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BACKGROUND Subthreshold depression is a highly prevalent condition and a risk factor for developing a major depressive episode . Internet-based cognitive behaviour therapy may be a promising approach for the treatment of subthreshold depression . The current study had two aims : ( 1 ) to determine whether an internet-based cognitive behaviour therapy intervention and a group cognitive behaviour therapy intervention are more effective than a waiting-list control group ; and ( 2 ) to determine whether the effect of the internet-based cognitive behaviour therapy differs from the group cognitive behaviour therapy intervention . METHOD A total of 191 women and 110 men with subthreshold depression were r and omized into internet-based treatment , group cognitive behaviour therapy ( Lewinsohn 's Coping With Depression course ) , or a waiting-list control condition . The main outcome measure was treatment response after 10 weeks , defined as the difference in pre- and post-treatment scores on the Beck Depression Inventory ( BDI ) . Missing data , a major limitation of this study , were imputed using the Multiple Imputation ( MI ) procedure Data Augmentation . RESULTS In the waiting-list control group , we found a pre- to post-improvement effect size of 0.45 , which was 0.65 in the group cognitive behaviour therapy condition and 1.00 within the internet-based treatment condition . Helmert contrasts showed a significant difference between the waiting-list condition and the two treatment conditions ( p=0.04 ) and no significant difference between both treatment conditions ( p=0.62 ) . CONCLUSIONS An internet-based intervention may be at least as effective as a commonly used group cognitive behaviour therapy intervention for subthreshold depression in people over 50 years of age Background The Internet has potential as a medium for health behavior change programs , but no controlled studies have yet evaluated the impact of a fully automated physical activity intervention over several months with real-time objective feedback from a monitor . Objective The aim was to evaluate the impact of a physical activity program based on the Internet and mobile phone technology provided to individuals for 9 weeks . Methods A single-center , r and omized , stratified controlled trial was conducted from September to December 2005 in Bedfordshire , United Kingdom , with 77 healthy adults whose mean age was 40.4 years ( SD = 7.6 ) and mean body mass index was 26.3 ( SD = 3.4 ) . Participants were r and omized to a test group that had access to an Internet and mobile phone – based physical activity program  ( n = 47 ) or to a control group ( n = 30 ) that  received no support . The test group received tailored solutions for perceived barriers , a schedule to plan weekly exercise sessions with mobile phone and email reminders , a message board to share their experiences with others , and feedback on their level of physical activity . Both groups were issued a wrist-worn accelerometer to monitor their level of physical activity ;  only the test group received real-time feedback via the Internet . The main outcome measures were accelerometer data and self-report of physical activity . Results At the end of the study period , the test group reported a significantly greater increase over baseline than did the control group for perceived control ( P < .001 ) and intention/expectation to exercise ( P < .001 ) . Intent-to-treat analyses of both the accelerometer data ( P = .02 ) and leisure time self-report data ( P = .03 ) found a higher level of moderate physical activity in the test group . The average increase ( over the control group ) in accelerometer-measured moderate physical activity was 2 h 18 min per week . The test group also lost more percent body fat than the control group ( test group : −2.18 , SD = 0.59 ; control group : −0.17 , SD = 0.81 ; P = .04 ) . Conclusions A fully automated Internet and mobile phone – based motivation and action support system can significantly increase and maintain the level of physical activity in healthy adults Background and aims Psychodynamic psychotherapy ( PDT ) is an effective treatment for major depressive disorder ( MDD ) , but not all clients with MDD can receive psychotherapy . Using the Internet to provide psychodynamic treatments is one way of improving access to psychological treatments for MDD . The aim of this r and omised controlled trial was to investigate the efficacy of an Internet-based psychodynamic guided self-help treatment for MDD . Methods Ninety-two participants who were diagnosed with MDD according to the Mini-International Neuropsychiatric Interview were r and omised to treatment or an active control . The treatment consisted of nine treatment modules based on psychodynamic principles with online therapist contact . The active control condition was a structured support intervention and contained psychoeducation and scheduled weekly contacts online . Both interventions lasted for 10 weeks . The primary outcome measure was the Beck Depression Inventory-II ( BDI-II ) . Results Mixed-effects model analyses of all r and omised participants showed that participants receiving Internet-based PDT made large and superior improvements compared with the active control group on the BDI-II ( between-group Cohen 's d = 1.11 ) . Treatment effects were maintained at a 10-month follow-up . Conclusions Internet-based psychodynamic guided self-help is an efficacious treatment for MDD that has the potential to increase accessibility and availability of PDT for MDD . Trial Registration Clinical trials.gov : BACKGROUND Major depression can be treated by means of cognitive-behavioural therapy , but as skilled therapists are in short supply there is a need for self-help approaches . Many individuals with depression use the internet for discussion of symptoms and to share their experience . AIMS To investigate the effects of an internet-administered self-help programme including participation in a monitored , web-based discussion group , compared with participation in web-based discussion group only . METHOD A r and omised controlled trial was conducted to compare the effects of internet-based cognitive-behavioural therapy with minimal therapist contact ( plus participation in a discussion group ) with the effects of participation in a discussion group only . RESULTS Internet-based therapy with minimal therapist contact , combined with activity in a discussion group , result ed in greater reductions of depressive symptoms compared with activity in a discussion group only ( waiting-list control group ) . At 6 months ' follow-up , improvement was maintained to a large extent . CONCLUSIONS Internet-delivered cognitive cognitive-behavioural therapy should be pursued further as a complement or treatment alternative for mild-to-moderate depression 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 r and omly 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 Background Depression is a burdensome , recurring mental health disorder with high prevalence . Even in developed countries , patients have to wait for several months to receive treatment . In many parts of the world there is only one mental health professional for over 200 people . Smartphones are ubiquitous and have a large complement of sensors that can potentially be useful in monitoring behavioral patterns that might be indicative of depressive symptoms and providing context -sensitive intervention support . Objective The objective of this study is 2-fold , first to explore the detection of daily-life behavior based on sensor information to identify subjects with a clinical ly meaningful depression level , second to explore the potential of context sensitive intervention delivery to provide in-situ support for people with depressive symptoms . Methods A total of 126 adults ( age 20 - 57 ) were recruited to use the smartphone app Mobile Sensing and Support ( MOSS )  , collecting context -sensitive sensor information and providing just-in-time interventions derived from cognitive behavior therapy . Real-time learning-systems were deployed to adapt to each subject ’s preferences to optimize recommendations with respect to time , location , and personal preference . Biweekly , participants were asked to complete a  self-reported depression survey ( PHQ-9 ) to track symptom progression . Wilcoxon tests were conducted to compare scores before and after intervention . Correlation analysis was used to test the relationship between adherence and change in PHQ-9 . One hundred twenty features were constructed based on smartphone usage and sensors including  accelerometer , Wifi  , and  global positioning systems ( GPS  )  . Machine-learning models used these features to infer behavior and context for PHQ-9 level prediction and tailored intervention delivery . Results A total of 36 subjects used MOSS for ≥2 weeks . For subjects with clinical depression ( PHQ-9≥11 ) at baseline and adherence ≥8 weeks ( n=12 ) , a significant drop in PHQ-9 was observed ( P=.01 ) . This group showed a negative trend between adherence and change in PHQ-9 scores ( rho=−.498 , P=.099 ) . Binary classification performance for biweekly PHQ-9 sample s ( n=143 ) , with a cutoff of PHQ-9≥11 , based on R and om Forest and Support Vector Machine leave-one-out cross validation result ed in 60.1 % and 59.1 % accuracy , respectively . Conclusions Proxies for social and physical behavior derived from smartphone sensor data was successfully deployed to deliver context -sensitive and personalized interventions to people with depressive symptoms . Subjects who used the app for an extended period of time showed significant reduction in self-reported symptom severity . Nonlinear classification models trained on features extracted from smartphone sensor data including Wifi , accelerometer , GPS , and phone use , demonstrated a proof of concept for the detection of depression superior to r and om classification . While findings of effectiveness must be reproduced in a RCT to proof causation , they pave the way for a new generation of digital health interventions leveraging smartphone sensors to provide context sensitive information for in-situ support and unobtrusive monitoring of critical mental health states Depression is among the most prevalent disorders worldwide . In view of numerous treatment barriers , internet-based interventions are increasingly adopted to " treat the untreated " . The present trial ( registered as NCT01401296 ) was conducted over the internet and aim ed to assess the efficacy of an online self-help program for depression ( Deprexis ) . In r and om order , participants with elevated depression symptoms received program access or were allocated to a wait-list control condition . After eight weeks , participants were invited to take part in an online re- assessment . To compensate for common problems of online studies , such as low completion rates and unclear diagnostic status , reminders and incentives were used , and clinical diagnoses were externally confirmed in a subgroup of 29 % of participants . Relative to the wait-list group , program users experienced significant symptom decline on the Beck Depression Inventory ( BDI ; primary outcome ) , the Dysfunctional Attitudes Scale ( DAS ) , the Quality of Life scale ( WHOQOL-BREF ) and the Rosenberg Self-Esteem Scale ( RSE ) . Compared to wait-list participants , symptom decline was especially pronounced among those with moderate symptoms at baseline as well as those not currently consulting a therapist . Completion ( 82 % ) and re-test reliability of the instruments ( r = .72-.87 ) were good . The results of this trial suggest that online treatment can be beneficial for people with depression , particularly for those with moderate symptoms Background . Psychodynamic psychotherapy is a psychological treatment approach that has a growing empirical base . Research has indicated an association between therapist-facilitated affective experience and outcome in psychodynamic therapy . Affect-phobia therapy ( APT ) , as outlined by McCullough et al. , is a psychodynamic treatment that emphasizes a strong focus on expression and experience of affect . This model has neither been evaluated for depression nor anxiety disorders in a r and omized controlled trial . While Internet-delivered psychodynamic treatments for depression and generalized anxiety disorder exist , they have not been based on APT . The aim of this r and omized controlled trial was to investigate the efficacy of an Internet-based , psychodynamic , guided self-help treatment based on APT for depression and anxiety disorders . Methods . One hundred participants with diagnoses of mood and anxiety disorders participated in a r and omized ( 1:1 ratio ) controlled trial of an active group versus a control condition . The treatment group received a 10-week , psychodynamic , guided self-help treatment based on APT that was delivered through the Internet . The treatment consisted of eight text-based treatment modules and included therapist contact ( 9.5 min per client and week , on average ) in a secure online environment . Participants in the control group also received online therapist support and clinical monitoring of symptoms , but received no treatment modules . Outcome measures were the 9-item Patient Health Question naire Depression Scale ( PHQ-9 ) and the 7-item Generalized Anxiety Disorder Scale ( GAD-7 ) . Process measures were also included . All measures were administered weekly during the treatment period and at a 7-month follow-up . Results . Mixed models analyses using the full intention-to-treat sample revealed significant interaction effects of group and time on all outcome measures , when comparing treatment to the control group . A large between-group effect size of Cohen ’s d = 0.77 ( 95 % CI : 0.37–1.18 ) was found on the PHQ-9 and a moderately large between-group effect size d = 0.48 ( 95 % CI : 0.08–0.87 ) was found on the GAD-7 . The number of patients who recovered ( had no diagnoses of depression and anxiety , and had less than 10 on both the PHQ-9 and the GAD-7 ) were at post-treatment 52 % in the treatment group and 24 % in the control group . This difference was significant , χ2(N = 100 , d f = 1 ) = 8.3 , p < .01 . From post-treatment to follow-up , treatment gains were maintained on the PHQ-9 , and significant improvements were seen on the GAD-7 . Conclusion . This study provides initial support for the efficacy of Internet-delivered psychodynamic therapy based on the affect-phobia model in the treatment of depression and anxiety disorders . The results support the conclusion that psychodynamic treatment approaches may be transferred to the guided self-help format and delivered via the Internet Background : Access to mental health care is limited . Internet-based interventions ( IBIs ) may help bridge that gap by improving access especially for those who are unable to receive expert care . Aim : This review explores current research on the effectiveness of IBIs for depression and anxiety . Results : For depression , therapist-guided cognitive behavioral therapy ( CBT ) had larger effect sizes consistently across studies , ranging from 0.6 to 1.9 ; while st and -alone CBT ( without therapist guidance ) had a more modest effect size of 0.3–0.7 . Even other interventions for depression ( non-CBT/non-r and omized controlled trial ( RCT ) ) showed modestly high effect sizes ( 0.2–1.7 ) . For anxiety disorders , studies showed robust effect sizes for therapist-assisted interventions with effect sizes of 0.7–1.7 ( efficacy similar to face-to-face CBT ) and st and -alone CBT studies also showed large effect sizes ( 0.6–1.7 ) . Non-CBT/Non- RCT studies ( only 3 ) also showed significant reduction in anxiety scores at the end of the interventions . Conclusion : IBIs for anxiety and depression appear to be effective in reducing symptomatology for both depression and anxiety , which were enhanced by the guidance of a therapist . Further research is needed to identify various predictive factors and the extent to which st and -alone Internet therapies may be effective in the future as well as effects for different patient population BACKGROUND Computerised cognitive-behavioural therapy ( CCBT ) might offer a solution to the current undertreatment of depression . AIMS To determine the clinical effectiveness of online , unsupported CCBT for depression in primary care . METHOD Three hundred and three people with depression were r and omly allocated to one of three groups : Colour Your Life ; treatment as usual ( TAU ) by a general practitioner ; or Colour Your Life and TAU combined . Colour Your Life is an online , multimedia , interactive CCBT programme . No assistance was offered . We had a 6-month follow-up period . RESULTS No significant differences in outcome between the three interventions were found in the intention-to-treat and per protocol analyses . CONCLUSIONS Online , unsupported CCBT did not outperform usual care , and the combination of both did not have additional effects . Decrease in depressive symptoms in people with moderate to severe depression was moderate in all three interventions . Online CCBT without support is not beneficial for all individuals with depression Background Depression and anxiety are major causes of absence from work and underperformance in the workplace . Cognitive behavioural therapy ( CBT ) can be effective in treating such problems and online versions offer many practical advantages . The aim of the study was to investigate the effectiveness of a computerized CBT intervention ( MoodGYM ) in a workplace context . Method The study was a phase III two-arm , parallel r and omized controlled trial whose main outcome was total score on the Work and Social Adjustment Scale ( WSAS ) . Depression , anxiety , psychological functioning , costs and acceptability of the online process were also measured . Most data were collected online for 637 participants at baseline , 359 at 6 weeks marking the end of the intervention and 251 participants at 12 weeks post-baseline . Results In both experimental and control groups depression scores improved over 6 weeks but attrition was high . There was no evidence for a difference in the average treatment effect of MoodGYM on the WSAS , nor for a difference in any of the secondary outcomes . Conclusions This study found no evidence that MoodGYM was superior to informational websites in terms of psychological outcomes or service use , although improvement to subthreshold levels of depression was seen in nearly half the patients in both groups Objective . The main hypothesis , and the objective of the study , was to test if the participants allocated to the treatment group would show a larger reduction in depressive symptoms than those in the control group . Methods . This study was a r and omized nine week trial of an Internet-administered treatment based on guided physical exercise for Major Depressive Disorder ( MDD ) . A total of 48 participants with mild to moderate depression , diagnosed using the Structured Clinical Interview for DSM-IV Axis I Disorders , were r and omized either to a treatment intervention or to a waiting-list control group . The main outcome measure for depression was the Beck Depression Inventory-II ( BDI-II ) , and physical activity level was measured using the International Physical Activity Question naire ( IPAQ ) . The treatment program consisted of nine text modules , and included therapist guidance on a weekly basis . Results . The results showed significant reductions of depressive symptoms in the treatment group compared to the control group , with a moderate between-group effect size ( Cohen ’s d = 0.67 ; 95 % confidence interval : 0.09–1.25 ) . No difference was found between the groups with regards to increase of physical activity level . For the treatment group , the reduction in depressive symptoms persisted at six months follow-up . Conclusions . Physical activity as a treatment for depression can be delivered in the form of guided Internet-based self-help . Trial Registration . The trial was registered at Clinical Trials.gov ( NCT01573130 ) Background Guided self-help programs for depression ( with associated therapist contact ) have been successfully delivered over the Internet . However , previous trials of pure self-help Internet programs for depression ( without therapist contact ) , including an earlier trial conducted by us , have failed to yield positive results . We hypothesized that methods to increase participant usage of the intervention , such as postcard or telephone reminders , might result in significant effects on depression . Objectives This paper presents a second r and omized trial of a pure self-help Internet site , ODIN ( Overcoming Depression on the InterNet ) , for adults with self-reported depression . We hypothesized that frequently reminded participants receiving the Internet program would report greater reduction in depression symptoms and greater improvements in mental and physical health functioning than a comparison group with usual treatment and no access to ODIN . Methods This was a three-arm r and omized control trial with a usual treatment control group and two ODIN intervention groups receiving reminders through postcards or brief telephone calls . The setting was a nonprofit health maintenance organization ( HMO ) . We mailed recruitment brochures by US post to two groups : adults ( n = 6030 ) who received depression medication or psychotherapy in the previous 30 days , and an age- and gender-matched group of adults ( n = 6021 ) who did not receive such services . At enrollment and at 5- , 10- and 16-weeks follow-up , participants were reminded by email ( and telephone , if nonresponsive ) to complete online versions of the Center for Epidemiological Studies Depression Scale ( CES-D ) and the Short Form 12 ( SF-12 ) . We also recorded participant HMO health care services utilization in the 12 months following study enrollment . Results Out of a recruitment pool of 12051 approached subjects , 255 persons accessed the Internet enrollment site , completed the online consent form , and were r and omized to one of the three groups : ( 1 ) treatment as usual control group without access to the ODIN website ( n = 100 ) , ( 2 ) ODIN program group with postcard reminders ( n = 75 ) , and ( 3 ) ODIN program group with telephone reminders ( n = 80 ) . Across all groups , follow-up completion rates were 64 % ( n = 164 ) at 5 weeks , 68 % ( n = 173 ) at 10 weeks , and 66 % ( n = 169 ) at 16 weeks . In an intention-to-treat analysis , intervention participants reported greater reductions in depression compared to the control group ( P = .03 ; effect size = 0.277 st and ard deviation units ) . A more pronounced effect was detected among participants who were more severely depressed at baseline ( P = .02 ; effect size = 0.537 st and ard deviation units ) . By the end of the study , 20 % more intervention participants moved from the disordered to normal range on the CES-D. We found no difference between the two intervention groups with different reminders in outcomes measures or in frequency of log-ons . We also found no significant intervention effects on the SF-12 or health care services . Conclusions In contrast to our earlier trial , in which participants were not reminded to use ODIN , in this trial we found a positive effect of the ODIN intervention compared to the control group . Future studies should address limitations of this trial , including relatively low enrollment and follow-up completion rates , and a restricted number of outcome measures . However , the low incremental costs of delivering this Internet program makes it feasible to offer this type of program to large population s with widespread Internet access OBJECTIVE Develop and pilot an Internet-facilitated cognitive-behavioral treatment intervention for depression , tailored to economically disadvantaged mothers of young children . METHOD Mothers ( N = 70 ) of children enrolled in Head Start , who reported elevated levels of depressive symptoms , were r and omized to either the 8-session , Internet-facilitated intervention ( Mom-Net ) or delayed intervention/facilitated treatment-as-usual ( DI/TAU ) . Outcomes were measured using the Beck Depression Inventory ( BDI-II ; Beck , Steer , & Brown , 1996 ) ; the Patient Health Question naire 9 ( PHQ-9 ; Spitzer et al. , 1999 ) , Behavioral Observations of Parent-Child Interactions using the  Living in Family Environments coding system  ( LIFE ; Hops , Davis , & Longoria , 1995 ) ; the  Dyadic Parent-Child Interaction Coding Systems  ( DPICS ; Eyberg , Nelson , Duke , & Boggs , 2005 ) ; the Parent Behavior Inventory ( PBI ; Lovejoy , Weis , O'Hare , & Rubin , 1999 ) ; and the Parenting Sense of Competence scale ( PSOC ; Gibaud-Wallston & W and ersman , 1978 ) . RESULTS Mom-Net demonstrated high levels of feasibility as indicated by low attrition and high program usage and satisfaction ratings . Participants in the Mom-Net condition demonstrated significantly greater reduction in depression , the primary outcome , at the level of both symptoms and estimates of criteria -based diagnoses over the course of the intervention . They also demonstrated significantly greater improvement on a question naire measure of parent satisfaction and efficacy as well as on both question naire and observational indices of harsh parenting behavior . CONCLUSIONS Initial results suggest that the Mom-Net intervention is feasible and efficacious as a remotely delivered intervention for economically disadvantaged mothers BACKGROUND Depression is associated with immense suffering and costs , and many patients receive inadequate care , often because of the limited availability of treatment . Web-based treatments may play an increasingly important role in closing this gap between dem and and supply . We developed the integrative , Web-based program Deprexis , which covers therapeutic approaches such as behavioral activation , cognitive restructuring , mindfulness/acceptance exercises , and social skills training . OBJECTIVE To evaluate the effectiveness of the Web-based intervention in a r and omized controlled trial . METHODS There were 396 adults recruited via Internet depression forums in Germany , and they were r and omly assigned in an 80:20 weighted r and omization sequence to either 9 weeks of immediate-program-access as an add-on to treatment-as-usual ( N = 320 ) , or to a 9-week delayed-access plus treatment-as-usual condition ( N = 76 ) . At pre- and post-treatment and 6-month follow-up , we measured depression ( Beck Depression Inventory ) as the primary outcome measure and social functioning ( Work and Social Adjustment Scale ) as the secondary outcome measure . Complete analyses and intention-to-treat analyses were performed . RESULTS Of 396 participants , 216 ( 55 % ) completed the post-measurement 9 weeks later . Available case analyses revealed a significant reduction in depression severity ( BDI ) , Cohen 's d = .64 ( CI 95 % = 0.33 - 0.94 ) , and significant improvement in social functioning ( WSA ) , Cohen 's d = .64 , 95 % ( CI 95 % = 0.33 - 0.95 ) . These improvements were maintained at 6-month follow-up . Intention-to-treat analyses confirmed significant effects on depression and social functioning improvements ( BDI : Cohen 's d = .30 , CI 95 % = 0.05 - 0.55 ; WSA : Cohen 's d = .36 , CI 95 % = 0.10 - 0.61 ) . Moreover , a much higher percentage of patients in the intervention group experienced a significant reduction of depression symptoms ( BDI : odds ratio [ OR ] = 6.8 , CI 95 % = 2.90 - 18.19 ) and recovered more often ( OR = 17.3 , 95 % CI 2.3 - 130 ) . More than 80 % of the users felt subjectively that the program had been helpful . CONCLUSIONS This integrative , Web-based intervention was effective in reducing symptoms of depression and in improving social functioning . Findings suggest that the program could serve as an adjunctive or st and -alone treatment tool for patients suffering from symptoms of depression INTRODUCTION Although depression can be treated effectively with Cognitive Behaviour Therapy ( CBT ) , only a small percentage of Chinese Australians access evidence -based treatment due to practical and cultural barriers . The present study examined the efficacy and acceptability of an Internet delivered CBT ( iCBT ) program to treat Chinese Australians with depression . METHODS The Chinese depression iCBT program ( the Brighten Your Mood Program ) is a culturally adapted version of the clinical ly efficacious Sadness iCBT Program . Fifty-five Chinese Australians with depression were r and omly allocated to either an immediate treatment group or to a waitlist control group . Treatment consisted of an 8 week program with 6 CBT online educational lessons , homework assignments , additional re sources presented in Chinese and English , and weekly telephone support with M and arin/Cantonese-speaking support personnel . An intention-to-treat model was used for data analyses . RESULTS Seventeen of twenty-five ( 68 % ) treatment group participants completed all lessons within the timeframe . Compared to controls , treatment group participants reported significantly reduced symptoms of depression on the Chinese versions of the Beck Depression Inventory ( CBDI ) and Patient Health Question naire-9 item ( CB-PHQ-9 ) . The within- and between-group effect sizes ( Cohen 's d ) were 1.41 and 0.93 on the CBDI , and 0.90 and 0.50 on the CB-PHQ-9 , respectively . Participants rated the procedure as acceptable , and gains were sustained at three-month follow-up . LIMITATIONS The study included several sub clinical participants and some measures that have not been previously vali date d with Chinese Australians . CONCLUSIONS Results provide preliminary support for the efficacy and acceptability of an iCBT program at reducing symptoms of depression in Chinese Australians BACKGROUND Previous studies in non clinical sample s have shown psychosocial treatments to be efficacious in the treatment of adolescent depression , but few psychotherapy treatment studies have been conducted in clinical ly referred , depressed adolescents . METHODS One hundred seven adolescent patients with DSM-III-R major depressive disorder ( MDD ) were r and omly assigned to 1 of 3 treatments : individual cognitive behavior therapy , systemic behavior family therapy ( SBFT ) , or individual nondirective supportive therapy ( NST ) . Treatments were 12 to 16 sessions provided in as many weeks . Intent-to-treat analyses were conducted using all follow-up data . RESULTS Of the 107 patients enrolled in the study , 78 ( 72.9 % ) completed the study , 4 ( 3.7 % ) never initiated treatment , 10 ( 9.3 % ) had exclusionary criteria that were undetected at entry , 8 ( 7.5 % ) dropped out , and 7 ( 6.5 % ) were removed for clinical reasons . Cognitive behavior therapy showed a lower rate of MDD at the end of treatment compared with NST ( 17.1 % vs 42.4 % ; P = .02 ) , and result ed in a higher rate of remission ( 64.7 % , defined as absence of MDD and at least 3 consecutive Beck Depression Inventory scores < 9 ) than SBFT ( 37.9 % ; P = .03 ) or NST ( 39.4 % ; p = .04 ) . Cognitive behavior therapy result ed in more rapid relief in interviewer-rated ( vs both treatments , P = .03 ) and self-reported depression ( vs SBFT , P = .02 ) . All 3 treatments showed significant and similar reductions in suicidality and functional impairment . Parents ' views of the credibility of cognitive behavior therapy improved compared with parents ' views of both SBFT ( P = .01 ) and NST ( P = .05 ) . CONCLUSIONS Cognitive behavior therapy is more efficacious than SBFT or NST for adolescent MDD in clinical setting s , result ing in more rapid and complete treatment response Internet-delivered psychological treatment of major depression  has been investigated in several trials , but the role of personalized treatment is less investigated . Studies suggest that guidance is important and that automated computerized programmes without therapist support are less effective . Individualized e-mail therapy for depression has not been studied in a controlled trial . Eighty-eight individuals with major depression were r and omized to two different forms of Internet-delivered cognitive behaviour therapy ( CBT ) , or to a waiting-list control group . One form of Internet treatment consisted of guided self-help , with weekly modules and homework assignments . St and ard CBT components were presented and brief support was provided during the treatment . The other group received e-mail therapy , which was tailored and did not use the self-help texts i.e. , all e-mails were written for the unique patient . Both treatments lasted for 8 weeks . In the guided self-help 93 % completed ( 27/29 ) and in the e-mail therapy 96 % ( 29/30 ) completed the posttreatment assessment . Results showed significant symptom reductions in both treatment groups with moderate to large effect sizes . At posttreatment 34.5 % of the guided self-help group and 30 % of the e-mail therapy group reached the criteria of high-end-state functioning ( Beck Depression Inventory score below 9 ) . At six-month follow-up the corresponding figures were 47.4 % and 43.3 % . Overall , the difference between guided self-help and e-mail therapy was small , but in favour of the latter . These findings indicate that both guided self-help and individualized e-mail therapy can be effective Background Internet-delivered interventions can effectively change health risk behaviors and their determinants , but adherence to these interventions once they are accessed is very low . Therefore , it is relevant and necessary to systematic ally manipulate website characteristics to test their effect on website use . This study focuses on user control as a website characteristic . Objective To test whether and how user control ( the freedom of choice to skip pages ) can increase website use and knowledge gained from the website . Methods Participants older than 18 years were drawn from the Dutch Internet population ( in June 2011 ) and completed a hepatitis knowledge question naire . Subsequently , they were r and omly assigned to three groups : ( 1 ) a tunneled version of the website with less user control ; ( 2 ) a high user control version of the website where visitors had the freedom of choice to skip pages ; and ( 3 ) a control group that was not exposed to the website . Participants completed ( 1 ) a question naire of vali date d measures regarding user perceptions immediately after exposure to the website ( except for the control group ) , and ( 2 ) a  hepatitis knowledge question naire after one week to test whether participants in the experimental groups only clicked through the website or actually processed and learned its content . Server registration s were used to assess website use . Analyses of covariance ( ANCOVA ) using all available data were conducted to determine whether user control increases website use . Structural equation models ( SEM ) using all available data were constructed to test how user control increases website use — a latent variable derived from number of pages visited and time on website . Results Of the 1044 persons invited to participate , 668 took part ( 668/1044 , 64.0 % ) . One half of participants ( 332/668 49.7 % ) were female and the mean age was 49 years ( SD 16 ) . A total of 571 participants completed the one-week follow-up measure regarding hepatitis knowledge ( 571/668 , 85.5 % ) . The findings demonstrate that having less user control ( ie , a tunneled version of the website ) had a negative effect on users ’ perception of efficiency ( F1,452 = 97.69 , P < .001 ) , but a positive effect on number of pages visited ( F1,452 = 171.49 , P < .001 ) , time on the website ( F1,452 = 6.32 , P = .01 ) , and knowledge gained from the website ( F1,452 = 134.32 , P < .001 ) . The direct effect of having less user control appeared to surpass the effect mediated by efficiency , because website use was higher among participants exposed to the tunneled version of the website in comparison with those having the freedom of choice to skip pages . Conclusions The key finding that visitors demonstrated increased website use in the tunneled version of the website indicates that visitors should be carefully guided through the intervention for future intervention websites BACKGROUND Internet-delivered treatments for depression have proved successful , with supported programs offering the potential for improved adherence and outcomes . Internet interventions are particularly interesting in the context of increasing access to interventions , and delivering interventions population -wide . METHODS The study was a r and omized controlled trial of an 7-module internet-delivered cognitive behavioral therapy ( iCBT ) program  for adults with depressive symptoms ( n = 96 ) compared to a waiting-list control group ( n = 92 ) . Participants received weekly support from a trained supporter . The primary outcome was depressive symptoms as measured by the Beck Depression Inventory ( BDI-II ) . The program was made available nationwide from an established and recognized charity for depression . RESULTS For the treatment group , post-treatment effect sizes reported were large for the primary outcome measure ( d = 0.91 ) . The between-group effects were moderate to large and statistically significant for the primary outcomes ( d = 0.50 ) favoring the treatment group . Gains were maintained at 6-month follow-up . CONCLUSION The study has demonstrated the efficacy of the internet-delivered Space from Depression treatment . Participants demonstrated reliable and statistically significant changes in symptoms from pre-to post-intervention . The study supports a model for delivering online depression interventions population -wide using trained supporters . TRIAL REGISTRATION NUMBER Current Controlled Trials IS RCT N03704676 . http://dx.doi.org/10.1186/IS RCT N03704676 PURPOSE The Internet offers a potential medium for delivering smoking cessation treatment to adolescents . However , few Internet-based cessation programs for adolescents have been evaluated . We describe adolescent use of a  home-based Internet intervention to stop smoking ( Stomp Out Smokes [ SOS ] ) and explore baseline characteristics associated with SOS use . METHODS Participants were 70 adolescent smokers aged 12 - 18 years ( 50 % female , 90 % Caucasian ) r and omized to receive the SOS intervention for 24 weeks as part of a larger clinical trial . SOS comprised 40 components , of which eight were primarily interactive ( e.g. , discussion support group , ask an expert , quit plan ) and 32 were primarily informational ( e.g. , managing withdrawal , medications to stop smoking ) . SOS use data were captured electronically , including total logins to the site , and type of SOS components used defined by page hits on the interactive and information components . RESULTS A total of 7,708 SOS website pages ( 6825 interactive and 883 informational ) were accessed over the 24 weeks . The highest proportion of page hits was for the discussion support group ( 35 % ) and quit plan ( 30 % ) . Interactive pages were significantly more likely to be used than informational pages ( median 65 vs. 6 , p < .001 ) . Males accessed fewer interactive pages compared with females ( p = .04 ) . No other baseline characteristics were univariately associated with total logins or use of informational or interactive pages . CONCLUSIONS Adolescent smokers most often used a discussion support group and other interactive Internet-based cessation components . Future studies design ed to increase adolescent use , and efficacy of , Internet-based cessation programs are warranted Background Most patients with mild to moderate depression receive treatment in primary care , but despite guideline recommendations , structured psychological interventions are infrequently delivered . Research supports the effectiveness of Internet-based treatment for depression ; however , few trials have studied the effect of the MoodGYM program plus therapist support . The use of such interventions could improve the delivery of treatment in primary care . Objective To evaluate the effectiveness and acceptability of a guided Web-based intervention for mild to moderate depression , which could be suitable for implementation in general practice . Methods Participants ( N=106 ) aged between 18 and 65 years were recruited from primary care and r and omly allocated to a treatment condition comprising 6 weeks of therapist-assisted Web-based cognitive behavioral therapy ( CBT ) , or to a 6-week delayed treatment condition . The intervention included the Norwegian version of the MoodGYM program , brief face-to-face support from a psychologist , and reminder emails . The primary outcome measure , depression symptoms , was measured by the Beck Depression Inventory-II ( BDI-II ) . Secondary outcome measures included the Beck Anxiety Inventory ( BAI ) , the Hospital Anxiety and Depression Scale ( HADS ) , the Satisfaction with Life Scale ( SWLS ) , and the EuroQol Group 5-Dimension Self-Report Question naire ( EQ-5D ) . All outcomes were based on self-report and were assessed at baseline , postintervention , and at 6-month follow-up . Results Postintervention measures were completed by 37 ( 71 % ) and 47 ( 87 % ) of the 52 participants in the intervention and 54 participants in the delayed treatment group , respectively . Linear mixed-models analyses revealed a significant difference in time trends between the groups for the BDI-II , ( P=.002 ) , for HADS depression and anxiety subscales ( P<.001 and P=.001 , respectively ) , and for the SWLS ( P<.001 ) . No differential group effects were found for the BAI and the EQ-5D . In comparison to the control group , significantly more participants in the intervention group experienced recovery from depression as measured by the BDI-II . Of the 52 participants in the treatment program , 31 ( 60 % ) adhered to the program , and overall treatment satisfaction was high . The reduction of depression and anxiety symptoms was largely maintained at 6-month follow-up , and positive gains in life satisfaction were partly maintained . Conclusions The intervention combining MoodGYM and brief therapist support can be an effective treatment of depression in a sample of primary care patients . The intervention alleviates depressive symptoms and has a significant positive effect on anxiety symptoms and satisfaction with life . Moderate rates of nonadherence and predominately positive evaluations of the treatment also indicate the acceptability of the intervention . The intervention could potentially be used in a stepped-care approach , but remains to be tested in regular primary health care . Trial Registration Australian New Zeal and Clinical Trials Registry : ACTRN12610000257066 ; http://apps.who.int/trial search /trial.aspx?trialid = ACTRN12610000257066 ( Archived by WebCite at http://www.webcitation.org/6Ie3YhIZa ) The aim of this study was to evaluate the effectiveness of a computer-tailored physical activity intervention delivered through the Internet in a real-life setting . Healthy adults ( n=526 ) , recruited in six worksites , between 25 and 55 years of age were r and omized to one of three conditions receiving , respectively , ( i ) online-tailored physical activity advice + stage-based reinforcement e-mails , ( ii ) online-tailored physical activity advice only , ( iii ) online non-tailored st and ard physical activity advice . At 6-month follow-up , no differences in physical activity between study conditions were found ; total physical activity , physical activity at moderate intensity and physical activity in leisure time significantly increased in all study conditions between baseline and follow-up . Further evaluation of the intervention material s showed that the tailored advice was more read , printed and discussed with others than the st and ard advice . Most of the respondents in the e-mail group indicated to be satisfied about the number , frequency and usefulness of the stage-based e-mails . In conclusion , although tailored advice was appreciated more than st and ard advice , no evidence was found that an online-tailored physical activity intervention program outperformed online st and ard information Background Depression is a common comorbidity in individuals with cognitive impairment . Those with cognitive impairments face unique challenges in receiving the benefits of many conventional therapies for depression , and may have poorer outcomes in areas such as recovery and quality of life . However , the stigmatization of mental health disorders , cost barriers and physical disabilities may prevent these individuals from seeking mental health care . An online , self-help intervention specifically developed for adults with cognitive deficits and depression may be particularly beneficial to this population . We aim to inform the design of such an intervention through a systematic review by answering the following research question : among adults with cognitive impairment ( including those with acquired brain injuries or neurodegenerative diseases ) , which technology-amenable interventions have been shown to effectively decrease symptoms of depression ? Specifically , psychotherapeutic and /or behavioural interventions that could be delivered in a self-guided , online system will be included . Methods Comprehensive electronic search es will be conducted in MEDLINE , EMBASE , PsycINFO and CINAHL . Additional studies will be obtained through manually search ing the references of relevant systematic review s , contacting primary authors of select articles and tracking conference proceedings and trial registries . Article titles and abstract s will be screened using predefined eligibility criteria , and then judged for their amenability to the proposed self-help , technology-based intervention . The full text of those articles with selected interventions will then be screened to determine final eligibility for inclusion . Included articles will be categorized by intervention type and assessed for risk of bias using the Cochrane Effective Practice and Organization of Care Risk of Bias tool for non-r and omized trials , controlled before-after studies and interrupted time series . The primary outcome will be a change in score on a vali date d depression scale , and adverse events will be documented as a secondary outcome . After data extraction from selected articles , pooling of data and meta- analysis will be conducted if a sufficient pool of studies with comparable methodology and quality are identified . Alternatively , plain language summaries will be developed . The quality of evidence will be assessed using the Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) system . Systematic review registration PROSPERO The sizeable percentage of adults who use smokeless tobacco ( ST ) represents an important public health target since the majority of ST users have a strong desire to quit , but many lack re sources . We tested the impact of an interactive , tailored Web-based intervention ( Enhanced Condition ) versus a more linear , text-based website ( Basic Condition ) in a r and omized trial with 2523 adult ST users . As is common in Internet-based research , there was considerable attrition : follow-up rates at 3 months , 6 months , and for both 3 and 6 months were 48 % , 45 % and 34 % , respectively . Results using repeated point prevalence of all tobacco use at 3 and 6 months showed that participants in the Enhanced Condition quit at significantly higher rates than those in the Basic Condition . Using a Complete Case analysis , abstinence was 40.6 % in the Enhanced Condition vs. 21.2 % in the Basic Condition ( p < .001 ) . Using intent-to-treat analysis , quit rates were 12.6 % vs. 7.9 % , respectively ( p < .001 ) . Similar results were obtained for only ST use . Unobtrusive measures of program exposure indicated that program use was significantly related to outcome as well as to attrition . We conclude that a tailored , interactive Web-assisted cessation program can be an efficacious method for assisting adult ST users to quit Background In r and omized controlled trials Internet sites have been shown to be effective in the treatment of  depression and anxiety .  However , it is unclear if the positive effects demonstrated in these trials transfer to community users of such sites . Objective To compare anxiety and depression outcomes for spontaneous visitors to a publicly accessible cognitive behavior therapy website ( MoodGYM ) ( http://moodgym.anu.edu.au ) with outcomes achieved through a r and omized controlled efficacy trial of the same site . Methods All community visitors to the MoodGYM site between April 2001 and September 2003 were sample d : 182 participants in the BlueMood Trial who had been r and omly assigned to the MoodGYM site as part of a large trial and 19607 visitors ( public registrants ) to the site .  Symptom assessment s ( quizzes ) were repeated within the website intervention to allow the examination of change in symptoms across modules . Outcome variables were ( 1 ) age , gender , initial depression severity scores , and number of assessment s attempted , and ( 2 ) symptom change measures based on Goldberg anxiety and depression scores recorded on a least two occasions . Results Public registrants did not differ from trial participants in gender , age , or initial level of depression , which was high for both groups relative to previously published epidemiological data sets . Trial participants completed more assessment s. No significant differences in anxiety or depression change scores were observed , with both public registrants and trial participants improving through the training program . Conclusions Public registrants to a cognitive behavior therapy website show significant change in anxiety and depression symptoms . The extent of change does not differ from that exhibited by participants enrolled on the website for a r and omized controlled trial OBJECTIVE The aim of this study was to examine the sensitivity and specificity of the suicide item on the  9-item Patient Health Question naire ( PHQ-9 ) when compared to a structured interview ( the Structured Clinical Interview for DSM-IV ; SCID-I mood module ) in primary care patients with elevated depression symptoms . METHOD In this cross-sectional study , we analyzed data from 166 patients from 2 primary care clinics , 1 in Rhode Isl and and 1 in Massachusetts , who were enrolled in studies that focused on depression in primary care . Of the total participants , 101 were enrolled in the survey study , and 65 were screened for or enrolled in either an open trial or a pilot r and omized controlled trial . Data were collected between May 2004 and May 2009 . RESULTS We found that the specificity of the PHQ-9 suicide screening item was 0.84 and sensitivity was 0.69 for the sample as a whole . CONCLUSIONS This study suggests that the routine use of the PHQ-9 may be useful in primary care practice in that it may identify individuals at risk for suicide who would not otherwise have been identified . However , denial of suicidality on the PHQ-9 should be probed further if there are other risk factors for suicide present . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00541957 Introduction Help4Mood is an interactive system with an embodied virtual agent ( avatar ) to assist in self-monitoring of patients receiving treatment for depression .  Help4Mood supports self-report and biometric monitoring and includes elements of cognitive behavioural therapy . We aim ed to evaluate system use and acceptability , to explore likely recruitment and retention rates in a clinical trial and to obtain an estimate of potential treatment response with a view to conducting a future r and omised controlled trial ( RCT ) . Methods We conducted a pilot RCT of Help4Mood in three centres , in Romania , Spain and Scotl and , UK . Patients with diagnosed depression ( major depressive disorder ) and current mild/moderate depressive symptoms were r and omised to use the system for four weeks in addition to treatment as usual ( TAU ) or to TAU alone . Results Twenty-seven individuals were r and omised and follow-up data were obtained from 21 participants ( 12/13 Help4Mood , 9/14 TAU ) . Half of participants r and omised to Help4Mood used it regularly ( more than 10 times ) ; none used it every day . Acceptability varied between users . Some valued the emotional responsiveness of the system , while others found it too repetitive . Intention to treat analysis showed a small difference in change of Beck Depression Inventory II ( BDI-2 ) scores  ( Help4Mood –5.7 points , TAU –4.2 ) . Post-hoc on-treatment analysis suggested that participants who used Help4Mood regularly experienced a median change in BDI-2 of –8 points . Conclusion Help4Mood is acceptable to some patients receiving treatment for depression although none used it as regularly as intended . Changes in depression symptoms in individuals who used the system regularly reached potentially meaningful levels Low-intensity interventions for people suffering from depressive symptoms are highly desirable . The aim of the present study was to investigate the outcomes of a web-based acceptance and commitment therapy (ACT)–based intervention without face-to-face contact for people suffering from depressive symptoms . Participants ( N = 39 ) with depressive symptoms were r and omly assigned to an Internet-delivered acceptance and commitment therapy ( iACT ) intervention or a waiting list control condition ( WLC ) . Participants were evaluated with st and ardized self-reporting measures ( Beck Depression Inventory [ BDI-II ] , Symptom Checklist–90 [ SCL-90 ] , Acceptance and Action Question naire [ AAQ-2 ] , Five Facet Mindfulness Question naire [ FFMQ ] , Automatic Thoughts Question naire [ ATQ ] , and White Bear Suppression Inventory [ WBSI ] ) at pre- and post-measurement . Long-term effects in the iACT group were examined using a 12-month follow-up . The iACT program comprised home assignments , online feedback given by master’s-level students of psychology over a 7-week intervention period , and automated email-based reminders . Significant effects were observed in favor of the iACT group on depression symptomatology ( between effect sizes [ ESs ] at post-treatment , iACT/WLC , g = .83 ) , psychological and physiological symptoms ( g = .60 ) , psychological flexibility ( g = .67 ) , mindfulness skills ( g = .53 ) , and frequency of automatic thoughts ( g = .57 ) as well as thought suppression ( g = .53 ) . The treatment effects in the iACT group were maintained over the 12-month follow-up period ( within-iACT ES : BDI-II , g = 1.33 ; SCL-90 , g = 1.04 ; ATQF/B [ Frequency/Believability ] , FFMQ , WBSI , AAQ-II , g = .74 - 1.08 ) . The iACT participants stated that they would be happy to recommend the same intervention to others with depressive symptoms . We conclude that an ACT-based guided Internet-delivered treatment with minimal contact can be effective for people with depressive symptoms AIMS To evaluate computer- versus therapist-delivered psychological treatment for people with comorbid depression and alcohol/cannabis use problems . DESIGN R and omized controlled trial . SETTING Community-based participants in the Hunter Region of New South Wales , Australia . PARTICIPANTS Ninety-seven people with comorbid major depression and alcohol/cannabis misuse . INTERVENTION All participants received a brief intervention ( BI ) for depressive symptoms and substance misuse , followed by r and om assignment to : no further treatment ( BI alone ) ; or nine sessions of motivational interviewing and cognitive behaviour therapy ( intensive MI/CBT ) . Participants allocated to the intensive MI/CBT condition were selected at r and om to receive their treatment ' live ' ( i.e. delivered by a psychologist ) or via a computer-based program ( with brief weekly input from a psychologist ) . MEASUREMENTS Depression , alcohol/cannabis use and hazardous substance use index scores measured at baseline , and 3 , 6 and 12 months post-baseline assessment . FINDINGS ( i ) Depression responded better to intensive MI/CBT compared to BI alone , with ' live ' treatment demonstrating a strong short-term beneficial effect which was matched by computer-based treatment at 12-month follow-up ; ( ii ) problematic alcohol use responded well to BI alone and even better to the intensive MI/CBT intervention ; ( iii ) intensive MI/CBT was significantly better than BI alone in reducing cannabis use and hazardous substance use , with computer-based therapy showing the largest treatment effect . CONCLUSIONS Computer-based treatment , targeting both depression and substance use simultaneously , results in at least equivalent 12-month outcomes relative to a ' live ' intervention . For clinicians treating people with comorbid depression and alcohol problems , BIs addressing both issues appear to be an appropriate and efficacious treatment option . Primary care of those with comorbid depression and cannabis use problems could involve computer-based integrated interventions for depression and cannabis use , with brief regular contact with the clinician to check on progress Depression presents a serious condition for the individual and a major challenge to health care and society . Internet-based cognitive behavior therapy ( ICBT ) is a treatment option supported in several trials , but there is as yet a lack of effective studies of ICBT in “ real world ” primary care setting s. We examined whether ICBT differed from treatment-as-usual ( TAU ) in reducing depressive symptoms after 3 months . TAU comprised of visits to general practitioner , registered nurse , antidepressant drugs , waiting list for , or psychotherapy , or combinations of these alternatives . Patients , aged ≥ 18 years , who tentatively met criteria for mild to moderate depression at 16 primary care centers in the south-western region of Sweden were recruited and then assessed in a diagnostic interview . A total of 90 patients were r and omized to either TAU or ICBT . The ICBT treatment included interactive elements online , a workbook , a CD with mindfulness and acceptance exercises , and minimal therapist contact . The treatment period lasted for 12 weeks after which both groups were assessed . The main outcome measure was Beck Depression Inventory-II ( BDI-II ) . Additional measures were Montgomery Åsberg Depression Rating Scale – self rating version ( MADRS-S ) and Beck Anxiety Inventory ( BAI ) . The analyses revealed no significant difference between the two groups at post treatment , neither on BDI-II , MADRS-S , nor BAI . Twenty patients ( 56 % ) in the ICBT treatment completed all seven modules . Our findings suggest that ICBT may be successfully delivered in primary care and that the effectiveness , after 3 months , is at par with TAU Background Internet-delivered mental health ( eMental Health ) interventions produce treatment effects similar to those observed in face-to-face treatment . However , there is a large degree of variation in treatment effects observed from program to program , and eMental Health interventions remain somewhat of a black box in terms of the mechanisms by which they exert their therapeutic benefit . Trials of eMental Health interventions typically use large sample sizes and therefore provide an ideal context within which to systematic ally investigate the therapeutic benefit of specific program features . Furthermore , the growth and impact of mobile phone technology within eMental Health interventions provides an opportunity to examine associations between symptom improvement and the use of program features delivered across computer and mobile phone platforms . Objective The objective of this study was to identify the patterns of program usage associated with treatment outcome in a r and omized controlled trial ( RCT ) of a fully automated , mobile phone- and Web-based self-help program , “ myCompass ” , for individuals with mild-to-moderate symptoms of depression , anxiety , and /or stress . The core features of the program include interactive psychotherapy modules , a symptom tracking feature , short motivational messages , symptom tracking reminders , and a diary , with many of these features accessible via both computer and mobile phone . Methods Patterns of program usage were recorded for 231 participants with mild-to-moderate depression , anxiety , and /or stress , and who were r and omly allocated to receive access to myCompass for seven weeks during the RCT .  Depression , anxiety , stress , and functional impairment were examined at baseline and at eight weeks . Results Log data indicated that the most commonly used components were the short motivational messages ( used by 68.4 % , 158/231 of participants ) and the symptom tracking feature ( used by 61.5 % , 142/231 of participants ) . Further , after controlling for baseline symptom severity , increased use of these alert features was associated with significant improvements in anxiety and functional impairment . Associations between use of symptom tracking reminders and improved treatment outcome remained significant after controlling for frequency of symptom tracking . Although correlations were not statistically significant , reminders received via SMS ( ie , text message ) were more strongly associated with symptom reduction than were reminders received via email . Conclusions These findings indicate that alerts may be an especially potent component of eMental Health interventions , both via their association with enhanced program usage , as well as independently . Although there was evidence of a stronger association between symptom improvement and use of alerts via the mobile phone platform , the degree of overlap between use of email and SMS alerts may have precluded identification of alert delivery modalities that were most strongly associated with symptom reduction . Future research using r and om assignment to computer and mobile delivery is needed to fully determine the most ideal platform for delivery of this and other features of online interventions . Trial Registration Australian New Zeal and Clinical Trials Registry ( ACTRN ) : 12610000625077 ; http://www.anzctr.org.au/Trial Search .aspx ? ( Archived by WebCite http://www.webcitation.org/6WPqHK0mQ ) OBJECTIVES Underst and ing the gap between people 's intentions and actual health behavior is an important issue in health psychology . Our aim in this study was to investigate whether self-regulatory processes ( monitoring goal progress and responding to discrepancies ) mediate the intention-behavior relation in relation to HIV medication adherence ( Study 1 ) and intensive exercise behavior ( Study 2 ) . METHOD In Study 1 , question naire and electronically monitored adherence data were collected at baseline and 3 months later from patients in the control arm of an HIV-adherence intervention study . In Study 2 , question naire data was collected at 3 time points 6-weeks apart in a cohort study of physical activity . RESULTS Complete data at all time points were obtained from 51 HIV-infected patients and 499 intensive exercise participants . Intentions were good predictors of behavior and explained 25 to 30 % of the variance .  Self-regulatory processes explained an additional 11 % ( Study 1 ) and 6 % ( Study 2 ) of variance in behavior on top of intentions . Regression and bootstrap analyses revealed at least partial , and possibly full , mediation of the intention-behavior relation by self-regulatory processes . CONCLUSIONS The present studies indicate that self-regulatory processes may explain how intentions drive behavior . Future tests , using different health behaviors and experimental design s , could firmly establish whether self-regulatory processes complement current health behavior theories and should become routine targets for intervention . ( PsycINFO Data base Record ( c ) 2012 APA , all rights reserved ) Background and Aims Major depression can be treated by means of cognitive behavior therapy , delivered via the Internet as guided self-help . Individually tailored guided self-help treatments have shown promising results in the treatment of anxiety disorders . This r and omized controlled trial tested the efficacy of an Internet-based individually tailored guided self-help treatment which specifically targeted depression with comorbid symptoms . The treatment was compared both to st and ardized ( non-tailored ) Internet-based treatment and to an active control group in the form of a monitored online discussion group . Both guided self-help treatments were based on cognitive behavior therapy and lasted for 10 weeks . The discussion group consisted of weekly discussion themes related to depression and the treatment of depression . Methods A total of 121 participants with diagnosed major depressive disorder and with a range of comorbid symptoms were r and omized to three groups . The tailored treatment consisted of a prescribed set of modules targeting depression as well as comorbid problems . The st and ardized treatment was a previously tested guided self-help program for depression . Results From pre-treatment to post-treatment , both treatment groups improved on measures of depression , anxiety and quality of life . The results were maintained at a 6-month follow-up . Subgroup analyses showed that the tailored treatment was more effective than the st and ardized treatment among participants with higher levels of depression at baseline and more comorbidity , both in terms of reduction of depressive symptoms and on recovery rates . In the subgroup with lower baseline scores of depression , few differences were seen between treatments and the discussion group . Conclusions This study shows that tailored Internet-based treatment for depression is effective and that addressing comorbidity by tailoring may be one way of making guided self-help treatments more effective than st and ardized approaches in the treatment of more severe depression . Trial Registration Clinical trials.gov Background Self-help or self-management strategies are commonly used to deal with depression , but not all are thought to be helpful . A previous study found that sub-threshold depression symptoms were improved by an e-mail intervention that encouraged the use of evidence -based self-help strategies . Aim To investigate whether these e-mails were effective for adults with a range of depression symptomatology including major depression . Method The study was a parallel-group r and omised controlled trial . Adult participants with any level of depressive symptoms were recruited over the internet from the United Kingdom , Australia , Canada , Irel and , New Zeal and and the United States . Participants were r and omised to receive a series of e-mails either promoting the use of evidence -based self-help strategies or containing depression information as a control . E-mails were sent automatically twice a week for six weeks . Depression symptoms were assessed with the self-rated Patient Health Question naire depression scale ( PHQ-9 ) . Results 1736 participants with a wide range of symptom severity were recruited and assigned to active ( n = 862 ) and control ( n = 874 ) groups . However , there was a significant attrition rate , with 66.9 % lost to follow-up at post-intervention . Both groups showed large improvements in depression symptoms overall , with no significant difference in improvement at the end of the study ( mean difference in improvement 0.35 points , 95 % CI : −0.57 to 1.28 , d = 0.11 , 95 % CI : −0.06 to 0.27 ) , although there was a small effect at the study mid-point . Results were similar for the sub-group of participants with major depression . The active group showed small to moderate improvements in self-help behaviour ( d = 0.40 , 95 % CI : 0.23 to 0.56 ) . Conclusions These results suggest that the e-mails were able to increase participants ’ use of evidence -based self-help , but that this did not improve depression more than an attention control . Clinical Trials.gov Background This paper reports the results of a pilot r and omized controlled trial comparing the delivery modality ( mobile phone/tablet or fixed computer ) of a cognitive behavioural therapy intervention for the treatment of depression . The aim was to establish whether a previously vali date d computerized program ( The Sadness Program ) remained efficacious when delivered via a mobile application . Method 35 participants were recruited with Major Depression ( 80 % female ) and r and omly allocated to access the program using a mobile app ( on either a mobile phone or iPad ) or a computer . Participants completed 6 lessons , weekly homework assignments , and received weekly email contact from a clinical psychologist or psychiatrist until completion of lesson 2 . After lesson 2 email contact was only provided in response to participant request , or in response to a deterioration in psychological distress scores . The primary outcome measure was the Patient Health Question naire 9 ( PHQ-9 ) . Of the 35 participants recruited , 68.6 % completed 6 lessons and 65.7 % completed the 3-months follow up . Attrition was h and led using mixed-model repeated- measures ANOVA . Results Both the Mobile and Computer Groups were associated with statistically significantly benefits in the PHQ-9 at post-test . At 3 months follow up , the reduction seen for both groups remained significant . Conclusions These results provide evidence to indicate that delivering a CBT program using a mobile application , can result in clinical ly significant improvements in outcomes for patients with depression . Trial registration Australian New Zeal and Clinical Trials Registry ACTRN Background There is need for more cost and time effective treatments for depression . This is the first r and omised controlled trial in which a blended treatment - including four face-to-face sessions and a smartphone application - was compared against a full behavioural treatment . Hence , the aim of the current paper was to examine whether a blended smartphone treatment was non-inferior to a full behavioural activation treatment for depression . Methods This was a r and omised controlled non-inferiority trial ( NCT01819025 ) comparing a  blended treatment ( n=46 ) against a full ten-session treatment ( n=47 ) for people suffering from major depression . Primary outcome measure was the BDI-II , that was administered at pre- and post-treatment , as well as six months after the treatment . Results Results showed significant improvements in both groups across time on the primary outcome measure ( within-group Cohen ’s d=1.35 ; CI [ −0.82 , 3.52 ] to d=1.47 ; CI [ −0.41 , 3.35 ] ; between group d=−0.13 CI [ −2.37 , 2.09 ] and d=−0.10 CI [ −2.53 , 2.33 ] ) . At the same time , the blended treatment reduced the therapist time with an average of 47 % . Conclusions We could not establish whether the blended treatment was non-inferior to a full BA treatment . Nevertheless , this study points to that the blended treatment approach could possibly treat nearly twice as many patients suffering from depression by using a smartphone applica¬tion as add-on . More studies are needed before we can suggest that the blended treatment method is a promising cost-effective alternative to regular face-to-face treatment for depression . Trial Registration Cognitive Behavioral Therapy Treatment of Depression With Smartphone Support BACKGROUND Mobile phone text message technology has the potential to improve outcomes for patients with depression and co-morbid Alcohol Use Disorder ( AUD ) . AIMS To perform a r and omised rater-blinded trial to explore the effects of supportive text messages on mood and abstinence outcomes for patients with depression and co-morbid AUD . METHODS Participants ( n=54 ) with a DSM IV diagnosis of unipolar depression and AUD who completed an in-patient dual diagnosis treatment programme were r  and omised to receive twice daily supportive text messages ( n=26 ) or a fortnightly thank you text message ( n=28 ) for three months . Primary outcome measures were Beck 's Depression Inventory ( BDI-II ) scores and Cumulative Abstinence Duration ( CAD ) in days at three months . TRIAL REGISTRATION NCT0137868 . RESULTS There was a statistically significant difference in three month BDI-II scores between the intervention and control groups ; 8.5 ( SD=8.0 ) vs. 16.7 ( SD=10.3 ) respectively after adjusting for the baseline scores , F ( 1 , 49)=9.54 , p=0.003 , η(p)(2)=0.17 . The mean difference in change BDI-II scores was -7.9 ( 95 % CI -13.06 to -2.76 , Cohen'sd=0.85 ) . There was a trend for a greater CAD in the text message group than the control group : 88.3 ( SD=6.2 ) vs. 79.3 ( SD=24.1 ) , t=1.78 , df=48 , p=0.08 . LIMITATIONS Limitations of the study include the small sample size , the potential for loss of rater blinding and the lack of long term follow-up to determine the longer term effects of the intervention . CONCLUSION Supportive text messages have the potential to improve outcomes for patients with comorbid depression and alcohol dependency syndrome BACKGROUND Despite strong evidence for its effectiveness , cognitive-behavioural therapy ( CBT ) remains difficult to access . Computerised programs have been developed to improve accessibility , but whether these interventions are responsive to individual needs is unknown . We investigated the effectiveness of CBT delivered online in real time by a therapist for patients with depression in primary care . METHODS In this multicentre , r and omised controlled trial , 297 individuals with a score of 14 or more on the Beck depression inventory ( BDI ) and a confirmed diagnosis of depression were recruited from 55 general practice s in Bristol , London , and Warwickshire , UK . Participants were r and omly assigned , by a computer-generated code , to online CBT in addition to usual care ( intervention ; n=149 ) or to usual care from their general practitioner while on an 8-month waiting list for online CBT ( control ; n=148 ) . Participants , research ers involved in recruitment , and therapists were masked in advance to allocation . The primary outcome was recovery from depression ( BDI score < 10 ) at 4 months . Analysis was by intention to treat . This trial is registered , number IS RCT N 45444578 . FINDINGS 113 participants in the intervention group and 97 in the control group completed 4-month follow-up . 43 ( 38 % ) patients recovered from depression ( BDI score < 10 ) in the intervention group versus 23 ( 24 % ) in the control group at 4 months ( odds ratio 2.39 , 95 % CI 1.23 - 4.67 ; p=0.011 ) , and 46 ( 42 % ) versus 26 ( 26 % ) at 8 months ( 2.07 , 1.11 - 3.87 ; p=0.023 ) . INTERPRETATION CBT seems to be effective when delivered online in real time by a therapist , with benefits maintained over 8 months . This method of delivery could broaden access to CBT . FUNDING BUPA Foundation OBJECTIVE To investigate use and views of a Web site design ed for weight control . DESIGN Question naire-based evaluation with data collected at baseline , 6 months , and 12 months . SETTING Data were collected as part of a community-based , r and omized controlled trial . PARTICIPANTS Subjects ( n = 111 ) were participants of the intervention arm of a r and omized controlled trial evaluating effectiveness of a Web site design ed for weight control in an obese sample . INTERVENTION Participants were asked to use the intervention Web site for weight control over a 12-month period . MAIN OUTCOME MEASURE(S ) Participants were asked to report their use and views of the Web site . In addition , use of the Web site was automatically recorded on logging onto the Web site . ANALYSIS Descriptive statistics , factor analysis . RESULTS Fifty-nine participants ( 53 % ) reported using the Web site at 6 months , with 32 participants ( 29 % ) still using it at 12 months . The average time spent on the Web site per visit was 21.1 minutes ( SD = 16.6 ) at 6 months and 13.6 minutes ( SD = 9.3 ) at 12 months , with an average number of logons of 15.8 ( SD = 15.2 ) over the trial period . In general , satisfaction scores for the Web site were positive . Scores for ability of the re source to encourage positive behavior change for weight control were marginally negative . Social support sections of the Web site were used least and received the lowest satisfaction ratings . CONCLUSIONS AND IMPLICATION S Despite positive satisfaction scores , use of the re source was limited . It is expected that participants ' limited ability to use the Internet may have limited the use of the re source and consequently reduced the social support available to participants . Future investigation of the views and use patterns of current users of Internet-based weight loss re sources would help inform future development of such tools BACKGROUND AND AIMS In the past decade , a large body of research has demonstrated that internet-based interventions can have beneficial effects on depression . However , only a few clinical trials have compared internet-based depression therapy with an equivalent face-to-face treatment . The primary aim of this study was to compare treatment outcomes of an internet-based intervention with a face-to-face intervention for depression in a r and omized non-inferiority trial . METHOD A total of 62 participants suffering from depression were r and omly assigned to the  therapist-supported internet-based intervention group ( n=32 ) and to the face-to-face intervention ( n=30 ) . The 8 week interventions were based on cognitive-behavioral therapy principles . Patients in both groups received the same treatment modules in the same chronological order and time-frame . Primary outcome measure was the Beck Depression Inventory-II ( BDI-II ) ; secondary outcome variables were suicidal ideation , anxiety , hopelessness and automatic thoughts . RESULTS The intention-to-treat analysis yielded no significant between-group difference ( online vs. face-to-face group ) for any of the pre- to post-treatment measurements . At post-treatment both treatment conditions revealed significant symptom changes compared to before the intervention . Within group effect sizes for depression in the online group ( d=1.27 ) and the face-to-face group ( d=1.37 ) can be considered large . At 3-month follow-up , results in the online group remained stable . In contrast to this , participants in the face-to-face group showed significantly worsened depressive symptoms three months after termination of treatment ( t=-2.05 , df=19 , p<.05 ) . LIMITATIONS Due to the small sample size , it will be important to evaluate these outcomes in adequately-powered trials . CONCLUSIONS This study shows that an internet-based intervention for depression is equally beneficial to regular face-to-face therapy . However , more long term efficacy , indicated by continued symptom reduction three months after treatment , could be only be found for the online group Background People with chronic obstructive pulmonary disease ( COPD ) continue to experience dyspnea with activities of daily living ( ADL ) despite optimal medical management . Information and communication technologies may facilitate collaborative symptom management and could potentially increase the reach of such interventions to those who are unable to attend face-to-face pulmonary rehabilitation or self-management programs . Objective The purpose of this r and omized study was to test the efficacy of two 6-month dyspnea self-management programs , Internet-based ( eDSMP ) and face-to-face ( fDSMP ) , on dyspnea with ADL in people living with COPD . Methods We r and omly assigned 50 participants with moderate to severe COPD who were current Internet users to either the  eDSMP ( n = 26 ) or  fDSMP ( n = 24 ) group . The content of the two programs was similar , focusing on education , skills training , and ongoing support for dyspnea self-management , including independent exercise . The only difference was the mode ( Internet/personal digital assistant [ PDA ] or face-to-face ) in which the education sessions , reinforcement contacts , and peer interactions took place . Participants returned to one of two academic clinical sites for evaluation at 3 and 6 months . The primary outcome of dyspnea with ADL was measured with the Chronic Respiratory Question naire . Secondary outcomes of exercise behavior , exercise performance , COPD exacerbations , and mediators , such as self-efficacy and social support , were also measured . A satisfaction survey was administered and a semistructured exit interview was conducted at the final visit . Results The study was stopped early due to multiple technical challenges with the eDSMP , but follow-up was completed on all enrolled participants . Data were available for 39 participants who completed the study ( female : 44 % ; age : 69.5 ± 8.5 years ; percent predicted forced expiratory volume in 1 s : 49.6 ± 17.0 % ) . The fDSMP and eDSMP showed similar clinical ly meaningful changes in dyspnea with ADL from baseline to 3 months ( fDSMP : + 3.3 points ; eDSMP : + 3.5 points ) and sustained these improvements at 6 months ( fDSMP : + 4.0 points ; eDSMP : + 2.5 points ; time effects P < .001 ; group by time P = .51 ) . Self-reported endurance exercise time ( P = .001 ) , physical functioning ( P = .04 ) , and self-efficacy for managing dyspnea ( P = .02 ) also showed positive improvements over time in both groups with no significant differences with respect to program modality . Participants who completed the study reported favorable satisfaction with the programs . Conclusions Although there were numerous technical challenges with the eDSMP , both dyspnea self-management programs were effective in reducing dyspnea with ADL in the short term . Our findings will need to be confirmed in a larger r and omized trial with more mature Web and personal digital assistant tools , use of a control group , and longer follow-up . Trial registration clinical trials.gov NCT00102401 , Background Internet-based cognitive behavioural therapy ( iCBT ) for depression is effective when guided by a clinician , less so if unguided . Question : Would guidance from a technician be as effective as guidance from a clinician ? Method R and omized controlled non-inferiority trial comparing three groups : Clinician-assisted vs. technician-assisted vs. delayed treatment .  Community-based volunteers applied to the VirtualClinic ( www.virtualclinic.org.au ) research program , and 141 participants with major depressive disorder were r and omized . Participants in the clinician- and technician-assisted groups received access to an iCBT program for depression comprising 6 online lessons , weekly homework assignments , and weekly supportive contact over a treatment period of 8 weeks . Participants in the clinician-assisted group also received access to a moderated online discussion forum . The main outcome measures were the Beck Depression Inventory ( BDI-II ) and the Patient Health Question naire-9 Item ( PHQ-9 ) . Completion rates were high , and at post-treatment , both treatment groups reduced scores on the BDI-II ( p<0.001 ) and PHQ-9 ( p<0.001 ) compared to the delayed treatment group but did not differ from each other . Within group effect sizes on the BDI-II were 1.27 and 1.20 for the clinician- and technician-assisted groups respectively , and on the PHQ-9 , were 1.54 and 1.60 respectively . At 4-month follow-up participants in the technician group had made further improvements and had significantly lower scores on the PHQ-9 than those in the clinician group . A total of approximately 60 minutes of clinician or technician time was required per participant during the 8-week treatment program . Conclusions Both clinician- and technician-assisted treatment result ed in large effect sizes and clinical ly significant improvements comparable to those associated with face-to-face treatment , while a delayed treatment control group did not improve . These results provide support for large scale trials to determine the clinical effectiveness and acceptability of technician-assisted iCBT programs for depression . This form of treatment has potential to increase the capacity of existing mental health services . Trial Registration Australian New Zeal and Clinical Trials Registry UNLABELLED Depression is a common and significant health problem among older adults . Unfortunately , while effective psychological treatments exist , few older adults access treatment . The aim of the present r and omized controlled trial ( RCT ) was to examine the efficacy , long-term outcomes , and cost-effectiveness of a therapist-guided internet-delivered cognitive behavior therapy ( iCBT ) intervention for Australian adults over 60 years of age with symptoms of depression . Participants were r and omly allocated to either a  treatment group  ( n=29 ) or a delayed-treatment waitlist control group  ( n=25 ) . Twenty-seven treatment group participants started the iCBT treatment  and 70 % completed the treatment within the 8-week course , with 85 % of participants providing data at posttreatment . Treatment comprised an online 5-lesson iCBT course with brief weekly contact with a clinical psychologist , delivered over 8 weeks . The primary outcome measure was the Patient Health Question naire-9 Item ( PHQ-9 ) , a measure of symptoms and severity of depression . Significantly lower scores on the PHQ-9 ( Cohen 's d=2.08 ; 95 % CI : 1.38 - 2.72 ) and on a measure of anxiety ( Generalized Anxiety Disorder-7 Item ) ( Cohen 's d=1.22 ; 95 % CI : 0.61 - 1.79 ) were observed in the treatment group compared to the control group at posttreatment . The treatment group maintained these lower scores at the 3-month and 12-month follow-up time points and the iCBT treatment was rated as acceptable by participants . The treatment group had slightly higher Quality -Adjusted Life-Years ( QALYs ) than the control group at posttreatment ( estimate : 0.012 ; 95 % CI : 0.004 to 0.020 ) and , while being a higher cost ( estimate $ 52.9l 95 % CI : -23.8 to 128.2 ) , the intervention was cost-effective according to commonly used willingness-to-pay thresholds in Australia . The results support the potential efficacy and cost-effectiveness of therapist-guided iCBT as a treatment for older adults with symptoms of depression . TRIAL REGISTRATION Australian and New Zeal and Clinical Trials Registry : ACTRN12611000927921 ; https://www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?id=343384 The aim of the present study was to investigate two interventions based on Acceptance and Commitment Therapy ( ACT ) for depressive symptoms : A face-to-face treatment ( ACT group ) was compared to a guided self-help treatment delivered via the Internet consisting of two assessment sessions ( pre and post ) and an ACT-based Internet program ( iACT ) .  Out patients experiencing at least mild depressive symptoms were r and omized to either approach . The iACT treatment group received access to an ACT-based Internet program and supportive web-based contact over a period of 6 weeks . The face-to-face group received ACT-based treatment once a week over the same period of time . In both groups , the results showed a significant effect on depression symptomatology , and general wellbeing after treatment and at the 18-month follow-up . However , the data indicated that the iACT group changed differently regarding depressive symptoms and wellbeing as compared to the face-to face ACT group . Results showed large pre-treatment to 18-month follow-up within-group effect sizes for all symptom measures in the iACT treatment group ( 1.59 - 2.08 ) , and for most outcome measures in the face-to-face ACT group ( 1.12 - 1.37 ) . This non-inferiority study provides evidence that guided Internet-delivered ACT intervention can be as effective as ACT-based face-to-face treatment for out patients reporting depressive symptoms , and it may offer some advantages over a face-to-face intervention OBJECTIVE To determine the efficacy of an Internet-based Arthritis Self-Management Program ( ASMP ) as a re source for arthritis patients unable or unwilling to attend small-group ASMPs , which have proven effective in changing health-related behaviors and improving health status measures . METHODS R and omized intervention participants were compared with usual care controls at 6 months and 1 year using repeated- measures analyses of variance . Patients with rheumatoid arthritis , osteoarthritis , or fibromyalgia and Internet and e-mail access ( n = 855 ) were r and omized to an intervention  ( n = 433 ) or  usual care control ( n = 422 ) group . Measures included 6 health status variables ( pain , fatigue , activity limitation , health distress , disability , and self-reported global health ) , 4 health behaviors ( aerobic exercise , stretching and strengthening exercise , practice of stress management , and communication with physicians ) , 5 utilization variables ( physician visits , emergency room visits , chiropractic visits , physical therapist visits , and nights in hospital ) , and self-efficacy . RESULTS At 1 year , the intervention group significantly improved in 4 of 6 health status measures and self-efficacy . No significant differences in health behaviors or health care utilization were found . CONCLUSION The Internet-based ASMP proved effective in improving health status measures at 1 year and is a viable alternative to the small-group ASMP BACKGROUND Guided internet-delivered cognitive behaviour therapy ( ICBT ) has been found to be effective in the treatment of mild to moderate depression , but there have been no direct comparisons with the more established group-based CBT with a long-term follow-up . METHOD Participants with mild to moderate depression were recruited from the general population and r and omized to either guided ICBT ( n=33 ) or to live group treatment ( n=36 ) . Measures were completed before and after the intervention to assess depression , anxiety , and quality of life . Follow-ups were conducted at one-year and three-year after the treatment had ended . RESULTS Data were analysed on an intention-to-treat basis using linear mixed-effects regression analysis . Results on the self-rated version of the Montgomery-Åsberg Depression Scale showed significant improvements in both groups across time indicating non-inferiority of guided ICBT , and there was even a tendency for the guided ICBT group to be superior to group-based CBT at three year follow-up . Within-group effect sizes for the ICBT condition at post-treatment showed a Cohen 's d=1.46 , with a similar large effect at 3-year follow-up , d=1.78 . For the group CBT the corresponding within-group effects were d=0.99 and d=1.34 , respectively . LIMITATIONS The study was small with two active treatments and there was no placebo or credible control condition . CONCLUSIONS Guided ICBT is at least as effective as group-based CBT and long-term effects can be sustained up to 3 years after treatment OBJECTIVE To evaluate the use of a local neighborhood environment-focused physical activity website and its effects on walking and overall physical activity in middle-aged adults . METHOD One-hundred and six ( 72 % women ) inactive adults aged 52+/-4.6 years were r and omly allocated to receive access to a neighborhood environment-focused website , ( Neighborhood group , n=52 ) or a motivational-information website ( Comparison group n=54 ) . Participants also received eleven emails over the 26 weeks . Study outcomes were objective ly-monitored website use , and self-reported total walking ( min/wk ) , total physical activity ( min/wk ) and neighborhood walking ( min/wk ) collected at baseline , 12 and 26 weeks . The study was conducted between August 2005 and February 2006 in Brisbane , Australia . RESULTS Website use was significantly greater among Neighborhood participants ( p=0.01 ) . Statistically significant increases in walking and total physical activity were observed in both groups . There was also a statistically significant interaction effect for total physical activity , with Neighborhood group participants maintaining more of their initial increase in physical activity at week-26 ( p<0.05 ) . Further , those in the Neighborhood group who used the website more often reported significantly more walking along the community trail at week-26 ( p=0.05 ) compared with those who did not . CONCLUSIONS A local neighborhood-environment focused physical activity website was more effective at engaging participants than a motivational-information website . Moreover , its use result ed in meaningful increases in physical activity relative to the comparison website Objective : To determine the efficacy of an Internet-based clinician-assisted cognitive behavioural treatment program ( the Panic program ) for panic disorder ( with or without agoraphobia ) . Method : Fifty-nine individuals meeting diagnostic criteria for panic disorder with agoraphobia were r and omly assigned to a treatment group or to a waitlist control group . Treatment group participants completed the Panic program , comprising six on-line lessons , weekly homework assignments , received weekly email contact from a psychiatry registrar , and contributed to a moderated online discussion forum with other participants . An intention-to-treat model was used for data analyses . Results : Twenty-three ( 79 % ) of treatment group participants completed all lessons within the 8-week program , and post-treatment data were collected from 22/29 treatment group and 22/25 waitlist group participants . Compared to the control group , treatment group participants reported significantly reduced symptoms of panic as measured by the Panic Disorder Severity Scale , Body Sensation Question naire , and Agoraphobic Cognitions Question naires . Significant reductions were also reported on measures of disability and depression . The mean within- and between-group effect size ( Cohen 's d ) on the Panic Disorder Severity Scale was 0.93 and 0.59 , respectively , and effects were sustained at 1-month follow-up . Mean therapist time per participant was 75 minutes for the program . Conclusions : These results replicate those from the open trial of the Panic Program indicating the efficacy of the Internet-based clinician-assisted cognitive behavioural treatment program for panic disorder with agoraphobia Holländare F , Johnsson S , R and estad M , Tillfors M , Carlbring P , And ersson G , Engström I. R and omized trial of Internet‐based relapse prevention for partially remitted depression Life- review therapy has been recognized as an effective therapeutic approach for depression in older adults . Additionally , the use of new media is becoming increasingly common in psychological interventions . The aim of this study was to investigate a life- review therapy in a face-to-face setting with additional computer use . This study explored whether a six-week life- review therapy with computer supplements from the e-mental health Butler system constitutes an effective approach to treat depression in older adults aged 65 and over . A total of 36 participants with elevated levels of depressive symptoms were r and omized to a  treatment group or a waiting-list control group and completed the post- assessment . Fourteen individuals in the intervention group completed the follow-up assessment . Analyses revealed significant changes from pre- to post-treatment or follow-up for depression , well-being , self-esteem , and obsessive reminiscence , but not for integrative reminiscence and life satisfaction . Depressive symptoms decreased significantly over time until the three-month follow-up in the intervention group compared to the control group ( pre to post : d = 1.13 ; pre to follow-up : d = 1.27 ; and group × time effect pre to post : d = 0.72 ) . Furthermore , the therapy led to an increase in well-being and a decrease in obsessive reminiscence among the participants in the intervention group from pre-treatment to follow-up ( well-being : d = 0.70 ; obsessive reminiscence : d = 0.93 ) . Analyses further revealed a significant but small group × time effect regarding self-esteem ( d = 0.19 ) . By and large , the results indicate that the life- review therapy in this combined setting could be recommended for depressive older adults The bidirectional causal relationships between psychotherapy homework ( HW ) compliance and changes in depression were assessed in 2 groups of depressed out patients treated with cognitive-behavioral therapy  using nonrecursive structural equation modeling techniques . The data were consistent with the hypothesis that HW compliance had a causal effect on changes in depression , and the magnitude of this effect was large . Patients who did the most HW improved much more than patients who did little or no HW . In contrast , depression severity did not appear to influence HW compliance . HW compliance did not appear to be a proxy for any other , unobserved ( 3rd ) variable , such as motivation . Although the causal effect of HW on depression was large , the correlation between HW and depression was small . Some possible explanations , along with suggestions for future studies , are proposed Disorder-specific cognitive behavioural therapy programs delivered over the internet ( iCBT ) with clinician guidance are effective at treating specific anxiety disorders and depression . The present study examined the efficacy of a transdiagnostic iCBT protocol to treat three anxiety disorders and /or depression within the same program ( the Wellbeing Program ) . Seventy-seven individuals with a principal diagnosis of major depression , generalised anxiety disorder , panic disorder , and /or social phobia were r and omly assigned to a Treatment or Waitlist Control group . Treatment consisted of CBT-based online educational lessons and homework assignments , weekly email or telephone contact from a clinical psychologist , access to a moderated online discussion forum , and automated emails . Eighty one percent of Treatment group participants completed all 8 lessons within the 10 week program . Post-treatment data were collected from 34/37 Treatment group and 35/37 Control group participants , and 3-month follow-up data were collected from 32/37 Treatment group participants . Relative to Controls , Treatment group participants reported significantly reduced symptoms of anxiety and depression as measured by the Depression Anxiety and Stress Scales-21 item , Patient Health Question naire-9 item , and Generalised Anxiety Disorder-7 item scales , with corresponding between-groups effect sizes ( Cohen 's d ) at post treatment of.56,.58 , and .52 , respectively . The clinician spent a mean time of 84.76 min ( SD=50.37 ) per person over the program . Participants rated the procedure as highly acceptable , and gains were sustained at follow-up . These results provide preliminary support for the efficacy of transdiagnostic iCBT in the treatment of anxiety and depressive disorders Disorder-specific cognitive behavior therapy ( DS-CBT ) is effective at treating major depressive disorder ( MDD ) while transdiagnostic CBT ( TD-CBT ) addresses both principal and comorbid disorders by targeting underlying and common symptoms . The relative benefits of these two models of therapy have not been determined . Participants with MDD ( n=290 ) were r and omly allocated to receive an internet delivered TD-CBT or DS-CBT intervention delivered in either clinician-guided ( CG-CBT ) or self-guided ( SG-CBT ) formats . Large reductions in symptoms of MDD ( Cohen 's d≥1.44 ; avg . reduction≥45 % ) and moderate-to-large reductions in symptoms of comorbid generalised anxiety disorder ( Cohen 's d≥1.08 ; avg . reduction≥43 % ) , social anxiety disorder ( Cohen 's d≥0.65 ; avg . reduction≥29 % ) and panic disorder ( Cohen 's d≥0.45 ; avg . reduction≥31 % ) were found . No marked or consistent differences were observed across the four conditions , highlighting the efficacy of different forms of CBT at treating MDD and comorbid disorders Background Depression and anxiety are common , disabling and chronic . Self-guided internet-delivered treatments are popular , but few people complete them . New strategies are required to realise their potential . Aims To evaluate the effect of automated emails on the effectiveness , safety , and acceptability of a new automated transdiagnostic self-guided internet-delivered treatment , the Wellbeing Course , for people with depression and anxiety . Method A r and omised controlled trial was conducted through the website : www.ecentreclinic.org . Two hundred and fifty seven people with elevated symptoms were r and omly allocated to the 8 week course either with or without automated emails , or to a waitlist control group . Primary outcome measures were the Patient Health Question naire 9-Item ( PHQ-9 ) and the Generalized Anxiety Disorder 7-Item ( GAD-7 ) . Results Participants in the treatment groups had lower PHQ-9 and GAD-7 scores at post-treatment than controls . Automated emails increased rates of course completion ( 58 % vs. 35 % ) , and improved outcomes in a sub sample with elevated symptoms . Conclusions The new self-guided course was beneficial , and automated emails facilitated outcomes . Further attention to strategies that facilitate adherence , learning , and safety will help realise the potential of self-guided interventions . Trial Registration Australian and New Zeal and Clinical Trials Registry BACKGROUND Internet-based cognitive behavior therapy for depression has been tested in several trials but there are no internet studies on behavioral activation ( BA ) , and no studies on BA over the internet including components of acceptance and commitment therapy ( ACT ) . The aim of this study was to develop and test the effects of internet-delivered BA combined with ACT against a waiting list control condition as a first test of the effects of treatment . METHODS Selection took place with a computerized screening interview and a subsequent semi-structured telephone interview . A total of 80 individuals from the general public were r and omized to one of two conditions . The treatment lasted for 8 weeks after which both groups were assessed . We also included a 3 month follow-up . The treatment included interactive elements online and a CD-ROM for mindfulness and acceptance exercises . In addition , written support and feedback was given by a therapist every week . RESULTS Results at posttreatment showed a large between group effect size on the Beck Depression inventory II d=0.98 ( 95%CI=0.51 - 1.44 ) . In the treated group 25 % ( 10/40 ) reached remission defined as a BDI score ≤ 10 vs. 5 % ( 2/40 ) in the control group . Results on secondary measures were smaller . While few dropped out from the study ( N=2 ) at posttreatment , the average number of completed modules was M=5.1 out of the seven modules . LIMITATIONS The study only included a waiting-list comparison and it is not possible to determine which treatment components were the most effective . CONCLUSIONS We conclude that there is initial evidence that BA with components of ACT can be effective in reducing symptoms of depression Depression is common but undertreated . Web-based self-help provides a widely accessible treatment alternative for mild to moderate depression . However , the lack of therapist guidance may limit its efficacy . The authors assess the efficacy of therapist-guided web-based cognitive behavioural treatment ( web-CBT ) of mild to moderate depression . Fifty-four individuals with chronic , moderate depression participated in a r and omized wait-list controlled trial , with an 18-month follow-up ( immediate treatment : n = 36 , wait-list control : n = 18 ) . Primary outcome measures were the Beck Depression Inventory ( BDI-IA ) and the Depression scale of the Symptom Checklist-90-Revised ( SCL-90-R. DEP ) . Secondary outcome measures were the Depression Anxiety Stress Scales and the Well-Being Question naire . Five participants ( 9 % ) dropped out . Intention-to-treat analyses of covariance revealed that participants in the treatment condition improved significantly more than those in the wait-list control condition ( .011 < p < .015 ) . With regard to the primary measures , between-group effects ( d ) were 0.7 for the BDI-IA and 1.1 for the SCL-90-R DEP . Posttest SCL-90- R DEP scores indicated recovery of 49 % of the participants in the treatment group compared with 6 % in the control group ( odds ratio = 14.5 ; p < .004 ) . On average , the effects were stable up to 18 months ( n = 39 ) , although medication was a strong predictor of relapse . The results demonstrate the efficacy of web-CBT for mild to moderate depression and the importance of therapist guidance in psychological interventions BACKGROUND Major depressive disorder ( MDD ) and generalized anxiety disorder ( GAD ) have the highest co-morbidity rates within the internalizing disorders cluster , yet no Internet-based cognitive behavioural therapy ( iCBT ) programme exists for their combined treatment . METHOD We design ed a six-lesson therapist-assisted iCBT programme for mixed anxiety and depression . Study 1 was a r and omized controlled trial ( RCT ) comparing the iCBT programme ( n = 46 ) versus wait-list control ( WLC ; n = 53 ) for patients diagnosed by structured clinical interview with MDD , GAD or co-morbid GAD/MDD . Primary outcome measures were the Patient Health Question naire nine-item scale ( depression ) , Generalized Anxiety Disorder seven-item scale ( generalized anxiety ) , Kessler 10-item Psychological Distress scale ( distress ) and 12-item World Health Organization Disability Assessment Schedule II ( disability ) . The iCBT group was followed up at 3 months post-treatment . In study 2 , we investigated the adherence to , and efficacy of the same programme in a primary care setting , where patients ( n = 136 ) completed the programme under the supervision of primary care clinicians . RESULTS The RCT showed that the iCBT programme was more effective than WLC , with large within- and between-groups effect sizes found ( > 0.8 ) . Adherence was also high ( 89 % ) , and gains were maintained at 3-month follow-up . In study 2 in primary care , adherence to the iCBT programme was low ( 41 % ) , yet effect sizes were large ( > 0.8 ) . Of the non-completers , 30 % experienced benefit . CONCLUSIONS Together , the results show that iCBT is effective and adherence is high in research setting s , but there is a problem of adherence when translated into the ' real world ' . Future efforts need to be placed on developing improved adherence to iCBT in primary care setting
BACKGROUND Existing research postulates a variety of components that show an impact on utilization of technology-mediated mental health information systems ( MHIS ) and treatment outcome .
Although research ers assessed the effect of isolated design elements on the results of Web-based interventions and the associations between symptom reduction and use of components across computer and mobile phone platforms , there remains uncertainty with regard to which components of technology-mediated interventions for mental health exert the greatest therapeutic gain .
Until now , no studies have presented results on the therapeutic benefit associated with specific service components of technology-mediated MHIS for depression .
OBJECTIVE This systematic review aims at identifying components of technology-mediated MHIS for patients with depression .
Updating prior review s , this study aims to ( 1 ) assess the effectiveness of technology-supported interventions for the treatment of depression and ( 2 ) add to the debate on what components in technology-mediated MHIS for the treatment of depression should be st and ard of care .