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Developing ACT-based Web Treatment for Depression

Päivi Lappalainen, Anna Granlund, Sari Siltanen,

Raimo Lappalainen

Department of Psychology

University of Jyväskylä, Finland

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Introduction

Depression is common, affecting about 121 million people worldwide

Depression is among the leading causes of disability worldwide.

Fewer than 25 % of those affected have access to effective treatments

There is a need to develop alternative approaches to help clients with depression.

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We developed a web-based treatment program (6 weeks) for clients experiencing depressive symptoms, and compared it to a 6 week face-to-face ACT-based treatment

Preliminary results: 6 months follow-up in October 2011

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The web-based treatment program

included 1 face-to-face session at the beginning (measurements) and weekly contact with the therapist (feedback on homework), approx. 40 (20-90 min).

consisted of 6 modules (one module per week), mostly text (information, exercises, homework) pictures and a few taped exercises

Each module included homework each week which the clients completed and placed in their own folder in the treatment platform

The modules were based on the core processes of ACT: Values, value-based actions, acceptance, cognitive fusion, contact with the present moment and self-as-context

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Criteria for eligibility Depression: 3 questions about depression (scale 0-10):

1) Have you experienced depressed mood most of the day, nearly every day (e.g., feels sad or irritable) without knowing why

2) Have you had periods with markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day

3) Have you had periods of several days, when you have felt so depressed that nothing can make you feel better

No simultaneous attendance in another treatment Basic computer skills and access to the Internet

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Procedure

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Research questions

Is a (mainly) web-based short intervention as efficient as a face-to-face treatment when treating mood disorders?

Do the clients accept a web-based short treatment?

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Method

We had an advertisement in the local newspaper in February 2011 seeking clients experiencing depressive symptoms

60 persons contacted the clinic and were interviewed in the telephone

38 participants were randomized to either a 6 week face-to-face or a 6 week Internet based ACT-treatment program

The treatment was delivered by 18 psychology students with no previous experience of ACT

Each student therapist had one face-to-face and one net client

UNIVERSITY OF JYVÄSKYLÄParticipant Characteristics:

Face-to-Face (n=19) Internet (n=19)

Sex Female Male

13 (68.4 %)6 (31.6 %)

13 (68.4 %)6 (31.6 %)

Age (M, SD) 46.95 (12.26) 42.26 (16.04)

Education 9 years 12 years University

1 (5.3 %)9 (47.4 %)9 (47.4 %)

3 (15.8 %)7 (36.8 %)9 (47.4 %)

Working/studying Yes No

8 (42.1 %)11 (57.9 %9

9 (47.4 %)10 (52.6 %)

Diagnosis Yes No Other than depression

8 (42.1 %)10 (52.6 %)1 (5.3 %)

10 (52.6 %)8 (42.1 %)1 (5.3 %)

Depression medication Yes No

6 (31.6 %)13 (68.4 %)

7 (36.8 %)12 (63.2 %)

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Time used in the web treatment program

30 min-1 hour/week 36.8 % (7 clients)

1-2 hours/week 42,1 % (8 clients)

2-3 hours/week 5.1 % (1 client)

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Results

BDI IIDepression

SCL-90Symptom Checklist

GHQGeneral Health Q

Life Satisfaction

Face-to-Face (n=18)PrePost

23.39.2

1.050.64

19.410.2

45.456.6

Internet (n= 19)PrePost

20.710.3

1.110.58

22.411.4

39.1*63.4

General self evaluated life satisfaction increased more in the internet group (significant interaction effect) On other variables: Similar changes during the time in both treatments

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ResultsAAQ-II KIMS

MindfulnessATQAutomatic Thoughts:How often?

ATQAutomatic Thoughts: How much believe?

WBSIThought Suppression

Face-to-Face (n=18)PrePost

38.548.9

120.8125.9

77.456.9

75.761.7

47.446.9

Internet (n= 19)PrePost

41.247.5

120.0126.0

74.053.6

68.649.8

49.843.2

Significant changes during the treatment in both groupsExcept for Internet group in KIMS (p = 0.09)

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Subjective Client Experiences

Face-to-face (n=18) Internet (n=19)

Satisfaction 8.8 (max 10) 8.4 (max 10)

Change in well-being 7.7 (max 10) 7.5 (max 10)

Better mood 13 (72.2 %) 15 (78.9%)

Less Anxiety 7 (38.9 %) 9 (47.4%)

More energy 6 (33.3 %) 6 (31.6%)

Less stress 3 (16.7 %) 6 (31.6%)

Increased physical activity (exercise)

2 (11.1%) 7 (36.8%)

Better health 2 (11.1%) 1 (5.3%)

Has learned new skills 12 (66.7%) 13 (68.4%)

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Experiences

Face-to-face (n=18) Internet (n=19)

Ideal lenght of treatment 19.3 weeks 9 weeks

I would recommend this kind of treatment

9.06 8.16

I need more help 5.89 4.84

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Conclusions

A 6 week Internet-based ACT treatment including 1 (face-to-face) session was as effective as a face-to-face treatment

The student delivered ACT-based Internet treatment was well accepted by the clients

There were some indications that after a brief ACT-intervention, the ideal lenght of the treatment was reported to be shorter in the Internet group

Our study supports the idea that the Internet-based ACT treatment is well suited for training psychologists