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Unguided e-therapy for adults with depressive symptoms: IPT vs. CBT

Unguided e-therapy for adults with depressive symptoms: IPT vs. CBT. Tara Donker a , Kathleen M. Griffiths b , Helen Christensen b , Kylie Bennett b , Anthony Bennett b , Annemieke van Straten a , Pim Cuijpers a a VU University, Amsterdam b Australian National University, Canberra .

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Unguided e-therapy for adults with depressive symptoms: IPT vs. CBT

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  1. Unguided e-therapy for adults with depressive symptoms: IPT vs. CBT Tara Donkera, Kathleen M. Griffithsb, Helen Christensenb, Kylie Bennettb , Anthony Bennettb, Annemieke van Stratena , Pim Cuijpersa a VU University, Amsterdam b Australian National University, Canberra

  2. Introduction Life time prevalence: 19% (Bijl et al., 1998)

  3. Introduction Top four leading causes of burden of disease worldwide (Lopez & Murray, 1998)

  4. Introduction Costs per capita for mood disorders: € 5,009 (Smit et al., 2006)

  5. Low-intensity treatment for depression and anxiety Marijke • 36 years • Single • Twochildren • Town • Part-timeworking • Mild depression

  6. Obstacles Long waitlists

  7. Obstacles 2 hrs of travelling to the clinic

  8. Obstacles Take leave from work

  9. Obstacles Arrange a babysit

  10. Obstacles Costs of babysit

  11. Obstacles +.. Costs of travelling, babysit..

  12. Low-intensity treatment for depression and anxiety Psychological self-help: |Standardized Independent Homework/tasks Via book, audio, internet.. Guidance by email, chat, telephone

  13. Advantages No wait lists

  14. Advantages Working from home

  15. Advantages 24/7

  16. Advantages Cost-effective

  17. Advantages Anonymous

  18. Low-intensity treatment for depression and anxiety Intensive face-to face treatment Low-intensity treatment Obstacles • Wait lists • Costs of therapy etc. • Time of travelling • Leave/babysit Advantages • Directly accessable • Cost-effective • Working from home • 24/7

  19. Introduction

  20. Introduction

  21. Introduction

  22. Introduction

  23. Introduction E-CBT = effective (e.g. Carlbring et al., 2009; Christensen et al., 2004;Kaldo et al., 2008; Ruwaard et al., 2009; Spek et al., 2008; Warmerdam et al., 2008)

  24. Introduction

  25. Introduction

  26. Introduction Depression: IPT = CBT (Cuijpers et al., 2011) Effect size: 0.04 (95% CI 0.14-0.21)

  27. Introduction = ?

  28. Design Internet-assisted Cognitive Behavior Therapy (CBT) & Interpersonal Psychotherapy (IPT):

  29. Design Internet-assisted Cognitive Behavior Therapy (CBT) & Interpersonal Psychotherapy (IPT): Compared to Internet-assisted CBT MoodGYM (control group)

  30. Design • Non-inferiority trial • H0: (IPT ≠ CBT) ≠ MoodGYM • H1: (IPT= CBT) = MoodGYM

  31. Design MoodGYM • Within effect size: 0.56 (95% CI: 0.33-0.79) (MacKinnon et al., 2008) • Determined sample size: N=450 on post-test

  32. Design MoodGYM • Between effect size: 0.33 (95% CI: 0.11-0.55) • Within effect size: 0.56 (95% CI: 0.33-0.79) (MacKinnon et al., 2008) • Determined sample size: N=450 on post-test

  33. Design • Non-inferiority trial • 3 e-conditions (IPT, New CBT, CBT MoodGYM) • Fully automated trial, 4 weeks • Online recruitment and screening

  34. Design • Inclusion: 18 years or older • Exclusion: currently under treatment by mental health specialist • 3 measurements (baseline, after 4 weeks and after 6-months) • Primary outcome: depressive symptoms

  35. Interpersonal Psychotherapy • Developed by Klerman and Weissman (1984) • Relationship between depression and experiences • IPT aims at improvement of interpersonal functioning and (inherent) depression

  36. Internet-assisted IPT - overview

  37. Internet-assisted IPT -week 1Role disputes • Identification of the dispute (with whom?) • Modification of communication patterns

  38. Internet-assisted IPT -week 2Problems making relationships • Realistic evaluation of can do`s/ can`t do`s • Increase social contacts

  39. Internet-assisted IPT -week 2 Problems making relationships

  40. Internet-assisted IPT – week 2

  41. Internet-assisted IPT - week 3 Role Changes • Investigate which old role is given up • Validate the loss • Support letting go of old role

  42. Internet-assisted IPT - week 3 Role Changes • Develop new skills for the new role • Develop new relationships and social support

  43. Internet-assisted IPT – week 3

  44. Internet-assisted IPT - week 4 Grief • Activate grief proces • Psychoeducation • Learn to express emotions • Finding new meaningful activities and social contacts replacing those which were lost

  45. Internet-assisted IPT – week 4

  46. Results: Participant flow N=1993 met inclusion criteria n=69 did not fill in baseline Q N=1924 included MoodGYM n=642 IPT n=641 CBT n=641

  47. Results: demographics • Gender: 71% female • Age category: 25-29 years (15.1%) • Country: 1: Australia (38%) • 2: United Kingdom (25%) • 3: United States (19%) • Education: higher degree (26%) • Previous treatment by professional: 80% • Been depressed before: 90%

  48. Results: depressive symptoms Mean CES-D at baseline (n.s.): • Moodgym: 35 (sd: 11.7) n=622 • IPT: 36 (sd: 11.9) n=623 • CBT: 36 (sd: 11.) n=615

  49. Results: depressive symptomscompleters only

  50. Results: depressive symptomscompleters only Pre-post test: • No significant differences across the condition (F=2.018; P=.13) • Effect sizes: MoodGYM: 0.81 CBT: 0.87 IPT: 0.77

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