Internet-Delivered Psychotherapy for Depression

Overseen By Lynn Tan, BSc

Age: 65+

Sex: Any

Trial Phase: Academic

Sponsor: University of Calgary

Disqualifiers: Suicidal ideation, Psychotic symptoms, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 10

Duration: 8 weeks

13 Participants Needed

Trial Summary

What is the purpose of this trial?

The goal of this mixed-methods, single-arm intervention study is to develop and evaluate a new internet-delivered psychotherapy option called Ger-iPST in older adults with symptoms of depression. The overall aim of this project is to improve access to psychotherapy for older adults by developing, adapting and implementing a new internet-based treatment option, Ger-iPST. Towards this aim, our objectives are to: 1. Examine the preliminary effectiveness of Ger-iPST for symptoms of depression. 2. Examine barriers and facilitators to the use of Ger-iPST. Participants will be asked to complete 8 weekly online therapy modules (Ger-iPST) through the Online Psycho Therapy Tool (OPTT); each module takes 45-60 minutes, and an extra 20-30 on weekly homework. Caregivers will be invited to assist participants if required. Homework exercises are submitted through the platform, and a clinician trained in PST l will provide personalized, asynchronous online feedback. Participants will receive a weekly phone call from a research assistant to support any technical issues with completing the online modules. Following completion of the Ger-iPST modules, participants will be interviewed to provide feedback on acceptability and barriers and facilitators to the use of Ger-iPST.

Do I need to stop my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications. It focuses on internet-delivered psychotherapy for depression, so it's best to consult with the trial coordinators or your doctor for guidance.

What data supports the effectiveness of the treatment Ger-iPST for depression?

Research shows that internet-delivered problem-solving therapy, like Ger-iPST, can significantly improve depressive symptoms over time. Studies have found that similar online therapies are highly usable, acceptable, and can create a strong therapeutic connection, leading to effective depression treatment. ^{1 2 3 4 5}

How is the Internet-Delivered Problem-Solving Therapy (Ger-iPST) for depression different from other treatments?

Ger-iPST is unique because it delivers therapy over the internet, allowing people to receive treatment from home without needing to visit a therapist in person. This approach can be more accessible and convenient, especially for those who have difficulty traveling or prefer online interactions. ^{1 2 4 6 7}

Research Team

Julia Kirkham, MD

Principal Investigator

University of Calgary

Eligibility Criteria

This trial is for people aged 65 or older who feel depressed, have a PHQ-9 score over 5, speak English, and can access the internet. It's not for those with immediate safety concerns like suicidal thoughts, psychotic symptoms, moderate cognitive issues (MoCA < 21), or those already in psychotherapy.

Inclusion Criteria

I am feeling depressed with a PHQ-9 score above 5.

I am 65 years old or older.

Have internet access

Exclusion Criteria

Individuals with moderate cognitive impairment (Montreal Cognitive Assessment (MoCA) < 21)

Individuals with acute safety concerns (e.g. suicidal ideation)

Individuals with psychotic symptoms

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

1 visit (in-person or videoconference)

Treatment

Participants complete 8 weekly online therapy modules (Ger-iPST) with online therapist support and weekly phone calls for technical assistance

8 weeks

8 visits (virtual)

Follow-up

Participants are interviewed to provide feedback on acceptability and barriers and facilitators to the use of Ger-iPST

1-2 weeks

1 visit (telephone or videoconference)

Treatment Details

Interventions

• Ger-iPST

Trial Overview The study tests Ger-iPST—an online therapy program designed to help older adults with depression. Participants will do weekly web-based modules and homework through OPTT and get feedback from clinicians plus support calls for technical help.

Participant Groups

Group I: Ger-iPST Experimental Treatment 1 Intervention

Prospective participants will be contacted by telephone to confirm eligibility, explain the study protocol, and obtain informed consent. An in-person or videoconference assessment will be used to administer baseline PHQ-9 to confirm enrolment criteria and will be asked questionnaire to gather demographic information. Participants will then be provided with an email link to access the Online Psycho Therapy Tool (OPTT). PHQ-9 will be collected again at the mid-point (4 weeks) and after completing the program through OPTT. Caregivers will be invited to assist the participant if required in completing Ger-iPST modules, and weekly telephone support calls by a research assistant will be provided to assist with any difficulty navigating technical aspects of the Ger-iPST platform.

Who Is Running the Clinical Trial?

University of Calgary

Lead Sponsor

Trials

827

Recruited

902,000+

Hotchkiss Brain Institute, University of Calgary

Collaborator

Trials

12

Recruited

2,400+

Findings from Research

A study involving 340 adults undergoing routine psychotherapy showed that adding an Internet intervention (Deprexis) significantly reduced depression symptoms and improved quality of life, with lasting effects observed at a 6-month follow-up.

The combined treatment approach led to greater therapeutic progress and higher rates of clinical improvement, regardless of the type of face-to-face therapy used, suggesting that blended treatment strategies can enhance outcomes for patients with mild to moderate depression.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Immediate and long-term effectiveness of adding an Internet intervention for depression to routine outpatient psychotherapy: Subgroup analysis of the EVIDENT trial. Schuster, R., Laireiter, AR., Berger, T., et al.[2022]

The ePST™ program, a stand-alone multimedia interactive treatment for depression, was well-received by participants, who found it highly usable, acceptable, and credible, with a therapeutic alliance comparable to live therapy.

Among the 29 participants, those who completed at least 4 sessions showed significant improvement in depressive symptoms over the 10-week study, suggesting that ePST™ may be an effective treatment option for depression.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility study of an interactive multimedia electronic problem solving treatment program for depression: a preliminary uncontrolled trial. Berman, MI., Buckey, JC., Hull, JG., et al.[2021]

An online, therapist-supported cognitive behavioral therapy (CBT) program for depression showed high engagement levels among 80 university students over an 8-week period, indicating that integrating therapist support can enhance user participation.

Participants experienced a significant reduction in depressive symptoms, with self-reported scores on the Beck Depression Inventory-II decreasing from an average of 25.47 to 15.53, demonstrating the program's efficacy with a large effect size (d=1.17).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A service-based evaluation of a therapist-supported online cognitive behavioral therapy program for depression. Sharry, J., Davidson, R., McLoughlin, O., et al.[2022]

In a pilot study involving 121 low-income homebound older adults, telehealth delivery of problem-solving therapy (tele-PST) was well-accepted, with participants showing positive attitudes towards it after 12 weeks, even overcoming initial skepticism.

Tele-PST was found to be as effective as in-person problem-solving therapy in reducing depression scores, with significant improvements maintained at 24 weeks, indicating its potential as a viable treatment option for this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Telehealth problem-solving therapy for depressed low-income homebound older adults. Choi, NG., Hegel, MT., Marti, N., et al.[2021]

Interpersonal psychotherapy (IPT) is effective for treating depression, but some patients may drop out or not respond adequately, highlighting the need to address treatment limitations.

To improve IPT outcomes, factors such as enhancing the therapeutic alliance, adapting treatment to individual patient characteristics, and potentially combining IPT with medication can be beneficial.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Failures in interpersonal psychotherapy (IPT): factors related to treatment resistances. Ravitz, P., McBride, C., Maunder, R.[2021]

Guided Internet-delivered psychotherapy (iPT) has been shown to be as effective as traditional face-to-face therapy for treating adults with depression, based on randomized controlled trials.

Low-intensity iPT interventions provide similar benefits to those with more therapist contact, while entirely self-guided programs offer some benefits but are less effective overall.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Internet-delivered psychotherapy for depression in adults. Titov, N.[2022]

A study involving 141 participants with major depressive disorder found that both clinician-assisted and technician-assisted internet-based cognitive behavioral therapy (iCBT) led to significant reductions in depression scores, demonstrating large effect sizes comparable to traditional face-to-face treatments.

At a 4-month follow-up, participants in the technician-assisted group showed further improvements and had significantly lower depression scores than those in the clinician-assisted group, suggesting that technician guidance can be as effective as clinician guidance in iCBT for depression.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Internet treatment for depression: a randomized controlled trial comparing clinician vs. technician assistance. Titov, N., Andrews, G., Davies, M., et al.[2022]

References

1. Netherlands pubmed.ncbi.nlm.nih.gov

Immediate and long-term effectiveness of adding an Internet intervention for depression to routine outpatient psychotherapy: Subgroup analysis of the EVIDENT trial. [2022]

2. England pubmed.ncbi.nlm.nih.gov

Feasibility study of an interactive multimedia electronic problem solving treatment program for depression: a preliminary uncontrolled trial. [2021]

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

A service-based evaluation of a therapist-supported online cognitive behavioral therapy program for depression. [2022]

4. England pubmed.ncbi.nlm.nih.gov

Telehealth problem-solving therapy for depressed low-income homebound older adults. [2021]

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

Failures in interpersonal psychotherapy (IPT): factors related to treatment resistances. [2021]

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

Internet-delivered psychotherapy for depression in adults. [2022]

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

Internet treatment for depression: a randomized controlled trial comparing clinician vs. technician assistance. [2022]