Treating Depression Digitally
The “Depression Coach” developed at the Department of Education and Psychology aims to alleviate symptoms of depression online / High effectiveness and low dropout rates confirmed in a recent evaluation
Sep 18, 2017
With the Depression Coach, patients suffering from depression do not have to visit a psychotherapist. Instead, they can get treatment onscreen from home. The new online therapy tool was developed at Freie Universität. Over the past three years it has been tested in cooperation with health insurer Techniker Krankenkasse.
The results of the final evaluation were recently presented in Berlin. Campus.leben caught up with Professor Christine Knaevelsrud of the Department of Education and Psychology, who developed the Depression Coach with her team.
Professor Knaevelsrud, what can the Depression Coach do that traditional therapy cannot?
What we offer is aimed at patients who aren’t looking for traditional talk therapy. Direct contact with a psychologist in an outpatient setting is an obstacle to some patients, so it sometimes keeps them from getting any therapy at all. In addition, our system is readily accessible. There are no months-long waiting lists. The Depression Coach also appeals to people in rural regions where it is harder to find a psychotherapy practice and those who just can’t get away from work during the usual office hours.
How does contact with the patients work in your service?
We don’t meet the patients, but we do talk to them by phone at the start of the therapy. Each patient is supported by a psychologist who looks at the information the patient provides online and keeps in touch with him or her. One important factor is for every patient to always receive care from the same psychologist, so that the psychologist can identify and evaluate developments. Aside from that, patients have to fill out a weekly questionnaire on how they feel. If the psychologist sees any indication of an alarming development in the questionnaire, the patient is contacted by phone right away. Using online intervention in the field of psychology is already a part of the regular healthcare system in the Netherlands, the UK, and Sweden. That isn’t the case in Germany yet; all we have had here so far have been research projects with pilot studies.
How does online therapy work?
At the start patients are given written tasks to complete. They are asked to answer certain questions. When did your depression start? What do you think triggered it? Do you see particular limitations? The second step is to work together to set goals to achieve through therapy. After that, a daily schedule is mapped out because people with depression tend to either overstructure or understructure their day-to-day lives. The idea then is to try out new valuation models. Patients with depression have a tendency to evaluate neutral information negatively. An exercise is used to try to break through this negative thought pattern. Patients are asked to evaluate everyday situations depicted in videos, audio clips, and text samples. Various possible answers are suggested to them to show that there are different ways to view a situation. After that the patients write down comparable situations from their own lives and are guided through the process of reinterpreting previous valuation patterns.
What were the results of the evaluation of the Depression Coach?
For those who chose online intervention – all of the patients were volunteers, of course – this seems to be a highly effective form of therapy that achieves success quickly and can be used right away. We have a dropout rate of 17 percent, which is well below that of outpatient forms of psychotherapy, where 20 to 30 percent of patients stop going. That’s actually pretty astonishing, given that there were 1100 patients participating. Because we were working with a large health insurer, we had access to a pool of more than ten million insured patients – that’s a very large number, unusually large for studies like these. This lets us make statements backed by solid research, including about side effects. That is impossible in many comparable studies, since the sample size is much too small. So far, our service has been designed for those with slight to moderate depression, but the research results show that the coach could also be used for patients with more severe depression.
What consequences will the evaluation have for your future research?
So far, the changes brought on by therapy have mainly been studied in a lab setting. We are now planning a follow-up study to show how patients’ observable behavior changes. After all, when therapy is successful, it is not just the patient’s mental condition that changes. There are tangible physical effects as well: Patients complain less about fatigue, and they are physically fitter. We aim to study the biological processes that underlie depression in greater detail and see what happens at the biological level during a course of therapy like this. Aside from that, it will still be possible for patients to participate in the previous program.
The interview was conducted by Manuel Krane.
Prof. Dr. Christine Knaevelsrud, Department of Education and Psychology, Freie Universität Berlin, Clinical Psychology and Psychotherapy, Email: firstname.lastname@example.org