Online Cognitive Behavioral Psychotherapy for Depression:

Pretrial assessment screening by telephone for in and exclusion criteria

A face to face appointment with one of the researchers to complete a computerized assessment: SCID and Beck Depression Inventory

Online CBT with a therapist online in real time

Patients were allocated to one therapist

Patients made their own appointments online

Sessions were secured by individual passwords

Patienst and therapists typed free text into the computer, with messages sent instantaneously; no other media or means of communication were used

So this is how you do online real time cognitive behavioral therapy. But does it work?

43 (38%) patients recovered from depression (BDI score <10) in the intervention group versus 23 (24%) in the control group at 4 months, and 46 (42%) versus 26 (26%) at 8 months

Why is this important?

The use of conventional CBT for depression is declining, the use of antidepressants is increasing, many patients referred for psychotherapy never show up, and 505 of those who attending a first visit drop out by the fourth session. Face to face psychotherapy demands a large amount of time, motivation and is an expensive treatment.

New techniques such as telephone and Internet based therapies are more convenient for patients, better accessible and with lower costs. The level of live therapist contact is the strongest influence on costs. The Internet psychotherapy program mentioned above seems to be a good balance between high and non therapist contact. Between face-to-face contact and self help programs. Drop out is low and the treatment efficacious.

By increasing access and lowering costs, new com munication technologies could provoke some much-needed disruptive innovation in psychotherapy

What do you think?

Therapist-delivered internet psychotherapy for depression in primary care: a randomised controlled trial by David Kessler, Glyn Lewis, Surinder Kaur, Nicola Wiles, Michael King, Scott Weich, Debbie J Sharp, Ricardo Araya, Sandra Hollinghurst, Tim J Peters; The Lancet Vol 374 August 22, 2009. http://www.thelancet.com/

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