JMIR Publications

ABSTRACT

Background:

Despite their prevalence, access to effective treatment remains limited due to financial, geographic, and social barriers. Online self-help groups offer a promising and scalable form of peer-based support beyond traditional clinical settings. Integrating Cognitive Behavioral Therapy (CBT) techniques such as cognitive restructuring and behavioral activation into self-help groups may enhance their effectiveness.

Objective:

This study evaluated the efficacy of a CBT-based Online Self-help group (COS), which integrates structured CBT techniques with peer-led group support, as a low-intensity intervention for individuals with depressive symptoms. A randomized controlled trial and a separately recruited waitlist control group were used to examine the efficacy of the COS.

Methods:

Participants were recruited online. After eligibility screening via a structured clinical interview, participants were randomly assigned to a COS group (n = 79) or an CBT-based mobile application group (n = 39). An additional waitlist control group (n = 48) was recruited separately during the second phase of the study. The COS intervention involved seven videoconferencing sessions that incorporated peer-led group discussions, sharing lived experiences, and core CBT techniques such as cognitive restructuring. The primary outcome measure was depressive symptoms, assessed using the Beck Depression Inventory-II, and the secondary outcome was suicidal ideation, estimated using the Beck Scale for Suicide Ideation, measured at baseline, post-intervention, and 3-month follow-up. Linear mixed models were used to evaluate group × time interaction effects. Reliable change indices were also calculated to assess clinical significance.

Results:

Among participants assigned to the COS group, 56.5% completed all seven sessions, and 81.2% attended five or more sessions. A significant Time × Group interaction was observed for depressive symptoms (F4, 288.47 = 7.23, P < .001). The COS group exhibited a substantial reduction in depressive symptoms from baseline to post-intervention (t285.76 = 10.77, P < .001), with a large within-group effect size (d = 1.38); this improvement was maintained at the 3-month follow-up. Suicidal ideation also significantly decreased in the COS group (t277.11 = 4.55, P < .001), with sustained effects at follow-up. Clinically meaningful improvement in depressive symptoms, as defined by the Reliable Change Index, was observed in 74.7% of COS participants. While both the COS and app-based CBT groups achieved comparable reductions in depressive symptoms, only the COS group demonstrated a significant reduction in suicidal ideation.

Conclusions:

Our RCT findings provide novel evidence for the efficacy of a structured, CBT-informed online self-help group intervention in reducing depressive symptoms and suicidal ideation. The COS program offers a scalable, accessible alternative to traditional therapy, particularly in settings with limited access to mental health professionals. Clinical Trial: Clinical Research Information Service (CRIS) KCT0007673 (One of the primary registries of the WHO International Clinical Trials Registry Platform).