Book ; Thesis: Mechanisms of change in internet-based interventions for depression. Mechanismen der Veränderung in der Onlinebehandlung der Depression
2020
Abstract: Unipolar depression ranks first on the World Health Organization's list of diseases responsible for global health burden. Different approaches of pharmacotherapy and face-to-face psychotherapy have been proven efficacious in reducing symptoms of ... ...
| Title translation | Mechanismen der Veränderung in der Onlinebehandlung der Depression |
|---|---|
| Abstract | Unipolar depression ranks first on the World Health Organization's list of diseases responsible for global health burden. Different approaches of pharmacotherapy and face-to-face psychotherapy have been proven efficacious in reducing symptoms of depression and are available for individuals affected by the disorder. Yet, a majority of those individuals do not receive evidence-based treatment. Barriers such as difficulties attending appointments at inconvenient locations and at inconvenient times might be responsible for this shortfall in mental health care. Internet-based Interventions (IBI) show potential to overcome such barriers by offering psychoeducation, treatment tools, and (in some cases) guidance by clinicians independent of time and location. While several randomized controlled trials provide convincing evidence for the utility of IBI in reducing symptoms of depression, little is known about the mechanisms that account for in-treatment symptom change. Possible contributors to change within IBI for depression may be features of the intervention (e.g., therapeutic support by clinicians), variables related to treatment processes (e.g., treatment uptake, therapeutic alliance, outcome expectations) or variables specific to individuals (e.g., sociodemographic or socioeconomical characteristics). This thesis presents the findings from three studies that seek to broaden our understanding of in-treatment symptom change in IBI. All three studies have been conducted with data collected from 1089 mildly to moderately depressed individuals drawn from the client-base of a public health insurance company. They were randomized to receive weekly feedback that was either fully-standardized or individualized by a counselor within an otherwise identical cognitive-behavioral IBI for depression. STUDY 1 investigated differences between the treatment conditions concerning changes on clinical (depression, anxiety, perseverative thinking) and psychosocial variables (emotional self-efficacy, quality of life, and perceived social support). The between-condition effects were estimated after the intervention as well as 3, 6, and 12 months after participants finished the program. Results revealed large within-group effects for depressive symptom reduction across conditions. However, between-group differences were nonsignificant for all outcomes at all measurement occasions. STUDY 2 compared the contributions of outcome expectations, therapeutic alliance (agreement on tasks and goals; bond), extra-therapeutic stressors, and the uptake of specific treatment components to weekly symptom change in both treatment arms. Results showed that reductions of extra-therapeutic stressors during the intervention and high agreements on tasks and goals of treatment were associated with depressive symptom reductions in both conditions. While the level of extra-therapeutic stress at baseline was only predictive of in-treatment symptom change in the fully-standardized condition, bond ratings were associated with symptom deterioration during the final week of treatment in the individualized condition only. STUDY 3 investigated whether distinct groups of participants experienced discernable symptom courses during the two treatment variants. In addition, we examined whether participants' psychosocial, socioeconomic or clinical characteristics were associated with membership in these groups. The results suggested that patterns of change and the associated groups did not differ across conditions. In both treatment variants most individuals (62.5%) were classified as "immediate improvers" with substantial improvement, commencing even before the start of treatment. Another class (37.4%) of individuals was labeled "delayed improvers" for their symptoms improved less overall and did not change up until week three of treatment. Individuals with higher perceived social support had higher odds of being classified as "immediate improvers". In contrast, individuals fulfilling the criteria for a current MDD in a structured clinical interview (SCID-I) and individuals with high outcome expectations had higher odds of being classified as "delayed improvers". In summary, the results stressed the similarities between standardized and individualized feedback in IBI for depression concerning efficacy and patterns of change. At the same time the findings highlighted that individuals' socio-demographic and clinical features influence both the mechanisms of change and symptom courses in IBI for depression, and they had differential effects depending on whether the feedback was standardized or individualized. - Contents: (1) Zagorscak, P., Heinrich, M., Sommer, D., Wagner, B. & Knaevelsrud, C. (2018). Benefits of individualized feedback in Internet-based interventions for depression: A randomized controlled trial. Psychotherapy and Psychosomatics, 87, 32-45. DOI: 10.1159/000481515. (2) Zagorscak, P., Heinrich, M., Schulze, J., Böttcher, J. & Knaevelsrud, C. (2020). Factors contributing to symptom change in standardized and individualized Internet-based interventions for depression: A randomized-controlled trial. Psychotherapy. Advance online publication. DOI: 10.1037/pst0000276. (3) Zagorscak, P., Heinrich, M., Bohn, J., Stein, J. & Knaevelsrud, C. (2020). How individuals change during Internet-based interventions for depression: A randomized controlled trial comparing standardized and individualized feedback. Brain and Behavior, 10:e01484. DOI: 10.1002/brb3.1484. |
| Keywords | Angst ; Anxiety ; Digital Interventions ; Digitale Interventionen ; Erwartungen ; Expectations ; Feedback ; Internetbasierte Therapie ; Lebensqualität ; Major Depression ; Mental Health Services ; Online Therapy ; Psychosoziale Dienste ; Psychotherapeutic Processes ; Psychotherapeutische Prozesse ; Psychotherapie ; Psychotherapy ; Quality of Life ; Rumination (Cognitive Process) ; Rumination (kognitiver Prozess) ; Selbstwirksamkeit ; Self-Efficacy ; Social Support ; Soziale Unterstützung ; Symptome ; Symptoms ; Therapeutic Alliance ; Therapeutische Allianz ; Therapie ; Treatment |
| Language | English |
| Size | 185 pp., 34 pp. appendix |
| Publisher | Freie Universität, Fachbereich Erziehungswissenschaft und Psychologie |
| Publishing place | Berlin |
| Document type | Book ; Thesis |
| Note | Elektronische Publikation im Internet. Kumulative Dissertation |
| DOI | 10.17169/refubium-26547 |
| Database | PSYNDEX |
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