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Across Europe, it is estimated that more than 30 million people suffer from major depression, but many are not diagnosed, do not receive adequate treatment or have difficulties accessing regular therapy. Researchers working in the E-COMPARED project sought to determine how those challenges could be addressed through internet-based treatments using easily accessible, always-on digital tools interwoven with traditional face-to-face cognitive behavioural therapy sessions to improve the scope and effectiveness of care.
“We developed a new blended cognitive behavioural therapy protocol for adults with major depression that combines the best of both worlds: digital and face-to-face sessions,” says E-COMPARED coordinator professor Heleen Riper at Vrije Universiteit in Amsterdam. “We also conducted the first large-scale European trials with a large number of participants and long-term follow-up to assess the clinical impact and cost-effectiveness of the approach.”
More than 800 patients in nine EU countries were given access to secure online platforms in which they could work through interactive exercises to help deal with depression. These included proven therapy techniques, such as psycho-education, behavioural activation, problem solving and relapse prevention.
Using their computers or smartphones, participants could learn about depression and its effects, enabling them to better assess their own health by monitoring their symptoms daily. They could then complete tasks to help them to better understand their symptoms and acquire a sense of control. The platform provides interactive exercises, videos and tasks to help patients cope with their illness and integrate the strategies they learn into their daily life, including setting positive goals and becoming more active.
The always accessible online tools were integrated with regular face-to-face sessions with therapists – an approach that trial results indicate is more effective in improving treatment outcomes than using standard therapy alone. Across the trials, patients showed a significant decrease in depressive symptoms when treated via E-COMPARED’s blended cognitive behavioural therapy compared to control groups undergoing regular therapy sessions.
“For the first time, we have an indication that blended treatment combining digital tools and face-to-face therapy may lead to better clinical outcomes than regular treatment for major depression in routine care,” Riper says.
An effective treatment
The digital tools were highly rated by trial participants, who valued the easy-to-use interface and the ability to instantly access exercises and tasks to monitor and tackle their symptoms. They also noted the importance of having face-to-face meetings with therapists.
Therapists also welcomed the technology, which provides greater insights into the evolution of patients’ symptoms in their daily life and can ease therapists’ workload, enabling them to treat more patients more effectively. The approach is likely to benefit healthcare providers, too, enabling resources, such as therapists’ time and skills, to be allocated more efficiently.
“Blended cognitive behavioural therapy is no less expensive from a healthcare provider’s perspective than standard therapy but the trials suggest it is more clinically effective,” Riper says.
Importantly, data generated by the digital tools can enable researchers to improve and personalise treatment approaches for depression. Used in combination with machine-learning technology, first results show it may predict which patient groups would benefit most from internet-based, standard or blended treatment by modelling patient characteristics.
“This project is an example of how you can go beyond the results of an initial EU project, the FP7 2009 ICT4Depression project, which developed some of the digital tools used in E-COMPARED,” Riper says. “We are now building an ongoing research platform, which could potentially be spun off into treatment platforms for patients across Europe as well.”