Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Sep 4, 2019
Date Accepted: Apr 19, 2020
What’s Inside Unguided Web-Based Interventions for Depression? An Evaluation of the Digital Realization and Treatment Fidelity to Established Guidelines.
ABSTRACT
Background:
Web-based interventions (WBI) for depression have widely been tested for usability and functioning. However, there are few findings about their therapeutic quality that go beyond global evaluations or the mere reduction of symptoms. Clinicians and scientists are calling for standardized assessment criteria for WBI, to enable effective and trustworthy patient care. A profound evaluation of WBI based on therapeutic guidelines and manuals is needed.
Objective:
The objective of this study was to evaluate the quality of unguided WBI for depression based on to what extent they follow state-of-the-art treatment guide-lines and manuals.
Methods:
A comprehensive online search revealed 11 desktop programs and 17 smartphone applications that met inclusion criteria, which were: availability for German users, interactivity, no guidance, and targeted at depression. All programs and apps were tested by independent researchers following a standardized procedure with a predefined symptom trajectory. During the testing all WBI were rated with a standardized list of criteria. Testing criteria were based on treatment guidelines and manuals for depression.
Results:
Overall interrater reliability for all raters was substantial with an intraclass correlation coefficient of ICC = .73 and Gwet’s AC1 = .80. Main features of WBI in-cluded: Mood tracking (86%), psychoeducation (75%), cognitive restructuring (75%), crisis management (71%), behavioral activation (68%), and relaxation training (64%). Overall, therapeutic meaningfulness was rated higher for desktop programs (M = 4.13, SD = 1.17) than for smartphone applications (M = 2.92, SD = 1.46).
Conclusions:
While many exercises from manuals are included in WBI, the necessary therapeutic depth of the interventions was not reached and risk management is often lacking. There is a need of further research targeting general principles for the development and evaluation of therapeutically sound WBI for depression.
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