Efficacy of the web-based PaarBalance program on relationship satisfaction, depression and anxiety - A randomized controlled trial

Digital Psychotherapies for Adults Experiencing Depressive Symptoms: Systematic Review and Meta-Analysis

BACKGROUND

Depression affects 5% of adults and it is a major cause of disability worldwide. Digital psychotherapies offer an accessible solution addressing this issue. This systematic review examines a spectrum of digital psychotherapies for depression, considering both their effectiveness and user perspectives.

OBJECTIVE

This review focuses on identifying (1) the most common types of digital psychotherapies, (2) clients' and practitioners' perspectives on helpful and unhelpful aspects, and (3) the effectiveness of digital psychotherapies for adults with depression.

METHODS

A mixed methods protocol was developed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search strategy used the Population, Intervention, Comparison, Outcomes, and Study Design (PICOS) framework covering 2010 to 2024 and 7 databases were searched. Overall, 13 authors extracted data, and all aspects of the review were checked by >1 reviewer to minimize biases. Quality appraisal was conducted for all studies. The clients' and therapists' perceptions on helpful and unhelpful factors were identified using qualitative narrative synthesis. Meta-analyses of depression outcomes were conducted using the standardized mean difference (calculated as Hedges g) of the postintervention change between digital psychotherapy and control groups.

RESULTS

Of 3303 initial records, 186 records (5.63%; 160 studies) were included in the review. Quantitative studies (131/160, 81.8%) with a randomized controlled trial design (88/160, 55%) were most common. The overall sample size included 70,720 participants (female: n=51,677, 73.07%; male: n=16,779, 23.73%). Digital interventions included "stand-alone" or non-human contact interventions (58/160, 36.2%), "human contact" interventions (11/160, 6.8%), and "blended" including stand-alone and human contact interventions (91/160, 56.8%). What clients and practitioners perceived as helpful in digital interventions included support with motivation and accessibility, explanation of task reminders, resources, and learning skills to manage symptoms. What was perceived as unhelpful included problems with usability and a lack of direction or explanation. A total of 80 studies with 16,072 participants were included in the meta-analysis, revealing a moderate to large effect in favor of digital psychotherapies for depression (Hedges g=-0.61, 95% CI -0.75 to -0.47; Z=-8.58; P<.001). Subgroup analyses of the studies with different intervention delivery formats and session frequency did not have a statistically significant effect on the results (P=.48 and P=.97, respectively). However, blended approaches revealed a large effect size (Hedges g=-0.793), while interventions involving human contact (Hedges g=-0.42) or no human contact (Hedges g=-0.40) had slightly smaller effect sizes.

CONCLUSIONS

Digital interventions for depression were found to be effective regardless of format and frequency. Blended interventions have larger effect size than those involving human contact or no human contact. Digital interventions were helpful especially for diverse ethnic groups and young women. Future research should focus on understanding the sources of heterogeneity based on intervention and population characteristics.

TRIAL REGISTRATION

PROSPERO CRD42021238462; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=238462.

Couples Therapy Delivered Through Videoconferencing: Effects on Relationship Outcomes, Mental Health and the Therapeutic Alliance

Changing technology, and the pervasive demand created by a greater need in the population for access to mental health interventions, has led to the development of technologies that are shifting the traditional way in which therapy is provided. This study investigated the efficacy of a behavioral couples therapy program conducted via videoconferencing, as compared to face-to-face. There were 60 participants, in couples, ranging in age from 21 to 69 years old. Couples had been in a relationship for between 1 to 49 years. The 30 couples were randomly allocated to the face-to-face or videoconferencing group. They all took part in Couple CARE—a couples behavioral education program which promotes self-change in order to increase relationship satisfaction. The six session manualized intervention was offered in an identical manner to all clients, in each condition. Data analysis was based on several questionnaires completed by each couple at pre, post and 3-months follow-up. Results showed that therapeutic alliance ratings did not differ between groups, but increased significantly over time for both groups. Additionally, the results indicated improvements in relationship satisfaction, mental health, and all other outcome scores over time, which did not differ based on condition. This study uniquely contributes to the literature exploring the use of technology to provide therapy. Specifically, the study provides evidence for couples therapy via videoconferencing as a viable alternative to face-to-face interventions, especially for those couples who may not have access to the treatment they require. It is anticipated that the results of this study will contribute to the field of online therapy, and add to fostering confidence in agencies to allow expansion of services conducted via videoconferencing.

Evaluation des webbasierten PaarBalance®-Partnerschaftsprograms bei beratungsbegleitendem Einsatz

<b><i>Hintergrund:</i></b> Beziehungsprobleme gehen mit psychischen und physischen Problemen einher. Auch wenn effektive Behandlungsmöglichkeiten existieren, suchen viele Paare spät oder keine professionelle Hilfe. Die Kombination eines Online-Programms mit einer Paarberatung kann helfen, Barrieren wie hohe Kosten, lange Anfahrtswege oder Wartezeiten zu reduzieren und den Zugang zu effektiver Beratung zu erleichtern. <b><i>Methoden:</i></b> Die Studie prüfte die Wirksamkeit des PaarBalance®-Online-Programms zur Verbesserung der Beziehungszufriedenheit in Kombination mit einer niederfrequenten Face-to-Face-Paarberatung in einem unkontrollierten Prä-post-Design. In diesem naturalistischen, an die Routinepraxis der Beratenden (<i>n</i> = 8) angelehnten Design erhielten die 92 Teilnehmenden, welche über die Beratungsstellen oder über Zeitungsartikel rekrutiert wurden, während eines 15-wöchigen Interventionszeitraums neben wenigen Beratungsterminen einen Zugang zum Online-Programm. Gemessen wurde die Auswirkung des kombinierten Unterstützungsangebots auf Beziehungszufriedenheit, Depressivität und Angst zu drei Messzeitpunkten (Prä, Post nach 15 Wochen und Follow-up nach 12 Wochen). Die Daten wurden mit hierarchisch linearen Modellen analysiert. <b><i>Ergebnisse:</i></b> Die Beziehungszufriedenheit verbesserte sich signifikant während der Interventionsphase (Cohens <i>d</i> = 0,29) und blieb während der Follow-up-Phase stabil. Für Depression und Angst zeigten sich keine signifikanten Veränderungen. <b><i>Schlussfolgerungen:</i></b> Die Ergebnisse weisen darauf hin, dass das PaarBalance®-Programm in Kombination mit einer niederfrequenten Paarberatung ein effektives Mittel zur Verbesserung der Beziehungszufriedenheit darstellen könnte. Zukünftige kontrollierte Studien sind nötig, um die Wirksamkeit dieses Modells abschließend zu klären.