Scheduled Telephone Support for Internet Cognitive Behavioral Therapy for Depression in Patients at Risk for Dropout: Pragmatic Randomized Controlled Trial.
BACKGROUND
Therapist-supported, internet-delivered cognitive behavioral therapy (iCBT) is efficient in the treatment of depression. However, the optimal mode and intensity of therapist support remain to be identified. Scheduled telephone support (STS) may improve adherence and outcomes but, as it is time- and resource-consuming, should be reserved for patients for whom the usual support may be insufficient.


OBJECTIVE
This paper aims to reveal whether add-on STS for patients at risk of dropping out improves treatment adherence and symptoms in iCBT for depression.


METHODS
Among patients participating in an ongoing large observational routine clinical practice study of iCBT for depression delivered nationwide by Helsinki University Hospital (HUS-iCBT), those demonstrating a ≥14-day delay in initiation of treatment received invitations to this subsidiary STS study. A total of 100 consenting patients were randomly allocated to either HUS-iCBT as usual (control group, n=50) or HUS-iCBT plus add-on STS (intervention group, n=50). Proportions of those reaching midtreatment and treatment end point served as the primary outcome; secondary outcomes were change in Beck Depression Inventory (BDI)-measured depressive symptoms and time spent in treatment.


RESULTS
Add-on STS raised the proportion of patients reaching midtreatment compared with HUS-iCBT as usual (29/50, 58% vs 18/50, 36%; P=.045) and treatment end point (12/50, 24% vs 3/50, 6%; P=.02). Change in BDI score also favored add-on STS (3.63 points vs 1.1 points; P=.049), whereas duration of treatment did not differ.


CONCLUSIONS
Add-on STS enhances adherence and symptom improvement of patients at risk of dropping out of iCBT for depression in routine clinical practice.


TRIAL REGISTRATION
International Standard Randomised Controlled Trial Number (ISRCTN) 55123131; http://www.isrctn.com/ISRCTN55123131.
['Pihlaja|Satu|S|0000-0002-2402-6956', 'Lahti|Jari|J|0000-0002-4310-5297', 'Lipsanen|Jari Olavi|JO|0000-0003-0746-2745', 'Ritola|Ville|V|0000-0001-9065-4347', 'Gummerus|Eero-Matti|EM|0000-0001-7485-4429', 'Stenberg|Jan-Henry|JH|0000-0003-1327-7757', 'Joffe|Grigori|G|0000-0002-0782-6812']
D000328:Adult D015928:Cognitive Behavioral Therapy D003863:Depression D005260:Female D006801:Humans D020407:Internet D008297:Male D013689:Telephone D016896:Treatment Outcome
scheduled telephone support depression adherence routine clinical practice internet CBT