Online cognitive behavioral therapy and problem-solving therapy for depressive symptoms: Exploring mechanisms of change

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Abstract

The purpose of this study was to evaluate treatment specificity and potential mediators of two online therapies for depressive symptoms. We conducted a randomized controlled trial in which 263 participants were randomized to online cognitive behavioral therapy (CBT), online problem-solving therapy (PST) or a waiting list control group. Both treatments were more effective than the control group in reducing dysfunctional attitudes, worry, negative problem orientation and enhancing feelings of control. No differences between the treatments were found on each of the potential mediators. Furthermore, results suggest that dysfunctional attitudes, worrying, a negative problem orientation and perceived control all played a mediating role in CBT as well as in PST. Our findings suggest that regardless of the theoretical background to the therapy, the psychological processes necessary for symptom reduction seem to be comparable.

Section snippets

Background

Several forms of psychotherapy that have been subjected to empirical study have been shown to produce therapeutic change with depressed adults (Lambert, 2004). However, little is known about how or why treatment works. The psychological processes responsible for therapeutic change are often referred to as mediators. A mediator is an intervening variable that may account (statistically) for the relationship between the independent and dependent variable (Kazdin, 2007). There are several reasons

Participants

A comprehensive description of the participants and the procedures can be found in (Warmerdam, van Straten, & Cuijpers, 2007). Participants were recruited through advertisements in daily and weekly newspapers and via the Internet. All adults aged 18 years and older with depressive symptoms willing to participate in a self-help course, were eligible for this study. The main inclusion criterion was the presence of depressive symptoms as indicated by a score of 16 or more on the Center of

Participants

The average age of the participants at baseline was 45 years (SD = 12.1). Most participants were female (71%) and the majority (91%) had been educated at a medium or higher level. Almost all participants were Dutch (92%). There were no statistically significant differences between the three groups with respect to the demographics. The mean score of the participants on the CES-D at baseline was 31.7 (SD: 7.5, median: 31.0). There were no statistically significant differences between the three

Discussion

The purpose of this study was to contribute to research on mechanisms of change in psychological treatment for depressive symptoms. We compared two theoretically different treatments, online CBT and online PST, with a waiting list control group. The first requirement of testing mediation was met, as we found in a previous study that both treatments were significantly more effective in reducing depression than a waiting list control group (Warmerdam et al., 2008). The current study showed that

Acknowledgements

This study is funded by the Faculty of Psychology and Education of the VU University, Amsterdam.

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