Today, when it’s becoming harder and more expensive to see a therapist face-to-face, people are looking for alternatives. I don’t blame them. More and more therapists are ditching accepting health insurance for payment, because companies continuously put up barriers to receiving payment. The payments themselves can be incredibly low, making it difficult for many therapists to make a decent living.
This has driven up the cost of therapy to consumers, all the while making it more difficult to access for those who can afford to do so.
Could an app help you with something as serious as severe depression? New research suggests the answer is a definite “Yes.”
What kind of app are we talking about? iCBT is its name (“Internet-based cognitive behavioral therapy”) and although I’m calling it an “app” here, it actually includes older self-guided websites too. Some of these sites have been around for more than a decade. That’s how well-established and robust these programs are in being able to deliver the gold-standard psychotherapy approach to treating depression — cognitive behavioral therapy.
How do these interventions work? Here’s how the researchers describe them:
In these interventions, patients complete interactive Web-based programs based on the principles of cognitive behavioral therapy with no therapeutic support, although sometimes technical support is available. The efficacy of these interventions can be enhanced by therapist support, although this effect may be smaller than previously thought (eg, standardized mean difference symptoms = 0.27).
These types of interventions have typically been in the form of a website accessed via a laptop or desktop computer. But with the commonplace ownership of smartphones, they’ve been adapted for mobile use on the go. Some have also been turned into apps you can download from an app store.
All of them are self-guided, meaning it is up to each individual to finish each module on their own. As motivation is a common problem among people with depression, this can be a challenge. Many apps try and address this with a reward system (such as daily points or rewards), or ancillary support services (such as group support or coaching services).
Why are these types of interventions so potentially game-changing for both researchers and people with depression?
The high prevalence of depression and the ubiquity of internet access and mobile phone ownership make self-guided iCBTs hugely promising in reducing the burden of disability associated with depressive symptoms, even if they were somewhat less effective than guided iCBTs.
Since anyone can access and use them at any time — no appointment necessary! — they have the potential to be game-changing when it comes to the treatment of depression.
Is iCBT Effective for Severe Depression?
In a word, “Yes.” The current researchers (Lorenzo-Luaces et al., 2018) analyzed significant previous research done on these Internet-based interventions, looking at whether the study excluded patients with severe depression. They also examined how effective iCBT appeared to be in the treatment of any type of depression, including the most severe types.
Their findings were counter-intuitive, as the researchers freely admit:
The perception that self-guided iCBT will not be effective for cases of more severely symptomatic depression aligns with common sense but is not supported by research data. For example, Bower et al. reported that the effects of self-guided internet-based therapies were more rather than less pronounced among patients high in symptom severity.
In our analyses, we found no evidence that the effects of iCBT varied strongly according to exclusions by high or low symptom severity.
In other words, iCBT is an effective treatment to consider for clinical depression. And not just mild to moderate clinical depression, but also severe depression too.
Even better for the iCBT studies, they tended not to use as many exclusion criteria for subjects as studies examining the effectiveness of psychotherapy or antidepressants did. For instance, many research studies will exclude subjects who have more than one diagnosis (not uncommon) or are also dealing with an alcohol or substance use problem.
Because of this, it is likely that findings from past iCBT research are more robust and generalizeable to ordinary people suffering from depression than studies conducted on antidepressants or psychotherapy. The iCBT studies looked more like groups of real people, sometimes with multiple concerns outside of depression alone.
If you haven’t tried an iCBT program or app and suffer from depression, I recommend giving one a try. There’s very little potential downside to trying one, and they can even be helpful as adjunct to psychotherapy (if you’re already seeing a therapist). Improving your depressive symptoms is a process that requires hard work and change. You have to put the effort into it, regardless of whether its an iCBT app or a psychotherapy session.
Recommended iCBT Apps to Try
Any of the below cognitive-behavioral therapy-based programs below may be helpful to you. If one isn’t working out for you or making you feel any better, it doesn’t hurt to try another.
For any platform with a web browser
MoodGym – The granddaddy of all Internet-based CBT programs
myCompass – Black Dog Institute
Karyotaki E, Riper H, Twisk J, Hoogendoorn A, Kleiboer A, Mira A, et al. (2017). Efficacy of self-guided internet-based cognitive behavioral therapy in the treatment of depressive symptoms: a meta-analysis of individual participant data. JAMA Psychiatry, 74(4), 351-359.
Lorenzo-Luaces L, Johns E, Keefe JR. (2018). The Generalizability of Randomized Controlled Trials of Self-Guided Internet-Based Cognitive Behavioral Therapy for Depressive Symptoms: Systematic Review and Meta-Regression Analysis. J Med Internet Res, 20(11), e10113.