Internet-delivered psychological treatment of major depression has been investigated
in several trials, but the role of personalized treatment is less investigated. Studies
suggest that guidance is important and that automated computerized programmes without
therapist support are less effective. Individualized e-mail therapy for depression
has not been studied in a controlled trial. Eighty-eight individuals with major depression
were randomized to two different forms of Internet-delivered cognitive behaviour therapy
(CBT), or to a waiting-list control group. One form of Internet treatment consisted
of guided self-help, with weekly modules and homework assignments. Standard CBT components
were presented and brief support was provided during the treatment. The other group
received e-mail therapy, which was tailored and did not use the self-help texts i.e.,
all e-mails were written for the unique patient. Both treatments lasted for 8 weeks.
In the guided self-help 93% completed (27/29) and in the e-mail therapy 96% (29/30)
completed the posttreatment assessment. Results showed significant symptom reductions
in both treatment groups with moderate to large effect sizes. At posttreatment 34.5%
of the guided self-help group and 30% of the e-mail therapy group reached the criteria
of high-end-state functioning (Beck Depression Inventory score below 9). At six-month
follow-up the corresponding figures were 47.4% and 43.3%. Overall, the difference
between guided self-help and e-mail therapy was small, but in favour of the latter.
These findings indicate that both guided self-help and individualized e-mail therapy
can be effective.
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