Internet-based Treatment of Depression in Primary Care: Does it work and what do therapists think of it?

Abstract: Computer based and Internet-delivered psychological treatments have been around for some time and research to date has in many cases shown them to be effective. However, the vast majority of research conducted so far has been performed outside of the health care system. The objective of this thesis is to investigate the effectiveness and feasibility of Internet-delivered treatment for mild to mode¬rate depression within primary care (PC). Study I compared the effects after treatment of Internet-delivered Cognitive behavior therapy (ICBT) to Treatment as usual (TAU). At 16 primary care centers (PCCs) in the Västra Götaland region in Sweden, patients thought to be suffering from mild to moderate depression were assessed. 90 patients were randomized to either ICBT or TAU. The ICBT-treatment used was Depressionshjälpen®, consisting of seven modules accessed via Internet, a workbook on paper, and minimal therapist contact. The treatment period was 12 weeks. Using univariate ANCOVAs, controlling for pre-treatment scores, no significant differences were found in the reduction in depression scores between the ICBT and TAU groups during- or post-treatment. The mean between group effect size for BDI-II at post was d = 0. Twenty (56%) of the ICBT participants completed all seven modules within the treatment period. Study II explored PC therapists’ attitudes and experiences of ICBT and the implementation of ICBT in PC, using qualitative methods from grounded theory and a framework of barriers to optimal care from implementation science. Eleven therapists answered a survey and four of these were subsequently interviewed. Five general themes were identified: 1) ICBT – was seen as a valuable alternative that could be used not only as a separate form of treatment but also as very useful integrated into face-to-face therapies. 2) The research project – was a rewarding experience. 3) Research within PC – is necessary, but challenging. 4) PC Psychology – has, according to the therapists, not yet been fully integrated into primary care. 5) PC Culture – is believed to revolve around the General Practitioners, and to focus on production, the somatic side of the patients’ health, and finances. Five possible barriers to implementation were also identified. Conclusion Internet-delivered treatments seem to be effective and feasible within PC and can be introduced as a complement to other treatments.