Evaluating an e-mental health program ("deprexis") as adjunctive treatment tool in psychotherapy for depression: design of a pragmatic randomized controlled trial.

BACKGROUND: Major depressive disorder (MDD) places a significant disease burden on individuals as well as on societies. Several web-based interventions for MDD have shown to be effective in reducing depressive symptoms. However, it is not known whether web-based interventions, when used as adjunctive treatment tools to regular psychotherapy, have an additional effect compared to regular psychotherapy for depression. METHODS/DESIGN: This study is a currently recruiting pragmatic randomized controlled trial (RCT) that compares regular psychotherapy plus a web-based depression program ("deprexis") with a control condition exclusively receiving regular psychotherapy. Adults with a depressive disorder (N = 800) will be recruited in routine secondary care from therapists over the course of their initial sessions and will then be randomized within therapists to one of the two conditions. The primary outcome is depressive symptoms measured with the Beck Depression Inventory (BDI-II) at three months post randomization. Secondary outcomes include changes on various indicators such as anxiety, somatic symptoms and quality of life. All outcomes are again assessed at the secondary endpoint six months post randomization. In addition, the working alliance and feasibility/acceptability of the treatment condition will be explored. DISCUSSION: This is the first randomized controlled trial to examine the feasibility/acceptability and the effectiveness of a combination of traditional face-to-face psychotherapy and web-based depression program compared to regular psychotherapeutic treatment in depressed outpatients in routine care. TRIAL REGISTRATION: ISRCTN20165665.

[Work-related behaviour and experience patterns and mental health: a study in psychotherapy trainees]. / Arbeitsbezogene Stressbelastung und psychische Gesundheit: Eine Befragung von Psychotherapeutinnen und therapeuten in Ausbildung.

In view of the fact that many reports have been published that emphasize the difficult conditions of the German psychotherapy training, the aim of this study was to investigate psychotherapy trainees´ work stress as well as work-related psychosocial risks and resources. Variables of interest were work-related behaviour and experience patterns (AVEM), effort-reward-imbalance, chronic stress and health-related quality of life. 321 participants completed an online survey. The distribution of work-related behaviour and experience patterns as well as the results regarding work overload and mental health are evidence of psychotherapy trainees' strain. AVEM-risk patterns are associated with effort-reward-imbalance, chronic stress and reduced mental health. These results clearly support claims for a modification of the psychotherapy training in Germany.

Evaluating an e-mental health program ("deprexis") as adjunctive treatment tool in psychotherapy for depression: Results of a pragmatic randomized controlled trial.

BACKGROUND: Depressive disorders place a significant disease burden on individuals as well as on societies. Several web-based interventions for depression have shown to be effective in reducing depressive symptoms. However, it is not known whether web-based interventions, when used as adjunctive treatment tools to regular psychotherapy, have an additional effect compared to regular psychotherapy for depression. METHODS: Adults (N = 98) with a unipolar affective disorder were recruited in routine outpatient psychotherapy practices in Germany from therapists over the course of their initial sessions and randomized within therapists to one of two active treatment conditions: regular psychotherapy or psychotherapy plus a web-based depression program ("deprexis"). Primary outcome was depressive symptoms measured with the Beck Depression Inventory (BDI-II) at 12 weeks. Secondary outcomes were anxiety symptoms, somatic symptoms and quality of life at 12 weeks and six months follow-up. The study also included an assessment of the working alliance after six and 12 weeks. RESULTS: The combination of psychotherapy with the web-based program was more effective than psychotherapy alone at 12 weeks, with medium between-group effect sizes on primary depressive symptoms (Cohen's d = .51) and small to medium between-group effect sizes on secondary outcomes (Cohen's d = .07-.55). Furthermore, we did not observe negative side effects in the blended format, e.g., a lower working alliance than in psychotherapy alone. LIMITATIONS: The study had a smaller than planned sample size and the dropout rate at follow-up was high. CONCLUSIONS: This study provides first evidence that the use of a web-based program as an adjunctive tool in regular psychotherapy could be a promising option to consider in future treatment for depression.