Brief Web-Based Intervention for Depression: Randomized Controlled Trial on Behavioral Activation

BACKGROUND: Web-based interventions have been shown to be effective for the treatment of depression. However, interventions are often complex and include a variety of elements, making it difficult to identify the most effective component(s). OBJECTIVE: The aim of this pilot study was to shed light on mechanisms in the online treatment of depression by comparing a single-module, fully automated intervention for depression (internet-based behavioral activation [iBA]) to a nonoverlapping active control intervention and a nonactive control group. METHODS: We assessed 104 people with at least mild depressive symptoms (Patient Health Questionnaire-9, >4) via the internet at baseline (t(0)) and 2 weeks (t(1)) and 4 weeks (t(2)) later. After the t(0) assessment, participants were randomly allocated to one of three groups: (1) iBA (n=37), (2) active control using a brief internet-based mindfulness intervention (iMBI, n=32), or (3) care as usual (CAU, n=35). The primary outcome was improvement in depressive symptoms, as measured using the Patient Health Questionnaire-9. Secondary parameters included changes in activity, dysfunctional attitudes, and quality of life RESULTS: While groups did not differ regarding the change in depression from t(0) to t(1) (η(p)(2)=.007, P=.746) or t(0) to t(2) (η(p)(2)=.008, P=.735), iBA was associated with a larger decrease in dysfunctional attitudes from t(0) to t(2) in comparison to CAU (η(p)(2)=.053, P=.04) and a larger increase in activity from t(0) to t(1) than the pooled control groups (η(p)(2)=.060, P=.02). A change in depression from t(0) to t(2) was mediated by a change in activity from t(0) to t(1). At t(1), 22% (6/27) of the participants in the iBA group and 12% (3/25) of the participants in the iMBI group indicated that they did not use the intervention. CONCLUSIONS: Although we did not find support for the short-term efficacy of the single-module iBA regarding depression, long-term effects are still conceivable, potentially initiated by changes in secondary outcomes. Future studies should use a longer intervention and follow-up interval. TRIAL REGISTRATION: DKRS (#DRKS00011562)