Internet-based cognitive behavioural therapy: A novel approach to treating depression in primary care patients

Abstract

The overall aim of this thesis was to explore the effectiveness and acceptability of a Web-based self-help program (MoodGYM) combined with brief face-to-face therapist support for adult primary care patients with mild to moderate depression. Depression is a highly prevalent disorder causing substantial suffering and impairment. Many depressed patients will receive all their treatment in primary health care. Structured psychological interventions are infrequently delivered in general practice, despite the development of several effective psychological therapies for depression, patients’ preferences for such treatments, and guideline recommendations. Studies indicate that guided internet-based treatments for depression are effective. A randomised controlled trial compared the guided internet-based intervention comprising MoodGYM and therapist support with a waitlist control group. Participants (n = 106) were primary care patients with mild to moderate depressive symptoms. Results indicated that the intervention was effective in reducing symptoms of depression and anxiety and in increasing life satisfaction. Treatment gains were largely maintained at 6-month follow-up. Moderate levels of non-adherence and positive ratings of treatment satisfaction indicated that the intervention was acceptable to patients. The intervention was introduced to general practitioners (GPs) through a 3-day educational course. Following the course most GPs recommended MoodGYM to their patients. However, follow-ups were not successfully implemented due to time constraints, competing tasks and inadequate module knowledge and practical training. Taken together these results indicate that the intervention may be effective and acceptable to primary care patients with mild to moderate depressive symptoms. A short educational course for GPs may promote recommendation of the program, but other approaches are needed to implement the full intervention including follow-ups. More comprehensive educational approaches may reach a selected group of GPs. However, multifaceted interventions including patient education, clinician education and organisational changes are necessary to implement such interventions more widely.