This Way Up - Depression Course

Description:

The course is designed to help in the management of symptoms of depression and is based on principles of cognitive behavioural therapy (CBT). The course comprises six online lessons to be completed within three months, plus homework activities, and regular email/phone contact with your own clinician in the supervised version. Each lesson takes about 20 minutes and an additional 3-4 hours per week to complete suggested homework activities.  Part of each lesson is presented as an illustrated story about a woman with depression who learns to gain mastery over her symptoms with the help of a clinical psychologist. As you progress through the lessons, automatic emails are sent to remind you to complete materials and to notify you of new resources. You will gain access to additional information about techniques such as managing sleep problems, panic, and other common co-morbid symptoms. In addition, you will be given access to vignettes written by previous participants about their own experiences of managing depression.

Service URL:

https://thiswayup.org.au/how-we-can-help/courses/depression/

Agency Responsible:

This Way Up; Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent's Hospital, Sydney; and the University of New South Wales (UNSW).

Details

Format:

Website.

Intervention Type:

Psychological – CBT.

Course Length:

Long (more than 5 modules). 6 lessons over 3 months

Support Option:

Clinical support. By your own clinician, self-directed course also available

Target Audience

Primary Category:

Depression.

Target Audience:

Adult.

Language:

English.

Access

Fee:

Fee-based. The course costs $59 or $59.99

Access:

Closed: Fee required. You need to be referred by your clinician to register for the supervised course. A self-directed version is also available

Contact Details:

Through an online form at:
https://thiswayup.org.au/about/contact-us

 

Research evidence

Research Trials:

13

Research RCTs:

5

Outcome Summary:

In an open trial (1), participants in this Depression Course showed significant improvements on measures of depression (d = 1.0) and reductions in measures of psychological distress (d = 1.1) and disability (d = 1.0). Following from this first study, the efficacy of the course was tested in two randomised controlled trials (RCTs). In the first RCT (2), participants in the course reported significantly reduced symptoms of depression compared to those in a wait list control group, with a mean between-group effect size of d = 0.76 across the two measures of depressive symptoms. The second RCT (3) compared three groups; Course with clinician assistance, Course with technician assistance, and a wait list control group. Post-treatment, participants in the two treatment groups had significantly reduced scores on measures of depression compared with the control group, but the treatment groups did not differ significantly from each other. Within group effect sizes on the two measures of depression were d = 1.27 (BDI-II) and d = 1.54 (PHQ-9) for the clinician group and d = 1.20 (BDI-II) and d = 1.60 (PHQ-9) for the technician assisted group. These results are comparable to those seen in face-to-face treatment of depression. Further, a follow-up study to this RCT found chronicity of depression among the treatment groups did not predict treatment outcome - suggesting the program may be of some value to patients with chronic depression as well mild/moderate depression.  

A study set in a clinical setting (4) produced similarly positive findings, with the vast majority of patients who underwent the program experiencing significant improvements in depressive symptoms.  Indeed, this study identified that the program tended to be less effective among patients with higher levels of severity, distress and impairment.

A study (5) was carried out on n=359 patients who were referred to the program by a clinician. In this study, significant improvement of depressive symptoms was found within the full sample from pre to post intervention. Additionally, 54% of those initially meeting criteria for probable diagnosis of depression evidenced clinically reliable change, defined as a reduction of at least 5 points on the PHQ9 and a reduction in depression severity category. Suicidal ideation was not found to be a barrier to effectiveness. A trial (6) was also carried out in patients with comorbid diabetes (type 1 and type 2) and major depressive disorder, with a treatment as usual control group (n=90). In this trial the intervention group had significantly more reduction in depressive symptoms than TAU controls with effect size d=0.78. They also performed significantly better than controls on measures of distress and anxiety.

A recent RCT was completed in the United States (n=77) comparing the Depression Course to a monitored attentional control (7), and this study also found that the intervention group had significantly better reductions in depression severity compared to controls with an effect size d=0.8. 57% of the intervention group reduced their Hamilton depression scores by at least 50% and the same percentage were in remission post-treatment. 

Two more RCTs have been carried out recently, one of which (11) compared the Depression course against self-directed bibliotherapy and a waitlist control group in a sample of N=270. All three intervention groups performed significantly better than controls, and the Depression Course group saw an effect size of d=0.86. the other study (12) looked at a sample of N=69 aged 50+ with co-morbid depression and osteoarthritis of the knee. The addition of the Depression course to treatment as usual resulted in significant improvements in depressive symptoms with g=1.01.

There is a solid body of evidence in support of the efficacy of the Depression Course in the treatmant of depression in a variety of demographics. 

Recommended rating, reviewer 1:

Recommended rating, reviewer 2:

Read more about Beacon's Smiley Rating System.

Research paper citations

Evidence evaluation studies:

(2) Perini, S., Titov, N., & Andrews, G. (2009). Clinician-assisted Internet-based treatment is effective for depression: Randomized controlled trial. Australian and New Zealand Journal of Psychiatry, 43, 571-578.

 

(1) Perini, S., Titov, N., & Andrews, G. (2008). The Climate Sadness program of internet-based treatment for depression: a pilot study. E-Journal of Applied Psychology, 4(2), 18–24.

 

(3) Titov, N., Andrews, G., Davies, M., McIntyre, K., Robinson, E., Solley, K. (2010). Internet treatment for depression: a randomized controlled trial comparing clinician vs. technician assistance. PLoS One, 5(6), e10939.

 

Wiersma, J.E., Titov, N., Van Schaik, D.J.F., Van Oppen, P., Beekman, A.T.F., Cuijpers, P., Andrews, G. (2011)  Treating Chronic Symptoms of Depression in the Virtual Clinic:  Findings on Chronicity of Depression in Patients Treated with Internet-Based Computerized Cognitive Behaviour Therapy for Depression.  The Journal of Psychotherapy and Psychosomatics, 80 (5): 313-315.

 

Sunderland, M., Wong, N., Hilvert-Bruce, Z., Andrews, G. (2012) Investigating trajectories of change in psychological distress amongst patients with depression and generalised anxiety disorder treated with internet cognitive behavioural therapy.  Behaviour Research and Therapy, 50(6): 374-80.

 

Watts S, Mackenzie A, Thomas C, Griskaitis A, Mewton L, Williams A, et al. CBT for depression: A pilot RCT comparing mobile phone vs. computer. BMC Psychiatry. 2013; 13.

 

(5) Williams, A. D., & Andrews, G. (2013). The effectiveness of internet cognitive behavioural therapy (iCBT) for depression in primary care: a quality assurance study. PLoS One, 8(2), e57447.

 

(6) Newby, J., Robins, L., Wilhelm, K., Smith, J., Fletcher, T., Gillis, I., ... & Andrews, G. (2017). Web-based cognitive behavior therapy for depression in people with diabetes mellitus: a randomized controlled trial. Journal of medical Internet research, 19(5).

 

(7) Rosso, I. M., Killgore, W. D., Olson, E. A., Webb, C. A., Fukunaga, R., Auerbach, R. P., ... & Rauch, S. L. (2017). Internet‐based cognitive behavior therapy for major depressive disorder: A randomized controlled trial. Depression and anxiety, 34(3), 236-245.

 

(11) Smith J, Newby JM, Burston N, Murphy MJ, Michael S, Mackenzie A, Kiln F, Loughnan SA, O’Moore KA, Allard BJ, Williams AD, Andrews G. Help from home for depression: A randomised controlled trial comparing internet-delivered cognitive behaviour therapy with bibliotherapy for depression. Internet Interventions. 2017; 9: 25-37.

 

(12) O’Moore KA, Newby JM, Andrews G, Hunter DJ, Bennell K, Smith J, Williams AD. Internet cognitive behavior therapy for depression in older adults with knee osteoarthritis: A randomized controlled trial. Arthritis Care and Research. 2018; 70: 61-70.

 

Additional references:

(8) Silverstone, P. H., Bercov, M., Suen, V. Y., Allen, A., Cribben, I., Goodrick, J., ... & Chakraborty, S. (2015). Initial findings from a novel school-based program, EMPATHY, which may help reduce depression and suicidality in youth. PLoS One, 10(5), e0125527.

 

Hilvert-Bruce, Z., Rossouw, P.J., Wong, N., Sunderland, M., Andrews, G. (2012)  Adherence as a determinant of effectiveness of internet cognitive behavioural therapy for anxiety and depressive disorders.  Behaviour Research and Therapy, 50, 463-468.

 

Choi, I., Andrews, G., Sharpe, L., & Hunt, C. (2015). Help-seeking characteristics of Chinese-and English-speaking Australians accessing Internet-delivered cognitive behavioural therapy for depression. Social 

psychiatry and psychiatric epidemiology, 50(1), 89-97.

 

Williams AD, Blackwell SE, Holmes EA, Andrews G. Positive imagery cognitive bias modification (CBM) and internet-based cognitive behavioural therapy (iCBT) versus control CBM and iCBT for depression: Study protocol for a parallel-group randomised controlled trial. BMJ Open. 2013; 3: e004049.

 

(10) Williams AD, O’Moore K, Blackwell SE, Smith J, Holmes EA, Andrews G. Positive imagery cognitive bias modification (CBM) and internet-based cognitive behavioral therapy (iCBT): A randomized controlled trial. Journal of Affective Disorders. 2015; 178: 131-141.

 

(13) Newby JM, Mewton L, Andrews G. Transdiagnostic versus disorder-specific internet-delivered cognitive behaviour therapy for anxiety and depression in primary care. Journal of Anxiety Disorders. 2017; 46: 25-34.