Self-Guided Intervention Benefits Patients with Depression and Anxiety

A 2013 study reported the outcomes of a new self-guided Internet-delivered treatment, the Wellbeing Course, for symptoms of anxiety and depression. The study found that the intervention resulted in significant symptom reductions. Furthermore, automated emails increased treatment completion and clinical improvement in a subsample with elevated anxiety and depression. In a follow-up study, Titov et al examined the clinical outcomes and effect of automated emails at 12 months post-treatment. The results indicated that the benefits of the Wellbeing Course were sustained at 12-month follow-up [PLoS One. 2014;9(2):e89591].

The randomized, controlled study included 257 patients who were followed up at 12 months post-treatment. The participants were assigned to 1 of 3 treatment groups: (1) Treatment Plus Automated Emails Group (TEG; n=100) received access to the Wellbeing Course with automated emails; (2) the Standard Treatment Group (TG; n=106) received access to the Wellbeing Course without automated emails; or (3) the delayed-treatment Waitlist Control Group (n=51) received access to the same treatment as the TEG following post-treatment.

The Wellbeing Course is a 5-lesson, transdiagnostic, Internet intervention based on a pragmatic model of psychotherapeutic change that assumes that symptoms of depression and anxiety are the result of unhelpful habits of thought or action. The primary outcome measures were depression and anxiety symptom severity as measured by the Patient Health Questionnaire-9 Item Scale (PHQ-9) and the Generalized Anxiety Disorder-7 Item Scale (GAD-7).

Twelve-month follow-up data were collected from 81%, 78%, and 87% of TEG, TG, and treated Waitlist Control Group, respectively. The findings showed that significant improvements in symptoms of anxiety and depression were observed over time in both TEG and TG groups, these improvements were sustained from post-treatment to 12-month follow-up and were associated with larger effect sizes. The post-treatment remission rates for the PHQ-9 and GAD-7 were sustained at the 12-month follow-up time points for TEG (64.7% and 63.1%, respectively) and TG (68.6% and 60.8%, respectively). The post-treatment remission rates were also sustained at 12-month follow-up for the comorbid samples of TEG and TG (73% and 74%, respectively). The remission rates for the control group and for the comorbid sample of the Waitlist Control Group following treatment were also sustained at 12-month follow-up.

At 12-month follow-up, up to 3.3% of TEG and 5% of TG obtained PHQ-9 or GAD-7 scores of ≥5 points higher compared to pretreatment. This result was not found among Waitlist Control Group participants. At 12-month follow-up, 3% of TEG and 1.8% of TG participants in the comorbid sample obtained PHQ-9 or GAD-7 scores of ≥5 points higher compared to pretreatment.

The investigators noted an important secondary outcome; the benefits of automated emails were no longer found at 12-month follow-up. These results raise the question of whether automated emails are helpful or necessary. The findings suggest that automated emails promote more rapid treatment response for individuals with elevated and comorbid symptoms, but they may not improve long-term outcomes, according to the researchers.