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Blending Internet-based and tele group treatment: Acceptability, effects, and mechanisms of change of cognitive behavioral treatment for depression - PubMed

Raphael Schuster  1 ,

Blending Internet-based and tele group treatment: Acceptability, effects, and mechanisms of change of cognitive behavioral treatment for depression

Raphael Schuster et al. Internet Interv. .

Abstract

The current COV-19 pandemic increases the need for remote treatment. Among several provision strategies, tele groups have been tested as an efficient option. Still, the number of studies is comparably low, with a clear lack of studies investigating supposed treatment mechanisms. Sixty-one mildly to moderately depressed participants from Salzburg, Bavaria, and Upper Austria were randomized to the intervention or a waiting list control group (RCT). The seven-week treatment comprised preparatory online modules, followed by personalized feedback and a subsequent tele group session. Large treatment effects were observed for depression (CES-D: d = 0.99, p < .001; PHQ-9: d = 0.87, p = .002), together with large effects for cognitive behavioral skills (cognitive style, and behavioral activation, d = 0.88-0.97). Changes in skills mediated treatment outcomes for CES-D and PHQ-9, suggesting comparable mechanisms as in face-to-face therapy. Two typical moderators, therapeutic alliance, and group cohesion, however, failed to predict outcome (p = .289), or only exhibited statistical tendencies (p = .049 to .071). Client satisfaction, system usability, and treatment adherence were high. Blending Internet-based and tele group interventions offers additional options for low-threshold care that is less dependent on population density, commuting distances, or constraints due to the current COV-19 crisis. Results indicate that the blended intervention is clinically effective by fostering core CBT skills. While findings suggest the notion that working alliance and group cohesion can be established online, their relevancy for outcomes of blended treatment needs to be further investigated.

Keywords: Blended treatment; Covid-19; Depression; Internet-based treatment; Tele therapy; Therapeutic process; Working alliance.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1

Study's flow chart.

Fig. 2

Putative mediators of treatment effect. Note. Outcomes for PHQ-9 are provided in Appendix 1. CSQ = Cognitive Style Questionnaire (CSQ-VSF-D); BADS = Behavioral Activation for Depression Scale; CES-D = Center for Epidemiological Studies-Depression scale. Note. Outcomes for PHQ-9 are provided in Appendix 1. CSQ = Cognitive Style Questionnaire (CSQ-VSF-D); BADS = Behavioral Activation for Depression Scale; CES-D = Center for Epidemiological Studies-Depression scale.

References

    1. Aguilera A., Bruehlman-Senecal E., Demasi O., Avila P. Automated text messaging as an adjunct to cognitive behavioral therapy for depression: a clinical trial. J. Med. Internet Res. 2017;19(5) doi: 10.2196/jmir.6914. - DOI - PMC - PubMed
    1. Andersson G. Internet interventions: past, present and future. Internet Interv. 2018;12(2):181–188. doi: 10.1016/j.invent.2018.03.008. - DOI - PMC - PubMed
    1. Apolinário-Hagen J., Vehreschild V., Alkoudmani R.M. Current views and perspectives on e-mental health: an exploratory survey study for understanding public attitudes toward internet-based psychotherapy in Germany. JMIR Ment.Health. 2017;4 doi: 10.2196/mental.6375. - DOI - PMC - PubMed
    1. Banbury A., Nancarrow S., Dart J., Gray L., Parkinson L. Telehealth interventions delivering home-based support group videoconferencing: systematic review. J. Med. Internet Res. 2018;20(2) doi: 10.2196/jmir.8090. - DOI - PMC - PubMed
    1. Bangor A., Kortum P., Miller J. Determining what individual SUS scores mean: adding an adjective rating scale. J. Usability Stud. 2009;4(3):114–123.

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