioral activation versus physical activity via the internet: A randomized controlled trial. [2018]