e-couch - depression

Description:

e-couch provides evidence-based information about emotional problems including their causes, treatments and ways to manage and prevent them. You can view some of this information before you register. When you register for the program you complete a number of quizzes, for example about depression and anxiety, which give feedback on how you are feeling. On return visits, these quizzes can graph your progress. The program includes five separate programs relating to depression, anxiety and worry, social anxiety, divorce and separation, and bereavement and loss. Each program includes an 'armchair' section with lots of information, a collection of self-help toolkits with practical advice and techniques based on CBT, IPT, physical activity and relaxation, and a workbook. You can complete the various activities within each program in any order - and your progress is tracked and displayed.

Service URL:

https://ecouch.anu.edu.au

Agency Responsible:

eHub Health.

Details

Format:

Website.

Intervention Types:

Psychological – CBT and Psychological – IPT. Also relaxation and physical activity

Course Length:

Long (more than 5 modules).

Support Option:

Automated only.

Target Audience

Primary Category:

Depression. Also generalised anxiety disorder, social anxiety, coping with divorce and separation, and dealing with bereavement and loss

Target Audiences:

Adolescent and Adult.

Language:

English.

Access

Fee:

Free.

Access:

Open: With registration.

Contact Details:

ecouch@ehubhealth.com

Research evidence

Research Trials:

3

Research RCTs:

2

Outcome Summary:

There have been three trials focussed on e-couch and depression. Two randomised controlled trials (RCTs) have examined the effectiveness of e-couch in reducing depressive symptoms, and an equivalence study has compared e-couch with a proven online depression treatment.

In the equivalence study, two treatment modules of the e-couch program (interpersonal therapy (IPT) and cognitive behaviour therapy (CBT) were assessed against an established online CBT intervention (MoodGYM) known to reduce depressive symptoms (1). Participants from the general population were randomly assigned to e-couch IPT (n=620), e-couch CBT (n=610), or an active control condition (MoodGYM, n=613). In each intervention, participants completed one module per week over four weeks alongside exercises and assessments. Compared to pre-intervention, participants in the e-couch IPT and CBT interventions showed large reductions in depression symptoms at 1) post-intervention, and 2) the 6 month follow-up, as did participants in MoodGYM. Notably, depression scores at post-intervention and levels of clinical improvement were similar across all three intervention groups suggesting that that e-couch IPT and e-couch CBT may be as effective in alleviating depression symptoms as MoodGYM. No absolute conclusion can be drawn from this study due to the lack of control group and the limitations of this type of trial.

In one RCT (2), 562 participants aged over 45 and with high risk of cardiovascular disease (CVD) or CVD, and also showing mild to moderation depressive symptoms were randomised to e-couch (n=280) or an attention control condition "HealthWatch" (n=282). They were given the opportunity to complete one online module each week for the 12 week intervention period.  Relative to the control group, e-couch participants reported  significantly lower scores for depression and anxiety at post-test as well as a greater participation rate in physical health activities. No additional follow-ups were reported.

In a second  RCT (3) examining the benefits of e-couch combined with an internet support group (ISG), 311 participants with high levels of psychological distress were recruited to one of four conditions: 1) e-couch; 2) e-couch plus ISG;  3) ISG; or 4) an attention control group (HealthWatch). Each group participated in a 12 week intervention program. At post intervention, e-couch was associated with a  greater reduction in the cases of depression, relative to the control group. No differences between these groups were evident at later follow-ups. The combination of e-couch + ISG appeared to be successful in reducing cases of depression at 6 and 12 month followups.

Overall, there is some supporting evidence indicating e-couch may be effective in the treatment of depressive symptoms in the short-term. This effect may be further enhanced in the long term by the use of an internet support group. Further research will provide insight into the longer term benefits of e-couch for the reduction of depression symptoms. 

Recommended rating, reviewer 1:

Recommended rating, reviewer 2:

Read more about Beacon's Smiley Rating System.

Research paper citations

1. Donker, T., Bennett, K. et al. (2013). Internet-Delivered Interpersonal Psychotherapy Versus Internet-Delivered Cognitive Behavioral Therapy for Adults With Depressive Symptoms: Randomized Controlled Noninferiority Trial. Journal of Medical Internet Research, 15(5), e82. 

2. Glozier, N., Christensen, H., Naismith, S. et al. (2013). Internet-delivered cognitive behavioural therapy for adults with mild to moderate depression and high cardiovascular disease risks: A randomised attention-controlled trial. PLoS ONE 8(3): e59139. doi:10.1371/journal.pone.0059139.

3. Griffiths, K. M., Mackinnon, A. J., Crisp, D. A. et al. (2012). The effectiveness of an online support group for members of the community with depression: A randomised controlled trial. PLOS ONE, 7(12): e53244. doi:10.1371/journal.pone.0053244.

Additional references:

Crisp, D. A., & Griffiths, K. M. (2016). Reducing depression through an online intervention: benefits from a user perspective. JMIR mental health, 3(1).

Crisp, D., Griffiths, K., Mackinnon, A., Bennett, K., & Christensen, H.  (2014). An online intervention for reducing depressive symptoms: Secondary benefits for self-esteem, empowerment and quality of life. Psychiatry Research, 216(1), 60-6.

Donker, T., Batterham, P. J. et al. (2013). Predictors and moderators of response to internet-delivered Interpersonal Psychotherapy and Cognitive Behavior Therapy for depression. Journal of Affective Disorders, 151(1), 343-51.

Donkin, L., Hickie, I. B., Christensen, H. et al. (2013). Rethinking the dose-response relationship between usage and outcome in an online intervention for depression: Randomized controlled trial. Journal of Medical Internet Research, 15(10), e231. 

Donkin, L., Hickie, I.B. et al. (2012). Sampling bias in an internet treatment trial for depression. Translational Psychiatry, 2, e174. 

Donkin, L., & Glozier, N. (2012). Motivators and motivations to persist with online psychological interventions: A qualitative study of treatment completers. Journal of Medical Internet Research, 14(3), e91.

Cockayne, N. L., Glozier, N., Naismith, S. L., Christensen, H., Neal, B., Hickie, I.B. (2011). Internet-based treatment for older adults with depression and co-morbid cardiovascular disease: protocol for a randomised, double-blind, placebo controlled trial. BMC Psychiatry, 11, 10.

Griffiths, K.M., Crisp, D., Christensen, H., Mackinnon, A.J., Bennett, K. (2010). The ANU WellBeing study: a protocol for a quasi-factorial randomised controlled trial of the effectiveness of an Internet support group and an automated Internet intervention for depression. BMC Psychiatry, 10, 20.