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


ABSTRACT:

Background

Internet-based cognitive behavioural therapy (iCBT) for depression is effective when guided by a clinician, less so if unguided.

Question

Would guidance from a technician be as effective as guidance from a clinician?

Method

Randomized controlled non-inferiority trial comparing three groups: Clinician-assisted vs. technician-assisted vs. delayed treatment. Community-based volunteers applied to the VirtualClinic (www.virtualclinic.org.au) research program, and 141 participants with major depressive disorder were randomized. Participants in the clinician- and technician-assisted groups received access to an iCBT program for depression comprising 6 online lessons, weekly homework assignments, and weekly supportive contact over a treatment period of 8 weeks. Participants in the clinician-assisted group also received access to a moderated online discussion forum. The main outcome measures were the Beck Depression Inventory (BDI-II) and the Patient Health QUESTIONnaire-9 Item (PHQ-9). Completion rates were high, and at post-treatment, both treatment groups reduced scores on the BDI-II (p<0.001) and PHQ-9 (p<0.001) compared to the delayed treatment group but did not differ from each other. Within group effect sizes on the BDI-II were 1.27 and 1.20 for the clinician- and technician-assisted groups respectively, and on the PHQ-9, were 1.54 and 1.60 respectively. At 4-month follow-up participants in the technician group had made further improvements and had significantly lower scores on the PHQ-9 than those in the clinician group. A total of approximately 60 minutes of clinician or technician time was required per participant during the 8-week treatment program.

Conclusions

Both clinician- and technician-assisted treatment resulted in large effect sizes and clinically significant improvements comparable to those associated with face-to-face treatment, while a delayed treatment control group did not improve. These results provide support for large scale trials to determine the clinical effectiveness and acceptability of technician-assisted iCBT programs for depression. This form of treatment has potential to increase the capacity of existing mental health services.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12609000559213.

SUBMITTER: Titov N 

PROVIDER: S-EPMC2882336 | biostudies-literature | 2010 Jun

REPOSITORIES: biostudies-literature

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Publications

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

Titov Nickolai N   Andrews Gavin G   Davies Matthew M   McIntyre Karen K   Robinson Emma E   Solley Karen K  

PloS one 20100608 6


<h4>Background</h4>Internet-based cognitive behavioural therapy (iCBT) for depression is effective when guided by a clinician, less so if unguided.<h4>Question</h4>Would guidance from a technician be as effective as guidance from a clinician?<h4>Method</h4>Randomized controlled non-inferiority trial comparing three groups: Clinician-assisted vs. technician-assisted vs. delayed treatment. Community-based volunteers applied to the VirtualClinic (www.virtualclinic.org.au) research program, and 141  ...[more]

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