Internet-based Cognitive Behavioral Therapy is a New Option for Depression
Study shows treatment options aren’t limited to the therapist’s couch
Brett Israel • November 22, 2009
Internet-based cognitive behavioral therapy (CBT), delivered in real time, can effectively reduce depression and may expand treatment options beyond a therapist’s office, according to research published this August in the journal The Lancet.
CBT has been shown to effectively treat depression, and previous studies have shown that CBT when combined with an anti-depressant drug is more effective than either treatment alone. Internet-based CBT could extend therapy’s reach and give psychiatrists another tool in the fight against depression.
Insurance companies do not cover Internet-based CBT. However, the study’s lead author, David Kessler, a psychiatrist from the University of Bristol, is optimistic that Internet-based CBT will be widely available within two to three years.
“We’ve found a very encouraging effect of delivering cognitive behavioral therapy using [the Internet],” said Kessler. “Therapists that want to deliver it this way and patients that want it this way should take heart.”
For the study, CBT was delivered via the Internet in real time by a therapist, in a conversation similar to instant messaging. The treatment was given to 113 randomly assigned individuals who were previously diagnosed with depression. Patients who received Internet-based CBT were twice as likely to recover from depression after four months, compared to a control group that received only the usual care from their general practitioner while on a waiting list for online CBT.
Patients for the trial ranged from mildly to severely depressed (Beck Depression Inventory (BDI) score ≥14). The patients received 10 sessions, each 55 minutes long, over 16 weeks. Researchers assessed therapy transcripts using the cognitive therapy rating scale. They reassessed patients’ BDI scores four months later to measure short-term gains, and then again after eight months to see if their improvements were sustained. After eight months, the patients’ chances of recovery were slightly lower than after four months, but Internet-based CBT still roughly doubled their chances of recovering from depression.
In this study, if seven people are treated using Internet-based CBT, one person will recover from depression.
While Internet-based therapy may still be years away from common usage, researchers see this therapy as a potential game changer, since using Internet therapy increases access and also may reduce inhibitions normally associated with in-person therapy. Internet-based CBT could also change the way sessions are organized.
CBT is typically delivered face to face by therapists during separate blocks of time, each close to an hour long. Internet-based CBT will help therapists break up the sessions so patients have greater access to treatment.
“The serving size of psychotherapy is 50 minutes. This makes it possible to change serving size,” said Gregory Simon, psychiatrist at Group Health Cooperative in Seattle. Simon authored a comment in the same issue of The Lancet about the study and urged psychotherapists to push the boundaries when it comes to new approaches to treatment.
Internet-based therapy has the potential to reduce psychotherapy costs. Psychotherapy is basically a cash business, according to Simon, because insurance companies do not usually cover treatments. Internet-based therapy can reduce patients’ time spent with therapists, and therefore reduce patients’ bills.
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About the Author
Brett Israel
Brett moved from the ATL to the Big Apple and joined the Science, Health and Environmental Reporting Program (SHERP) at NYU to refine his science writing skills and to learn how to earn a paycheck as a science journalist. Brett Israel graduated with a B.S. in biochemistry and molecular biology from the University of Georgia and then spent time in the biochemistry Ph.D. program at Emory University. While looking for something to keep him busy outside of lab, he started covering science for the Emory student newspaper and discovered a greater passion for writing about the work of others than performing his own experiments. In his free time, Brett enjoys cheering for the Georgia Bulldogs and any pro sports team from Atlanta, and riding Greyhound buses up and down the east coast.
Brett lives in Brooklyn, New York with his pit bull Hanks.
2 Comments
This article is confusing, on several counts. First of all, I do not understand is meant by the statement, “In this study, if seven people are treated using Internet-based CBT, one person will recover from depression.” Does this mean that one in seven people treated with CBT recover from depression? If so, then this is a much worse outcome than doing nothing at all. In the previous paragraph, the author states that,”Internet-based CBT still roughly doubled their chances of recovering from depression.” This contradicts the previously quoted statement.
Secondly, the statement that “Psychotherapy is basically a cash business…because insurance companies do not usually cover treatments” is false. Insurance companies certainly do cover psychotherapy treatment by psychologists and social workers, probably less so for psychiatrists who are mainly responsible for medication monitoring. If insurance companies think they can cut costs by offering internet CBT, or any other kind of treatment, I imagine they will be most interested in providing it as an option if it is found to be equally or more effective.
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