Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2018 Mar;49(2):295-307.
doi: 10.1016/j.beth.2017.04.004. Epub 2017 May 1.

Efficacy of Guided iCBT for Depression and Mediation of Change by Cognitive Skill Acquisition

Nicholas R Forand  1 , Jeffrey G Barnett  2 , Daniel R Strunk  3 , Mohammed U Hindiyeh  2 , Jason E Feinberg  4 , John R Keefe  5
Affiliations
Randomized Controlled Trial

Efficacy of Guided iCBT for Depression and Mediation of Change by Cognitive Skill Acquisition

Nicholas R Forand et al. Behav Ther. 2018 Mar.

Abstract

Guided internet CBT (iCBT) is a promising treatment for depression; however, it is less well known through what mechanisms iCBT works. Two possible mediators of change are the acquisition of cognitive skills and increases in behavioral activation. We report results of an 8-week waitlist controlled trial of guided iCBT, and test whether early change in cognitive skills or behavioral activation mediated subsequent change in depression. The sample was 89 individuals randomized to guided iCBT (n = 59) or waitlist (n = 30). Participants were 75% female, 72% Caucasian, and 33 years old on average. The PHQ9 was the primary outcome measure. Mediators were the Competencies of Cognitive Therapy Scale-Self Report and the Behavioral Activation Scale for Depression-Short Form. Treatment was Beating the Blues plus manualized coaching. Outcomes were analyzed using linear mixed models, and mediation with a bootstrap resampling approach. The iCBT group was superior to waitlist, with large effect sizes at posttreatment (Hedges' g = 1.45). Dropout of iCBT was 29% versus 10% for waitlist. In the mediation analyses, the acquisition of cognitive skills mediated subsequent depression change (indirect effect = -.61, 95% bootstrapped biased corrected CI: -1.47, -0.09), but increases in behavioral activation did not. iCBT is an effective treatment for depression, but dropout rates remain high. Change in iCBT appears to be mediated by improvements in the use of cognitive skills, such as critically evaluating and restructuring negative thoughts.

Keywords: behavioral activation; cognitive skills; depression; guided iCBT; mediation.

PubMed Disclaimer

Conflict of interest statement

Disclosure Statement

The authors declare that there are no conflicts of interest.

Figures

Figure 1
Figure 1. Differences between Beating the Blues Studies and Versions
Figure 2
Figure 2. Beating the Blues v2.5 Session Summaries and Project
Note. Topics listed include only those introduced in that session. Some topics are reviewed or added to in subsequent sessions, including the ABC model (sessions 2 and 3), pleasurable activities (session 3), and problem solving (sessions 4 and 5).
Figure 3
Figure 3. CONSORT Diagram
Figure 4
Figure 4. Mediation of Change in Depression by Change in CBT Skills and Behavioral Activation
Note. Betas are unstandardized, and the parentheses contain 95% bootstrapped biased corrected confidence intervals. All models controlled for change in PHQ9 from weeks 0–3. PHQ9, Patient Health Questionnaire – 9; CCTS-SR, Competencies of Cognitive Therapy Scale – Self Report; BADS-SF, Behavioral Activation for Depression Scale – Short Form.
See this image and copyright information in PMC

References

    1. Adler AD, Strunk DR, Fazio RH. What Changes in Cognitive Therapy for Depression? An Examination of Cognitive Therapy Skills and Maladaptive Beliefs. Behavior Therapy. 2015;46(1):96–109. https://doi.org/10.1016/j.beth.2014.09.001. - DOI - PMC - PubMed
    1. Andersson G, Cuijpers P. Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cognitive Behaviour Therapy. 2009;38(4):196–205. https://doi.org/10.1080/16506070903318960. - DOI - PubMed
    1. Andersson G, Hesser H, Veilord A, Svedling L, Andersson F, Sleman O, Carlbring P. Randomised controlled non-inferiority trial with 3-year follow-up of internet-delivered versus face-to-face group cognitive behavioural therapy for depression. Journal of Affective Disorders. 2013;151(3):986–994. https://doi.org/10.1016/j.jad.2013.08.022. - DOI - PubMed
    1. Andrews G, Cuijpers P, Craske MG, McEvoy P, Titov N. Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PloS One. 2010;5(10):e13196. https://doi.org/10.1371/journal.pone.0013196. - DOI - PMC - PubMed
    1. Barber JP, DeRubeis RJ. Change in compensatory skills in cognitive therapy for depression. The Journal of Psychotherapy Practice and Research. 2001;10(1):8–13. - PMC - PubMed

Publication types