Internet-based versus face-to-face cognitive-behavioral intervention for depression: A randomized controlled non-inferiority trial

Background and aims: In the past decade, a large body of research has demonstrated that intemet-based interventions can have beneficial effects on depression. However, only a few clinical trials have compared internet-based depression therapy with an equivalent Face-to-lace treatment. The primary aim of this study was to compare treatment outcomes of an intemet-based intervention with a face-to-face intervention for depression in a randomized non-inferiority trial. Method: A total of 62 participants suffering from depression were randomly assigned to the therapist-supported intemet-based intervention group (n=32) and to the face-to-face intervention (n=30). The 8 week interventions were based on cognitive-behavioral therapy principles. Patients in both groups received the same treatment modules in the same chronological order and time-frame. Primary outcome measure was the Beck Depression inventory-II (BDI-II); secondary outcome variables were suicidal ideation, anxiety, hopelessness and automatic thoughts. Results: The intention-to-treat analysis yielded no significant between-group difference (online vs face-to-face group) for any of the pre- to post-treatment measurements. At post-treatment both treatment conditions revealed significant symptom changes compared to before the intervention. Within group effect sizes for depression in the online group (d=1.27) and the face-to-face group (d=1.37) can be considered large. At 3-month follow-up, results in the online group remained stable. In contrast to this, participants in the face-to-face group showed significantly worsened depressive symptoms three months after termination of treatment (t=-2.05, df = 19, p < .05). Limitations: Due to the small sample size, it will be important to evaluate these outcomes in adequately-powered trials. Conclusions: This study shows that an intemet-based intervention for depression is equally beneficial to regular face-to-face therapy. However, more long term efficacy, indicated by continued symptom reduction three months after treatment, could be only be found for the online group. (C) 2013 Elsevier B.V. All rights reserved.