Comparison of online and in-person cognitive behavioral therapy in individuals diagnosed with major depressive disorder: a non-randomized controlled trial

Nazanin Alavi; Elnaz Moghimi; Callum Stephenson; Gilmar Gutierrez; Jasleen Jagayat; Anchan Kumar; Yijia Shao; Shadé Miller; Caitlin S Yee; Anthi Stefatos; Maedeh Gholamzadehmir; Zara Abbaspour; Amirhossein Shirazi; Tessa Gizzarelli; Ferwa Khan; Charmy Patel; Archana Patel; Megan Yang; Mohsen Omrani

doi:10.3389/fpsyt.2023.1113956

Comparison of online and in-person cognitive behavioral therapy in individuals diagnosed with major depressive disorder: a non-randomized controlled trial

Front Psychiatry. 2023 Apr 28:14:1113956. doi: 10.3389/fpsyt.2023.1113956. eCollection 2023.

Authors

Nazanin Alavi^{1

2

3}, Elnaz Moghimi¹, Callum Stephenson¹, Gilmar Gutierrez¹, Jasleen Jagayat², Anchan Kumar¹, Yijia Shao⁴, Shadé Miller¹, Caitlin S Yee¹, Anthi Stefatos¹, Maedeh Gholamzadehmir⁴, Zara Abbaspour¹, Amirhossein Shirazi³, Tessa Gizzarelli¹, Ferwa Khan¹, Charmy Patel¹, Archana Patel¹, Megan Yang¹, Mohsen Omrani^{1

3}

Affiliations

¹ Department of Psychiatry, Queen's University, Kingston, ON, Canada.
² Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.
³ OPTT Inc., Toronto, ON, Canada.
⁴ Department of Psychology, University of Toronto, Toronto, ON, Canada.

Abstract

Objective: The increased prevalence of major depressive disorder (MDD) amid the COVID-19 pandemic has resulted in substantial growth in online mental health care delivery. Compared to its in-person counterpart, online cognitive behavioral therapy (e-CBT) is a time-flexible and cost-effective method of improving MDD symptoms. However, how its efficacy compares to in-person CBT is yet to be explored. Therefore, the current study compared the efficacy of a therapist-supported, electronically delivered e-CBT program to in-person therapy in individuals diagnosed with MDD.

Methods: Participants (n = 108) diagnosed with MDD selected either a 12 week in-person CBT or an asynchronous therapist-supported e-CBT program. E-CBT participants (n = 55) completed weekly interactive online modules delivered through a secure cloud-based online platform (Online Psychotherapy Tool; OPTT). These modules were followed by homework in which participants received personalized feedback from a trained therapist. Participants in the in-person CBT group (n = 53) discussed sessions and homework with their therapists during one-hour weekly meetings. Program efficacy was evaluated using clinically validated symptomatology and quality of life questionnaires.

Results: Both treatments yielded significant improvements in depressive symptoms and quality of life from baseline to post-treatment. Participants who opted for in-person therapy presented significantly higher baseline symptomatology scores than the e-CBT group. However, both treatments demonstrated comparable significant improvements in depressive symptoms and quality of life from baseline to post-treatment. e-CBT seems to afford higher participant compliance as dropouts in the e-CBT group completed more sessions on average than those in the in-person CBT group.

Conclusion: The findings support e-CBT with therapist guidance as a suitable option to treat MDD. Future studies should investigate how treatment accessibility is related to program completion rates in the e-CBT vs. in-person group.

Clinical trial registration: ClinicalTrials.Gov Protocol Registration and Results System (NCT04478058); clinicaltrials.gov/ct2/show/NCT04478058.

Keywords: cognitive behavioral therapy; depression; electronic; internet therapy; mental health; mental health care; online mental health; psychotherapy.

Associated data

ClinicalTrials.gov/NCT04478058