Online Psychiatric Counseling Appears Effective

Aug. 22, 2009— -- If you're feeling depressed but can't see a shrink in person, the next best thing may be instant messaging, according to a new British study.

Online cognitive behavioral therapy for depression -- with patients and therapists communicating in real time via instant messaging, or IM -- was not only effective, but could broaden access to treatment, researchers reported in the Aug. 22 issue of The Lancet.

After four months, 38 percent of patients who had participated in the Internet-based therapy program had recovered from depression, compared with 24 percent of those in a control group, according to Dr. David Kessler of the University of Bristol.

After eight months' follow-up, 42 percent of the treatment group -- but only 26 percent of controls -- had recovered.

Researchers said they undertook the study because of a "growing unease" about the increasing use of antidepressant medications and the lack of availability of psychological treatments such as cognitive behavior therapy (CBT), particularly in remote areas.

CBT is an approach to depression and other ailments aimed at identifying and modifying harmful, negative thinking patterns and the behaviors associated with them.

Studies and actual practice have already shown that CBT does not need to be delivered in a face-to-face setting. Telephone-based CBT programs with live therapists have been proven effective, the study's authors noted. On the other hand, they noted, computerized self-help programs -- in which software acts as therapist -- are inflexible, and patients are unlikely to keep up with them.

To investigate whether CBT with a therapist online is feasible and effective, Kessler and colleagues undertook a controlled trial which included 297 patients, aged 18 to 75, whose scores on a standard assessment know as the Beck Depression Inventory (BDI) were 14 or higher. About two-thirds were women.

Almost all had additional psychiatric diagnoses, such as generalized anxiety disorder, and more than two-thirds had baseline BDI scores higher than 28, indicating severe depression.Patients initially were assessed in person, and then randomly assigned to online CBT, or placed on an eight-month waiting list for live CBT, plus usual care from their primary care physician.