Can Internet-Based Therapy Help People with Mild Depression?

What you need to know

• Internet-based cognitive behavioral therapy (ICBT) can effectively reduce mild depressive symptoms in Chinese adults
• ICBT was as effective as face-to-face group therapy and more effective than no treatment
• Improvements from ICBT were maintained 6 months after treatment ended
• ICBT may help increase access to mental health care for people with mild depression who are less likely to seek in-person therapy

What is subthreshold depression?

Subthreshold depression refers to having some symptoms of depression that cause distress or impairment, but not enough symptoms to meet the full criteria for major depression. People with subthreshold depression often experience:

• Low mood
• Decreased interest in activities
• Sleep problems
• Fatigue
• Difficulty concentrating

While not as severe as major depression, subthreshold depression can still significantly impact a person’s quality of life and increase their risk of developing major depression in the future. Finding effective treatments for subthreshold depression is important for improving well-being and potentially preventing more severe depression.

The challenge of treating mild depression

Many people with mild depressive symptoms are reluctant to seek face-to-face therapy due to factors like:

• Stigma around mental health treatment
• Time and transportation barriers
• Cost of in-person therapy
• Believing their symptoms aren’t severe enough to warrant treatment

This means a large number of people with subthreshold depression go without any mental health support. Internet-based treatments could help overcome some of these barriers by offering a more accessible and private option.

What is internet-based cognitive behavioral therapy (ICBT)?

ICBT adapts traditional cognitive behavioral therapy techniques into an online format that people can access from home. Key features include:

• Structured lessons teaching CBT skills for managing depression
• Interactive exercises and homework assignments
• Optional guidance from a therapist via messaging
• Self-paced format allowing flexible scheduling

ICBT aims to make evidence-based therapy more widely available to those who may not otherwise access mental health treatment.

How the study worked

The researchers conducted a randomized controlled trial with 329 Chinese adults who had symptoms of mild depression. Participants were randomly assigned to one of three groups:

1. Internet-based CBT (5 weekly online lessons)
2. Face-to-face group CBT (5 weekly in-person group sessions)
3. Waitlist control group (no treatment for 5 weeks)

The study measured participants’ depression symptoms, anxiety, and other outcomes before treatment, immediately after the 5-week program, and 6 months later.

Key findings

ICBT reduced depression symptoms

Participants who completed the online CBT program showed significant reductions in depression symptoms compared to the waitlist group. These improvements were maintained 6 months later.

ICBT was as effective as face-to-face therapy

The online CBT group had similar improvements in depression as the in-person group therapy. On some measures, the ICBT group even showed slightly better outcomes.

High satisfaction with ICBT

Over 80% of ICBT participants completed all 5 lessons. Most reported high satisfaction and said they would recommend the program to others.

Additional benefits

Beyond depression, ICBT participants also saw improvements in:

• Anxiety symptoms
• Repetitive negative thinking (rumination)

Why these findings matter

This study provides strong evidence that internet-based CBT can effectively treat mild depression symptoms in Chinese adults. Some key implications include:

1. Increased access to care: ICBT could help reach people who are unlikely to seek face-to-face therapy, potentially preventing worsening of symptoms.

2. Cost-effective option: Online programs require less therapist time than traditional therapy, potentially allowing more people to be treated.

3. Cultural adaptability: The ICBT program was tailored for Chinese participants and proved highly acceptable, suggesting online formats can be adapted for different cultures.

4. Prevention potential: Treating milder depression symptoms early may help prevent the development of more severe depression.

Limitations to consider

While promising, this study had some limitations:

• Participants were mostly well-educated with higher incomes, so results may not generalize to all populations
• The study only followed participants for 6 months, so longer-term effects are unknown
• It’s unclear if results would be similar for individual face-to-face therapy versus the group format used

Conclusions

Internet-based cognitive behavioral therapy appears to be an effective, accessible option for treating mild depressive symptoms in Chinese adults. For people struggling with low mood who are hesitant to seek in-person therapy, ICBT could be a good first step toward improving mental health. However, those with more severe symptoms should still consult a healthcare provider about treatment options. As online mental health programs continue to develop, they have the potential to expand access to evidence-based care for people with a range of mental health concerns.

• ICBT can effectively reduce mild depression symptoms
• Online therapy may help reach people unlikely to seek in-person treatment
• More research is needed on long-term effects and use in diverse populations