JMIR Publications

ABSTRACT

Background:

Web-based interventions have shown to be effective in the treatment of depression. However, interventions are often complex including various elements and rendering firm conclusions about the “active ingredient” unlikely.

Objective:

The aim of the present pilot study was to shed light on mechanisms in the online treatment of depression by comparing a single-module, fully automated, distinct intervention for depression (internet-based behavioral activation, iBA) to a non-overlapping active, fully automated control intervention and a non-active control group.

Methods:

We assessed 104 people with at least mild depressive symptoms (PHQ-9 > 4) via the internet at baseline (t0), two weeks (t1), and four weeks (t2) later. After assessment at t0, participants were randomly allocated to one of three groups: 1) iBA (n=37), 2) brief internet-based mindfulness (iM, active control, n=32), or 3) care as usual (CAU, n=35). The primary outcome was the improvement of depressive systems (PHQ-9). Secondary parameters included change in activity (Behavioral Activation for Depression Scale, BADS), mindfulness (Kentucky Inventory of Mindfulness Skills, KIMS-D), dysfunctional attitudes (Dysfunctional Attitude Scale, DAS), and quality of life (The World Health Organization Quality of Life, WHOQOL).

Results:

While groups neither differ regarding change in depression from t0 to t1 (ηp2 =.007, P=.746,) nor from t0 to t2 (ηp2=.008, P=.735), iBA was associated with a larger decrease in dysfunctional attitudes (DAS) from t0 to t2 (ηp2=.053, P=.04) and a larger increase in activity (BADS) from t0 to t1(ηp2=.060, P=.02) in comparison to the pooled control groups. Change in depression from t0 to t2 was mediated by change in activity (BADS) from t0 to t1. At t1 assessment, 22% participants in the iBA group (n=6) and 12% participants in the iM group (n=3) indicated that they did not use the intervention.

Conclusions:

While we did not find support for the short-term efficacy of one-module iBA regarding depression, long-term effects are still conceivable (potentially initiated by change in secondary outcomes). Future studies should use a longer intervention and follow-up interval. Clinical Trial: DKRS (#DRKS00011562)