Internet-based treatment of depression: a randomized controlled trial comparing guided with unguided self-help

Cogn Behav Ther. 2011;40(4):251-66. doi: 10.1080/16506073.2011.616531.


Internet-delivered self-help for depression with therapist guidance has shown efficacy in several trials. Results from meta-analyses suggest that guidance is important and that self-help programs without support are less effective. However, there are no direct experimental comparisons between guided and unguided internet-based treatments for depression. The present study compared the benefits of a 10-week web-based unguided self-help treatment with the same intervention complemented with weekly therapist support via e-mail. A waiting-list control group was also included. Seventy-six individuals meeting the diagnostic criteria of major depression or dysthymia were randomly assigned to one of the three conditions. The Beck Depression Inventory (BDI-II) was used as the primary outcome measure. Secondary outcomes included general psychopathology, interpersonal problems, and quality of life. Sixty-nine participants (91%) completed the assessment at posttreatment and 59 (78%) at 6-month follow-up. Results showed significant symptom reductions in both treatment groups compared to the waiting-list control group. At posttreatment, between-group effect sizes on the BDI-II were d = .66 for unguided self-help versus waiting-list and d = 1.14 for guided self-help versus waiting-list controls. In the comparison of the two active treatments, small-to-moderate, but not statistically significant effects in favor of the guided condition were found on all measured dimensions. In both groups, treatment gains were maintained at 6-month follow-up. The findings provide evidence that internet-delivered treatments for depression can be effective whether support is added or not. However, all participants were interviewed in a structured diagnostic telephone interview before inclusion, which prohibits conclusions regarding unguided treatments that are without any human contact.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cognitive Behavioral Therapy / methods*
  • Cognitive Behavioral Therapy / statistics & numerical data
  • Depressive Disorder, Major / therapy*
  • Directive Counseling / methods*
  • Directive Counseling / statistics & numerical data
  • Dysthymic Disorder / therapy*
  • Electronic Mail
  • Female
  • Humans
  • Internet
  • Interpersonal Relations
  • Male
  • Middle Aged
  • Patient Compliance / statistics & numerical data
  • Patient Satisfaction / statistics & numerical data
  • Psychiatric Status Rating Scales / statistics & numerical data
  • Quality of Life / psychology
  • Self Care / methods*
  • Self Care / psychology
  • Therapy, Computer-Assisted / methods*
  • Waiting Lists