Internet-based CBT for adolescents with low self-esteem: a pilot randomized controlled trial.

Low self-esteem is a common problem among adolescents and is related to psychiatric problems such as depression and anxiety. However, effective and available interventions primarily targeting low self-esteem are scarce, in particular for youths. To address this gap, the aim of this pilot study was to evaluate a novel internet-based Cognitive Behavioral Therapy (ICBT) program for low self-esteem in adolescents using a randomized controlled design. Fifty-two participants (15-19 years) were recruited and randomly allocated to seven weeks of therapist-supported ICBT (n=26) or to a waitlist control condition (n=26). The primary outcome was the Rosenberg Self-Esteem Scale (RSES). Secondary outcomes measured domain-specific aspects of self-esteem, self-compassion, quality of life, depression and anxiety. The treatment group showed significantly higher levels of self-rated self-esteem compared to the control group at post-treatment, with a large between-group effect-size (RSES, d = 1.18). Further, the treatment had significant positive impact on secondary measures of self-esteem, self-compassion, quality of life, depression and anxiety. The results of this pilot-RCT suggest that ICBT can be effective for treating low self-esteem in adolescents, decrease depression and anxiety levels, and increasing quality of life. Replication of the results in larger samples is needed.

Internet-based CBT for patients with depressive disorders in primary and psychiatric care: Is it effective and does comorbidity affect outcome?

Internet-based cognitive behavior therapy (ICBT) has proved effective in reducing mild to moderate depressive symptoms. However, only a few studies have been conducted in a regular healthcare setting which limits the generalizability of the results. The influence of psychiatric comorbidity on outcome is not well understood. In the current study, patients with mild to moderate depressive symptoms in primary and psychiatric care were interviewed using the SCID-I and SCID-II to assess psychiatric diagnoses. Those included were randomly allocated to ICBT (n = 48) or to an active control condition (n = 47). Both groups received therapist support. At post-treatment, ICBT had reduced depressive symptoms on the BDI-II more than the active control intervention (p = .021). However, the difference between groups was no longer significant at the 6-, 12- or 24-month follow-ups. The within-group effect size after ICBT (BDI-II) was large (d = 1.4). A comorbid anxiety disorder didn't moderate the outcome, while the presence of a personality disorder predicted significantly less improvement in depressive symptoms. ICBT had a large effect on depressive symptoms in a sample from regular healthcare. It is possible to obtain a large effect from ICBT despite comorbid anxiety, however, including patients with a comorbid personality disorder in the current form of ICBT seems questionable.