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Effectiveness and cost effectiveness of guided online treatment

Effectiveness and cost effectiveness of guided online treatment for patients with major depressive disorder on a waiting list for psychotherapy: study protocol of a randomized controlled trial

 

Robin Maria Francisca Kenter, Annemieke van Straten, Sabine Heleen Hobbel, Filip Smit, Judith Bosmans, Aartjan Beekman and Pim Cuijpers

 

Background: 

Depressive disorders are highly prevalent and result in negative consequences for both patients and society. It is therefore important that these disorders are treated adequately. However, due to increased demand for mental healthcare and subsequent increased costs, it would be desirable to reduce costs associated with major depressive disorder while maintaining or improving the quality of care within the healthcare system. Introducing evidence-based online self-help interventions in mental healthcare might be the way to maintain clinical effects while minimizing costs by reducing the number of face-to-face sessions. This study aims to evaluate the clinical and economical effects of a guided online self-help intervention when offered to patients with major depressive disorder on a waiting list for psychotherapy in specialized mental health centers (MHCs).

Methods:

Patients at mental health centers identified with a Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) diagnosis of major depression who are awaiting face-to-face treatment are studied in a randomized controlled trial. During this waiting list period, patients are randomized and either (1) receive an internet-based guided self-help treatment or (2) receive a self-help book. The 5-week internet-based guided self-help intervention and the self-help booklet are based on problem solving treatment. After the intervention, patients are allowed to start regular face-to-face treatment at MHCs. Costs and effects are measured at baseline, after the intervention at 6 to 8 weeks, 6 months and 12 months. The primary outcome measure is symptoms of depression. Secondary outcome measures are diagnosis of depression, number of face-to-face sessions, absence of work and healthcare uptake in general. Additional outcome measures are anxiety, insomnia, quality of life and mastery.

Discussion:

This study evaluates the effectiveness and cost effectiveness of internet-based guided self-help in patients at specialized mental health centers. The aim is to demonstrate whether the introduction of internet-based self-help interventions in regular mental healthcare for depressive disorders can maintain clinical effects and reduce costs. Strengths and limitations of this study are discussed. 

Abstract from:

Kenter et al. Trials 2013, 14:412

http://www.trialsjournal.com/content/14/1/412 

 
 
A PSYCHODYNAMIC PERSPECTIVE ON A SYSTEMATIC REVIEW OF ONLINE PSYCHOTHERAPY FOR ADULTS

A PSYCHODYNAMIC PERSPECTIVE ON A SYSTEMATIC REVIEW OF ONLINE PSYCHOTHERAPY FOR ADULTS 

 

Research by

DIOGO DE BITENCOURT MACHADO, PRICILLA BRAGA LASKOSKI, CHARLIE TRELLES SEVERO, ANA MARGARETH BASSOLS, ANA SFOGGIA, CLARICE KOWACS, DANIELA VALLE KRIEGER, MARIANA BENETTI TORRES, MARINA BENTO GASTAUD, RAFAEL STELLA WELLAUSEN, STEFANIA PIGATTO TECHE and CLAUDIO LAKS EIZIRIK


A variety of new psychotherapy modalities has arisen in which the contact between patient and therapist takes place via the internet. The main objective of this systematic review is to investigate the types of online psychotherapy (OP) conducted nowadays, and to describe their main characteristics to psychodynamic psychotherapists who may wish to better understand the current scientific literature on the subject. The review used two databases, EMBASE and PsycINFO. Fifty-nine studies were retrieved and the main online psychotherapy modalities identified were self-therapy programmes usin g contact via email or chat; videoconference; and therapy exclusively via chat or email. The result of these studies suggests that OP is more effective than a waiting list control group. When compared with face-to-face therapies, OP showed similar effects. Most studies involved cognitive behavioural therapy; only two studies involved a form of psychodynamic psychotherapy. Different forms of communication allow patient and therapist to establish different relationships and therapeutic possibilities. OPs may be feasible treatment alternatives; however, it remains unclear, especially in relation to psychodynamic treatments, if therapeutic technique in OP, which involves changes in comparison with face-to-face therapies, would be useful in severe cases. Psychodynamic psychotherapists should adopt a posture of constant reflection on the changes taking place in the world and their impact on the minds of individuals, without, nevertheless, idealizing the ‘new’.

Abstract from:

British Journal of Psychotherapy 32, 1 (2016) 79–108 

 
 










 
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