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
. 2024 Dec 16:8:e46860.
doi: 10.2196/46860.

Participant Adherence and Contact Behavior in a Guided Internet Intervention for Depressive Symptoms: Exploratory Study

Oliver Thomas Bur #  1 , Thomas Berger #  1
Affiliations
Randomized Controlled Trial

Participant Adherence and Contact Behavior in a Guided Internet Intervention for Depressive Symptoms: Exploratory Study

Oliver Thomas Bur et al. JMIR Form Res. .

Abstract

Background: The number of studies on internet-based guided self-help has rapidly increased during the last 2 decades. Guided self-help comprises 2 components: a self-help program that patients work through and usually weekly guidance from therapists who support patients using the self-management program. Little is known about participants' behavior patterns while interacting with therapists and their use of self-help programs in relation to intervention outcomes.

Objective: This exploratory study aimed to investigate whether the number of messages sent to the therapist (ie, contact behavior) is an indicator of the outcome, that is, a reduction in depressive symptoms. Furthermore, we investigated whether adherence was associated with outcome. Most importantly, we investigated whether different combinations of adherence and contact behavior were associated with outcome.

Methods: Drawing on a completer sample (n=113) from a randomized full factorial trial, participants were categorized into 4 groups. The groups were based on median splits of 2 variables, that is, the number of messages sent to therapists (low: groups 1 and 2; high: groups 3 and 4) and adherence (low: groups 1 and 3; high: groups 2 and 4). The 4 groups were compared in terms of change in depressive symptoms (measured with the Patient Health Questionnaire-9) from pre- to posttreatment and pretreatment to follow-up, respectively.

Results: On average, participants sent 4.5 (SD 3.7) messages to their therapist and completed 18.2 (SD 5.2) pages of the program in 6.39 (SD 5.39) hours. Overall, analyses revealed no main effect for participants' messages (H1=0.18, P=.67) but a significant main effect for adherence on changes in depressive symptoms from pre- to posttreatment (H1=5.10, P=.02). The combined consideration of adherence and messages sent to the therapist revealed group differences from pre- to posttreatment (H3=8.26, P=.04). Group 3 showed a significantly smaller improvement in symptoms compared with group 4 (Z=-2.84, P=.002). Furthermore, there were group differences from pretreatment to follow-up (H3=8.90, P=.03). Again, group 3 showed a significantly smaller improvement in symptoms compared with group 4 (Z=-2.62, P=.004) and group 2 (Z=-2.47, P=.007). All other group comparisons did not yield significant differences.

Conclusions: This exploratory study suggests that participants characterized by low adherence and frequent messaging do not improve their symptoms as much as other participants. These participants might require more personalized support beyond the scope of guided internet interventions. The paper underscores the importance of considering individual differences in contact behavior when tailoring interventions. The results should be interpreted with caution and further investigated in future studies.

Trial registration: ClinicalTrials.gov NCT04318236.

Keywords: adherence; contact behavior; depression; digital health; guidance; internet intervention; intervention; messages; online; participant; therapy.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

References

    1. Andersson G, Carlbring P, Titov N, Lindefors N. Internet interventions for adults with anxiety and mood disorders: a narrative umbrella review of recent meta-analyses. Can J Psychiatry. 2019 Jul;64(7):465–470. doi: 10.1177/0706743719839381. doi. Medline. - DOI - PMC - PubMed
    1. Andersson G, Berger T. In: Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change. Barkham M, Lutz W, Castonguay LG, editors. Wiley; 2021. Internet approaches to psychotherapy: empirical findings and future directions; pp. 749–772.
    1. Bur OT, Krieger T, Moritz S, Klein JP, Berger T. Optimizing the context of support of web-based self-help in individuals with mild to moderate depressive symptoms: a randomized full factorial trial. Behav Res Ther. 2022 May;152:104070. doi: 10.1016/j.brat.2022.104070. doi. Medline. - DOI - PubMed
    1. Karyotaki E, Efthimiou O, Miguel C, et al. Internet-based cognitive behavioral therapy for depression: a systematic review and individual patient data network meta-analysis. JAMA Psychiatry. 2021 Apr 1;78(4):361–371. doi: 10.1001/jamapsychiatry.2020.4364. doi. Medline. - DOI - PMC - PubMed
    1. Moshe I, Terhorst Y, Philippi P, et al. Digital interventions for the treatment of depression: a meta-analytic review. Psychol Bull. 2021 Aug;147(8):749–786. doi: 10.1037/bul0000334. doi. Medline. - DOI - PubMed

Publication types

Associated data