Exploring Internet-Delivered Treatment for Depression

Abstract

Internet-delivered treatment for patients with depressive disorders is evaluated as an effective and flexible treatment approach. Worldwide, the number of individuals with depressive disorders is increasing, and there is a considerable gap between the number of people in need of treatment and available treatment. Delivering treatments over the internet is proposed as a potential solution to bridge this treatment gap. These treatments have been reported to have both benefits and challenges. This thesis aimed to investigate therapist-guided internet-delivered treatments for depression, focusing on essential aspects to consider when studying, providing, and developing these interventions to complement studies of treatment effects. Three research questions were posed: 1) How have therapist-guided internet-delivered treatments for depression been studied, and are there any gaps in the research? 2) How do therapists experience providing therapist-guided internet-delivered treatment for patients with depression? 3) How do participants with personal experience of depression view a new internet-delivered acceptance and commitment therapy program for depression? Three studies were conducted to answer these questions. Study I is a scoping review, where 111 studies on guided internet-delivered treatment for depression were identified. Several research gaps were uncovered regarding how the studies were designed, the treatment approaches tested, the representation of participants, and how treatment completion was defined and reported. In Study II, therapists with clinical experience of the treatment program “eCoping” were interviewed about providing this treatment. The therapists described that predicting which patients would benefit from the program was complex. The program was experienced as putting high demands on patients, therapists, and clinics. Furthermore, it was emphasized that the program would not be a good fit for every patient, and the lack of possibilities to tailor the treatment was described as a challenge. In Study III, participants with personal experience of depression were interviewed about their views of an internet-delivered acceptance and commitment therapy program. The impact depressive symptoms could have on adherence to the treatment was emphasized. Combining the program with other treatments was viewed as an acceptable and good treatment option, but the program was viewed as insufficient as a standalone program. The participants also expressed the need for personalized treatment and raised concerns about the program’s standardized format. Altogether, the work in this thesis provides a comprehensive insight into vital aspects to consider when studying, providing, and developing internet-delivered interventions. This could be a valuable contribution to a research field aiming to address an increasing treatment gap.