Effektivität computer- und internetgestützter kognitiver Verhaltenstherapie bei Depression

Zusammenfassung

Anliegen Systematischer Überblick zur Wirksamkeit von computergestützter kognitiver Verhaltenstherapie bei depressiven Erkrankungen. Methode Literaturrecherche in Medline, Web of Science, Cochrane und PsycINFO. Ergebnisse 16 Studien wurden identifiziert. Effekte der Interventionen sind abhängig von der Häufigkeit und Dauer des Therapeutenkontaktes und der Art der Kontrollgruppe. Die Effektstärken erstrecken sich von Cohens d = 0,0 bis d = 1,1. Schlussfolgerungen Computergestützte Verhaltenstherapie stellt eine niedrigschwellige Interventionsmethode dar, die vor allem bei Patienten mit leichter und mittelschwerer depressiver Symptomatik wirksam ist. In unterversorgten Gebieten kann sie zur Versorgungsoptimierung beitragen und Baustein eines gestuften Behandlungsplanes („stepped care”) sein.

Abstract

Objective The aim of this study was to conduct a systematic literature search in order to assess effectiveness of computer- and internet-based cognitive behavioural therapy (CCBT). Methods Medline, Cochrane Library, Web of Science and PsycINFO were searched for relevant articles. Only RCTs were included. Effect sizes were calculated and quality of studies was assessed. Results 16 studies were retrieved and included. Effect sizes depended on therapist time involvement and control group intervention (waiting list vs. active control group) and ranged between 0.0 and 1.1. Conclusions CCBT provides an effective and potentially cost-effective interventional strategy for depressive disorders. Effects of no and minimal contact therapies are confounded with conditions of control groups and need further investigation. While patients with Major Depression seem to benefit from computer-based therapy with regular therapist contact, it remains unclear whether unattended self-help interventions over the internet are effective for this patient population. However, these interventions are effective in patients with mild to moderate depressive symptomatology. CCBT may serve as a first step of treatment within stepped care approaches and may help to offer treatment to individuals in remote areas and to decrease barriers to seek psychiatric care caused by stigma perception.

kognitive Verhaltenstherapie - computergestützte Therapie - Depressionen

cognitive behavioural therapy - computer-assisted therapy - depression

Literatur

• 1 Alonso J, Angermeyer M C, Bernert S et al. Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.  Acta Psychiatr Scand Suppl. 2004;  (420) 21-27
• 2 Wittchen H, Jacobi F. Size and burden of mental disorders in Europe – a critical review and appraisal of 27 studies.  Eur Neuropsychopharmacol. 2005;  15 357-376
• 3 Frei A, Ajdacic-Gross V, Rössler W et al. Auswirkungen von depressiven Störungen auf objektive Lebensqualitätsbereiche.  Psychiat Prax. 2004;  31 298-303
• 4 Cuijpers P, Smit F. Excess mortality in depression: a meta-analysis of community studies.  J Affect Disord. 2002;  72 227-236
• 5 Kessler R C, Heeringa S, Lakoma M D et al. Individual and societal effects of mental disorders on earnings in the United States: results from the national comorbidity survey replication.  Am J Psychiatry. 2008;  165 703-711
• 6 Luppa M, Heinrich S, Angermeyer M C et al. Cost-of-illness studies of depression: a systematic review.  J Affect Disord. 2007;  98 29-43
• 7 Günther O H, Friemel S, Bernert S et al. Die Krankheitslast von depressiven Erkrankungen in Deutschland.  Psychiat Prax. 2007;  34 292-301
• 8 Cuijpers P, van Straten A, Warmerdam L. Problem solving therapies for depression: a meta-analysis.  Eur Psychiatry. 2007;  22 9-15
• 9 Hollon S D, Stewart M O, Strunk D. Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety.  Annu Rev Psychol. 2006;  57 285-315
• 10 Wolf N J, Hopko D R. Psychosocial and pharmacological interventions for depressed adults in primary care: a critical review.  Clin Psychol Rev. 2008;  28 131-161
• 11 Cuijpers P, van Straten A, van Shaik A et al. Psychological treatment of depression in primary care: a meta-analysis.  Br J Gen Pract. 2009;  59 e51-60
• 12 Wittchen H U, Holsboer F, Jacobi F. Met and unmet needs in the management of depressive disorder in the community and primary care: the size and breadth of the problem.  J Clin Psychiatry. 2001;  62 (S 26) 23-28
• 13 Sielk M, Altiner A, Janssen B et al. Prävalenz und Diagnostik depressiver Störungen in der Allgemeinarztpraxis.  Psychiat Prax. 2009;  36 169-174
• 14 Schulz H. Psychotherapeutische Versorgung. Berlin: Robert Koch-Institut; 2008
• 15 Bermejo I, Bachmann L, Kriston L et al. Fachärztliche Depressionsbehandlung – subjektive Wahrnehmung der Versorgungssituation und erlebte Barrieren.  Psychiat Prax. 2008;  35 392-398
• 16 Cartreine J A, Ahern D K, Locke S E. A roadmap to computer-based psychotherapy in the United States.  Harv Rev Psychiatry. 2010;  18 80-95
• 17 Cuijpers P. Bibliotherapy in unipolar depression: a meta-analysis.  J Behav Ther Exp Psychiatry. 1997;  28 139-147
• 18 Spek V, Cuijpers P, Nyklícek I et al. Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis.  Psychol Med. 2007;  37 319-328
• 19 Statistisches Bundesamt .Informationsgesellschaft in Deutschland. Ausgabe 2009.. Wiesbaden: Statistisches Bundesamt; 2009
• 20 National Institute for Health and Clinical Excellence .Guidance on the Use of Computerised Cognitive Behavioural Therapy for Anxiety and Depression. Technology Appraisal 97.. London: NICE; 2006
• 21 Marks I M, Cavanagh K, Gega L. Hands-on help. Computer-aided psychotherapy.. Hove: Psychology Press; 2007
• 22 Higgins J PT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2. [updated September 2009], 2009. Verfügbar unter: http://www.cochrane-handbook.org 28.5.2010
• 23 Moncrieff J, Churchill R, Drummond D C et al. Development of a quality assessment instrument for trials of treatments for depression and neurosis.  Int J Methods Psychiatr Res. 2001;  10 126-133
• 24 Cohen J W. Statistical power analysis for the behavioral sciences.. 2. Aufl. Hillsdale, NJ: Erlbaum; 1988
• 25 Wilson D B, Lipsey M W. The role of method in treatment effectiveness research: evidence from meta-analysis.  Psychol Methods. 2001;  6 413-429
• 26 Ruwaard J, Schrieken B, Schrijver M et al. Standardized web-based cognitive behavioural therapy of mild to moderate depression: a randomized controlled trial with a long-term follow-up.  Cogn Behav Ther. 2009;  38 206-221
• 27 Christensen H, Griffiths K M, Mackinnon A J et al. Online randomized controlled trial of brief and full cognitive behaviour therapy for depression.  Psychol Med. 2006;  36 1737-1746
• 28 Clarke G, Eubanks D, Reid E et al. Overcoming Depression on the Internet (ODIN) (2): a randomized trial of a self-help depression skills program with reminders.  J Med Internet Res. 2005;  7 e16
• 29 Clarke G, Reid E, Eubanks D et al. Overcoming depression on the Internet (ODIN): a randomized controlled trial of an Internet depression skills intervention program.  J Med Internet Res. 2002;  4 e14
• 30 Clarke G, Kelleher C, Hornbrook M et al. Randomized effectiveness trial of an Internet, pure self-help, cognitive behavioral intervention for depressive symptoms in young adults.  Cogn Behav Ther. 2009;  38 222-234
• 31 Andersson G, Bergström J, Holländare F et al. Internet-based self-help for depression: randomised controlled trial.  Br J Psychiatry. 2005;  187 456-461
• 32 Christensen H, Griffiths K M, Jorm A F. Delivering interventions for depression by using the internet: randomised controlled trial.  BMJ. 2004;  328 265
• 33 Kessler D, Lewis G, Kaur S et al. Therapist-delivered Internet psychotherapy for depression in primary care: a randomised controlled trial.  Lancet. 2009;  374 628-634
• 34 de Graaf L E, Gerhards S A, Arntz A et al. Clinical effectiveness of online computerised cognitive-behavioural therapy without support for depression in primary care: randomised trial.  Br J Psychiatry. 2009;  195 73-80
• 35 Gerhards S A, de Graaf L E, Jacobs L E et al. Economic evaluation of online computerised cognitive-behavioural therapy without support for depression in primary care: randomised trial.  Br J Psychiatry. 2010;  196 310-318
• 36 Spek V, Cuijpers P, Nyklícek I et al. One-year follow-up results of a randomized controlled clinical trial on internet-based cognitive behavioural therapy for subthreshold depression in people over 50 years.  Psychol Med. 2008;  38 635-639
• 37 Spek V, Nyklícek I, Smits N et al. Internet-based cognitive behavioural therapy for subthreshold depression in people over 50 years old: a randomized controlled clinical trial.  Psychol Med. 2007;  37 1797-1806
• 38 Warmerdam L, van Straten A, Twisk J et al. Internet-based treatment for adults with depressive symptoms: randomized controlled trial.  J Med Internet Res. 2008;  10 e44
• 39 Wright J H, Wright A S, Albano A M et al. Computer-assisted cognitive therapy for depression: maintaining efficacy while reducing therapist time.  Am J Psychiatry. 2005;  162 1158-1164
• 40 Vernmark K, Lenndin J, Bjärehed J et al. Internet administered guided self-help versus individualized e-mail therapy: A randomized trial of two versions of CBT for major depression.  Behav Res Ther. 2010;  48 368-376
• 41 Perini S, Titov N, Andrews G. Clinician-assisted Internet-based treatment is effective for depression: Randomized controlled trial.  Aust N Z J Psychiatry. 2009;  43 571-578
• 42 Kazdin A E, Bass D. Power to detect differences between alternative treatments in comparative psychotherapy outcome research.  J Consult Clin Psychol. 1989;  57 138-147
• 43 Andersson G, Cuijpers P. Internet-based and other computerized psychological treatments for adult depression: a meta-analysis.  Cogn Behav Ther. 2009;  38 196-205
• 44 Cuijpers P, Smit F, Bohlmeijer E et al. Efficacy of cognitive-behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias.  Br J Psychiatry. 2010;  196 173-178
• 45 Gega L, Marks I, Mataix-Cols D. Computer-aided CBT self-help for anxiety and depressive disorders: experience of a London clinic and future directions.  J Clin Psychol. 2004;  60 147-157
• 46 Schielein T, Klein H E, Hübner-Liebermann B et al. Via Internet zum Psychiater. Via Internet to the Psychiatrist.  Psychiat Prax. 2009;  36 40-42
• 47 Cuijpers P, Muñoz R F, Clarke G N et al. Psychoeducational treatment and prevention of depression: the „Coping with Depression” course thirty years later.  Clin Psychol Rev. 2009;  29 449-458
• 48 Leiberich P, Nedoschill J, Nickel M et al. Self-help and consultation via Internet. Self-responsible users redefine the physician-patient relationship.  Med Klin (Munich). 2004;  99 263-268
• 49 National Institute for Health and Clinical Excellence .Depression in Adults. Depression: the treatment and management of depression in adults. National Clinical Practice Guideline 90.. London: NICE; 2009
• 50 Parikh S V, Segal Z V, Grigoriadis S et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. II. Psychotherapy alone or in combination with antidepressant medication.  J Affect Disord. 2009;  117 (S 01) S15-25
• 51 Kaltenthaler E, Shackley P, Stevens K et al. A systematic review and economic evaluation of computerised cognitive behaviour therapy for depression and anxiety.  Health Technol Assess. 2002;  6 1-89
• 52 DeRubeis R J, Hollon S D, Amsterdam J D et al. Cognitive therapy vs medications in the treatment of moderate to severe depression.  Arch Gen Psychiatry. 2005;  62 409-416

1 Zwecks besserer Lesbarkeit werden folgend ausschließlich die männlichen Formen zur Beschreibung von Personen- und Berufsgruppen, bestehend aus Vertretern beider Geschlechter, verwendet.

2 d = μ_IG − μ_KG / √(σ₁ + σ₂) / 2

3 Spek et al. (2007, 2008) sind Publikationen derselben Studie, werden hier daher nur einfach gezählt. Gleiches gilt für de Graaf et al. (2009) und Gerhards et al. (2010).