1. UNIVERSITY OF JYVÄSKYLÄ Developing ACT-based Web Treatment for Depression Päivi Lappalainen, Anna Granlund, Sari Siltanen, Raimo Lappalainen Department of Psychology University of Jyväskylä, Finland

2. UNIVERSITY OF JYVÄSKYLÄ Introduction Depression is common, affecting about 121 million people worldwide Depression is among the leading causes of disability worldwide. Fewer than 25 % of those affected have access to effective treatments There is a need to develop alternative approaches to help clients with depression.

3. UNIVERSITY OF JYVÄSKYLÄ We developed a web-based treatment program (6 weeks) for clients experiencing depressive symptoms, and compared it to a 6 week face-to-face ACT-based treatment Preliminary results: 6 months follow-up in October 2011

4. UNIVERSITY OF JYVÄSKYLÄ The web-based treatment program included 1 face-to-face session at the beginning (measurements) and weekly contact with the therapist (feedback on homework), approx. 40 (20-90 min). consisted of 6 modules (one module per week), mostly text (information, exercises, homework) pictures and a few taped exercises Each module included homework each week which the clients completed and placed in their own folder in the treatment platform The modules were based on the core processes of ACT: Values, value-based actions, acceptance, cognitive fusion, contact with the present moment and self-as-context

5. UNIVERSITY OF JYVÄSKYLÄ Criteria for eligibility Depression: 3 questions about depression (scale 0-10): 1) Have you experienced depressed mood most of the day, nearly every day (e.g., feels sad or irritable) without knowing why 2) Have you had periods with markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day 3) Have you had periods of several days, when you have felt so depressed that nothing can make you feel better No simultaneous attendance in another treatment Basic computer skills and access to the Internet

6. UNIVERSITY OF JYVÄSKYLÄ Procedure Assessed for eligibility (n = 40) Face-to-face treatment (n = 18) Internet treatment (n = 19) Randomized (n = 37)

7. UNIVERSITY OF JYVÄSKYLÄ Research questions Is a (mainly) web-based short intervention as efficient as a face-to-face treatment when treating mood disorders? Do the clients accept a web-based short treatment?

8. UNIVERSITY OF JYVÄSKYLÄ Method We had an advertisement in the local newspaper in February 2011 seeking clients experiencing depressive symptoms 60 persons contacted the clinic and were interviewed in the telephone 38 participants were randomized to either a 6 week face-to-face or a 6 week Internet based ACT-treatment program The treatment was delivered by 18 psychology students with no previous experience of ACT Each student therapist had one face-to-face and one net client

9. UNIVERSITY OF JYVÄSKYLÄ Participant Characteristics: Face-to-Face (n=19)Internet (n=19) Sex Female Male 13 (68.4 %) 6 (31.6 %) 13 (68.4 %) 6 (31.6 %) Age (M, SD)46.95 (12.26)42.26 (16.04) Education 9 years 12 years University 1 (5.3 %) 9 (47.4 %) 3 (15.8 %) 7 (36.8 %) 9 (47.4 %) Working/studying Yes No 8 (42.1 %) 11 (57.9 %9 9 (47.4 %) 10 (52.6 %) Diagnosis Yes No Other than depression 8 (42.1 %) 10 (52.6 %) 1 (5.3 %) 10 (52.6 %) 8 (42.1 %) 1 (5.3 %) Depression medication Yes No 6 (31.6 %) 13 (68.4 %) 7 (36.8 %) 12 (63.2 %)

10. UNIVERSITY OF JYVÄSKYLÄ Time used in the web treatment program 30 min-1 hour/week36.8 % (7 clients) 1-2 hours/week42,1 % (8 clients) 2-3 hours/week5.1 % (1 client)

11. UNIVERSITY OF JYVÄSKYLÄ Results BDI II Depression SCL-90 Symptom Checklist GHQ General Health Q Life Satisfaction Face-to-Face (n=18) Pre Post 23.3 9.2 1.05 0.64 19.4 10.2 45.4 56.6 Internet (n= 19) Pre Post 20.7 10.3 1.11 0.58 22.4 11.4 39.1* 63.4 General self evaluated life satisfaction increased more in the internet group (significant interaction effect) On other variables: Similar changes during the time in both treatments

12. UNIVERSITY OF JYVÄSKYLÄ Results AAQ-IIKIMS Mindfulness ATQ Automatic Thoughts: How often? ATQ Automatic Thoughts: How much believe? WBSI Thought Suppression Face-to-Face (n=18) Pre Post 38.5 48.9 120.8 125.9 77.4 56.9 75.7 61.7 47.4 46.9 Internet (n= 19) Pre Post 41.2 47.5 120.0 126.0 74.0 53.6 68.6 49.8 43.2 Significant changes during the treatment in both groups Except for Internet group in KIMS (p = 0.09)

13. UNIVERSITY OF JYVÄSKYLÄ Subjective Client Experiences Face-to-face (n=18)Internet (n=19) Satisfaction8.8 (max 10)8.4 (max 10) Change in well-being7.7 (max 10)7.5 (max 10) Better mood13 (72.2 %)15 (78.9%) Less Anxiety7 (38.9 %)9 (47.4%) More energy6 (33.3 %)6 (31.6%) Less stress3 (16.7 %)6 (31.6%) Increased physical activity (exercise) 2 (11.1%)7 (36.8%) Better health2 (11.1%)1 (5.3%) Has learned new skills12 (66.7%)13 (68.4%)

14. UNIVERSITY OF JYVÄSKYLÄ Experiences Face-to-face (n=18)Internet (n=19) Ideal lenght of treatment19.3 weeks9 weeks I would recommend this kind of treatment 9.068.16 I need more help5.894.84

15. UNIVERSITY OF JYVÄSKYLÄ Conclusions A 6 week Internet-based ACT treatment including 1 (face-to-face) session was as effective as a face-to- face treatment The student delivered ACT-based Internet treatment was well accepted by the clients There were some indications that after a brief ACT- intervention, the ideal lenght of the treatment was reported to be shorter in the Internet group Our study supports the idea that the Internet-based ACT treatment is well suited for training psychologists