Internet therapy for depression
By Sumant, Finland Correspondent
Oct 4, 2004, 15:40

Little is known about the effectiveness of educational interventions for reducing the stigma associated with depression. A new study from Australia has found that the internet can offer an opportunity for people with depression to access programmes that reduce personal stigma.

Published in the October issue of the British Journal of Psychiatry, the study set out to investigate the effects on stigma of two internet depression sites.

A sample of 525 people with raised scores on a depression assessment scale were randomly allocated to a depression information site (BluePages), a cognitive-behavioural skills training website (MoodGYM), or an attention control condition.

The BluePages website provided information about depression, symptoms, sources of help, treatments and prevention. It stated that depression is as disabling as multiple sclerosis, can and should be treated, and stressed the importance of seeking help. The site included biographies of famous people with depression.

The MoodGYM website consisted of five interactive modules covering cognitive therapy, behavioural methods for overcoming negative thinking, relaxation, problem solving, assertiveness and self-esteem training, and strategies for coping with relationship break-up.

Participants were directed to read a different specified module of both sites each week for five weeks, and were in weekly telephone contact of ten minutes with an interviewer who monitored their progress.

The control intervention involved five weekly telephone contacts of 10 minutes with an interviewer, who asked open-ended questions about factors that might influence depression, including physical and artistic activities, hobbies and educational activities, relationships, social support, financial management, work stress and relationships, health and nutrition and alcohol intake.

Personal stigma (personal stigmatising attitudes to depression) and perceived stigma (perception of what most other people believe) were assessed before and after the intervention.

It was found that, relative to the control, the internet sites significantly reduced personal stigma, although the effects were small. BluePages had no effect on perceived stigma, but MoodGYM was associated with an increase in perceived stigma relative to the control.

The authors of the study comment that whatever mechanism led to increased perceived stigma in the MoodGYM group, it did not influence their personal views. It may be advisable for clinicians delivering cognitive-behavioural therapy to consider strategies for reducing perceived stigma.

Interestingly, the control group showed a decrease in perceived stigma. Whereas interviews with the internet participants focused on programme activities and feedback, questions asked of control participants related to their own personal experiences. Perhaps the experience of talking to another, non-judgemental person affected participants' perceptions about the attitudes of others.

Changes in personal stigma were not related to changes in depressive symptoms. Controlling for intervention, neither were theses changes connected to depression literacy nor to cognitive-behavioural therapy literacy.

The authors of the study conclude that depression literacy and cognitive behavioural therapy programmes can be helpful in decreasing personal stigma in people with depression. The internet offers an opportunity to disseminate such programmes widely and at low cost, but further research is needed.

Griffiths KM, Christensen H, Jorm AF, Evans K and Groves C (2004) Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: Randomised controlled trial, British Journal of Psychiatry, 185, 342-349.

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