None listed
Conditions
Brief summary
Background: Psychological treatments via the internet have proven effective in reducing depressive symptom complaints. A first evlaluation of the provided treatment programm yielded large pre-post-effects on depression, anxiety, perseverative thinking, and well-being. However, little is known about the influence of temporal ordering of provided treatment modules on symptom improvements, patterns of change, treatment adherence and if different groups of individuals are affected differently. Therefore, systematic evaluations of temporal ordering effects are necessary to gain deeper insight into which treatment components are the most critical ingredients for successful online interventions for depression. Intervention: Depressed participants are allocated at random to a two-armed cognitive-behavioral online-intervention with regular weekly contact to a psychologist (guided intervention). The two treatment arms differ in the ordering of provided treatment modules [Arm 1: Expressive Writing – behavioral activation – cognitive restructuring – expressive writing; Arm 2: Expressive Writing – cognitive restructuring – behavioral activation – expressive writing]. Both treatment arms receive the same psychoeducational information about their symptoms and treatment modules to reduce depressive complaints (e.g. positive activation, cognitive restructuring, emotional insight). Engaging tools on the website help participants with the completion of these tasks. Method: Both groups are compared with regard to therapeutic outcomes (e.g. depressive symptoms), the influence of the ordering of provided treatment modules on symptom change and adherence, as well as predictors of treatment-success.
Interventions
Guided online-intervention.
Duration and general information:
The intervention lasts 6 weeks. Participants need to invest approximately 90 minutes per week/module. The modules are completed over multiple (two to seven) shorter sessions per week, depending on the task at hand and on participant's preferences. Every week a different topic relevant to depression is presented and the participants are instructed to perform cognitive-behavioral tasks in order to reduce their symptom severity. All t
Guided online-intervention. Duration and general information: The intervention lasts 6 weeks. Participants need to invest approximately 90 minutes per week/module. The modules are completed over multiple (two to seven) shorter sessions per week, depending on the task at hand and on participant's preferences. Every week a different topic relevant to depression is presented and the participants are instructed to perform cognitive-behavioral tasks in order to reduce their symptom severity. All treatment content (psychoeducational content as well as specific treatment tools) is delivered online. Participants gain individualized password-protected access to an online-platform. Participants receive weekly written feedback via e(lectronic)-mail from a trained psychologist (personally assigned; psychologist with at least finished itermediate examination of their psycho-therapeutic training). Psychologists comment on participants' letters/activities/tool usage and to provide further instructions as well as emotional support. Psychologists are provided with standardized text blocks, which are completed by individualized feedback lines. Participants are able to contact a psychologist at any time if they need to via e-mail on the website (additional contact on demand). They receive an answer within two working days. Adherence: Login of participants is monitored. Inactive participants will automatically receive login-reminders via e-mail after 3, 7, 14 and 20 days of inactivity to increase adherence. Participants are guided by a team of psychologist trained in the use of online-interventions. The treatment-specific training of psychologists takes 3 days (8 hours each) and gives theoretical background regarding online-interventions for depression and concrete instructions on how to use the platform and to interact with participants. Additional information on how to react in critical situations (e.g. suicidal participants online) is provided. An intervention manual is provided to ensure the psychologists adherence to the treatment. Meetings for supervision-purposes are scheduled monthly. Both an researching psychologist on the area of online interventions and a licensed psychotherapist provide the training as well as the supervision. Contents, aims and methods of the intervention in detail: The RCT contains two treatment arms (Arm 1: BAF - Behavioral Activation First; Arm 2: Cognitive Restructuring First - CRF) . Both arms contain the same treatment modules, e.g. the same psychoeducational content as well as the same treatment techniques. Both treatment arms differ in the ordering of behavioral activation and cognitive restructuring techniques (see control condition). Arm 1: BAF – ordering of provided treatment modules: Insight in depressive symptoms (Week 1) Topic: Symptoms of depression Aim: Insight into own symptoms. Method: Expressive writing Behavioral activation I (Week 2) Topic: Positive activation Aim: Insight into own behavior related to depressive symptoms, increasing own level of activity. Method: Calendar of daily activities, diary of positive daily events Behavioral activation II (Week 3) Topic: Lack of motivation, difficulties to perform positive activities. Aim: Coping with difficulties, increasing own level of activity. Method: Written coping plans in the calendar of daily activities Cognitive Restructuring I (Week 4) Topic: Thought processes that worsen depressive symptoms. Aim: Insight into own thoughts related to depression; cognitive restructuring. Method: Cognitive bias modification training Cognitive Restructuring II (Week 5) Topic: Distorted perceptions that worsen depressive symptoms. Aim: Insight into own perceptions related to depression; cognitive restructuring Method: Cognitive bias modification training and thought protocols Relapse prevention (week 6) Topic: "Alarm signals" that indicate relapse Aim: Developing strategies to prevent relapse, summing up own participation in program. Method: Expressive writing
Sponsors
Freie Universitaet Berlin
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
German-speaking adults suffering from depression with access to the internet
Exclusion criteria
Schizophrenia, schizotypal and delusional disorders (F20-F29) Sucidal participants Severely depressed participants Patients in concurrent psychotherapeutic treatment
Outcome results
None listed