Over the past few years, numerous internet-based apps and websites, such as BetterHelp, which offers online therapy and other behavioral health services, have made claims to treat depression. The subjects of the Indiana University study were specifically those applications that provide treatment with cognitive behavioral therapy, a form of psychotherapy that focuses on changing thought patterns and behavior to alleviate symptoms of depression and other mental disorders.
The study was led by Lorenzo Lorenzo-Luaces, a clinical professor in the IU Bloomington College of Arts and Sciences’ Department of Psychological and Brain Sciences. Co-authors of the study include Emily Johns, a 2017 IU graduate and project manager in the lab of IU Distinguished Professor Linda Smith, and John R. Keefe, a Ph.D. student at the University of Pennsylvania. The report reviewed 21 pre-existing studies with a total of 4,781 participants for the study, which was published in the November issue of the Journal of Medical Internet Research.
Previous studies had examined the effectiveness of individual cognitive behavioral therapy (CBT) delivered via the Internet using a range of methods (web, apps, conferencing, etc.). In the past, CBT, a type of talk therapy, has been shown to be effective in treating depression in adults with mild to moderate depression. A number of barriers, including cost, availability and stigma, prevent many from accessing these services. Delivering CBT over the Internet (iCBT) may help address some of the barriers.
Researchers led by Charles Koransky, M.D., a psychiatric resident at the University of Maryland Medical Center, sought to assess whether iCBT for adults with depressive symptoms leads to a reduction in these symptoms. They identified and reviewed 14 randomized controlled studies published between 2005 and 2015 in which iCBT was used with adults with depression.
Until the Indiana University study, however, “no review had examined whether the effects of these treatments were inflated by excluding patients with more severe depression or additional conditions such as anxiety or alcohol abuse.”
“Before this study, I thought past studies were probably focused on people with very mild depression, those who did not have other mental health problems, and were at low risk for suicide,” Lorenzo-Luaces said. “To my surprise, that was not the case. The science suggests that these apps and platforms can help a large number of people.”
For Lorenzo-Luaces, online-based cognitive behavioral therapy apps are an important new tool for addressing a major public health issue: that individuals with mental health disorders like depression far outnumber the mental health providers available to treat them. Furthermore, people with depression are also expensive for the health care system.
“Close to one in four people meet the criteria for major depressive disorder,” he said. “If you include people with minor depression or who have been depressed for a week or a month with a few symptoms, the number grows, exceeding the number of psychologists who can serve them. … They tend to visit primary-care physicians more often than others. They have more medical problems, and their depression sometimes gets in the way of their taking their medication for other medical problems.”
By conducting a “meta-regression analysis” of 21 studies, Lorenzo-Luaces and collaborators decisively determined that internet-based therapy platforms effectively alleviate depression. A central question was determining whether previous studies distorted the strength of these systems’ effects by excluding people with severe depression.
The conclusion was that the apps worked in cases of mild, moderate and severe depression.