Brief Web-Based Intervention for Depression: Randomized Controlled Trial on Behavioral Activation

Background: Web-based interventions have been shown to be effective for the treatment of depression. However, interventions are often complex and include a variety of elements, making it difficult to identify the most effective component(s).

Objective: The aim of this pilot study was to shed light on mechanisms in the online treatment of depression by comparing a single-module, fully automated intervention for depression (internet-based behavioral activation [iBA]) to a nonoverlapping active control intervention and a nonactive control group.

Methods: We assessed 104 people with at least mild depressive symptoms (Patient Health Questionnaire-9, >4) via the internet at baseline (t₀) and 2 weeks (t₁) and 4 weeks (t₂) later. After the t₀ assessment, participants were randomly allocated to one of three groups: (1) iBA (n=37), (2) active control using a brief internet-based mindfulness intervention (iMBI, n=32), or (3) care as usual (CAU, n=35). The primary outcome was improvement in depressive symptoms, as measured using the Patient Health Questionnaire-9. Secondary parameters included changes in activity, dysfunctional attitudes, and quality of life.

Results: While groups did not differ regarding the change in depression from t₀ to t₁ (η_p²=.007, P=.746) or t₀ to t₂ (η_p²=.008, P=.735), iBA was associated with a larger decrease in dysfunctional attitudes from t₀ to t₂ in comparison to CAU (η_p²=.053, P=.04) and a larger increase in activity from t₀ to t₁ than the pooled control groups (η_p²=.060, P=.02). A change in depression from t₀ to t₂ was mediated by a change in activity from t₀ to t₁. At t₁, 22% (6/27) of the participants in the iBA group and 12% (3/25) of the participants in the iMBI group indicated that they did not use the intervention.

Conclusions: Although we did not find support for the short-term efficacy of the single-module iBA regarding depression, long-term effects are still conceivable, potentially initiated by changes in secondary outcomes. Future studies should use a longer intervention and follow-up interval.

Trial registration: DKRS (#DRKS00011562).