Skip to main content
SpringerLink
Log in

An Internet-Based Intervention for Depressive Symptoms: Preliminary Data on the Contribution of Behavioral Activation and Positive Psychotherapy Strategies

  • Conference paper
  • First Online:
Pervasive Computing Paradigms for Mental Health (MindCare 2019)

  • 677 Accesses

Abstract

Depression is one of the most prevalent mental disorders worldwide. Cognitive Behavioral Therapy is a well-known evidence-based therapy. However, interventions are multi-component, and we do not know the specific mechanisms responsible for the change produced by depression therapies. Therapeutic components of most interventions have focused on reducing negative symptoms rather than on improving positive affect, well-being, and character strengths. Positive Psychotherapeutic strategies (PPs) are designed to fill this gap. These PPs have shown efficacy in improving depressive symptoms. Nonetheless, we do not know the specific contribution of a PPs component. Internet-based interventions are effective in treating depression. Using a dismantling design, we are currently carrying out a randomized controlled trial with the objective of evaluating the efficacy of an Internet-based protocol for depressive symptoms (including Behavioral Activation and PPs), the protocol without the PPs component, and the protocol without the BA component. In the present paper, we present preliminary results of nine participants randomized to one of the three conditions, exploring the pre-treatment to post-treatment changes and presenting the qualitative data on the participants’ opinions of the BA and PPs. Participants in the intervention groups with the BA component presented greater improvements in their negative affect and depression; and participants in the PPs improved their positive affect and resilience. Regarding usefulness, the BA group pointed to the improvement in their relationships and to knowing that the activity is related to their mood, and the PPs learned about their psychological strength and saw the positive side of things more.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Gabilondo, A., Rojas-Farreras, S., Vilagut, G., Haro, J.M., Fernández, A., Pinto-Meza, A., et al.: Epidemiology of major depressive episode in a Southern European country: results from the ESEMeD-Spain project. J. Affect. Disord. 120, 76–85 (2010)

    Article  Google Scholar 

  2. Haro, J.M., Ayuso-Mateos, J.L., Bitter, I., Demotes-Mainard, J., Leboyer, M., Lewis, S.W., et al.: ROAMER: roadmap for mental health research in Europe. Int J Methods Psychiatr Res. 23(S1), 1–14 (2014). http://www.ncbi.nlm.nih.gov/pubmed/24375532

    Article  Google Scholar 

  3. World Health Organization: Depression and Other Common Mental Disorders. CC BY-NC-SA 30 IGO, no. 1, pp. 1–22 (2017)

    Google Scholar 

  4. Cuijpers, P., Andersson, G., Donker, T., van Straten, A.: Psychological treatment of depression: results of a series of meta-analyses. Nord. J. Psychiatry 65(6), 354–364 (2011). http://www.tandfonline.com/doi/full/10.3109/08039488.2011.596570

    Article  Google Scholar 

  5. Nakagawa, A., Sado, M., Mitsuda, D., Fujisawa, D., Kikuchi, T., Abe, T., et al.: Effectiveness of cognitive behavioural therapy augmentation in major depression treatment (ECAM study): study protocol for a randomised clinical trial. BMJ Open 4(10) (2014). http://www.ncbi.nlm.nih.gov/pubmed/25335963

    Article  Google Scholar 

  6. National Collaborating Centre for Mental Health (Great Britain): Royal College of Psychiatrists. Depression : The treatment and management of depression in adults. Royal College of Psychiatrists 705 p. (2010)

    Google Scholar 

  7. Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., Dobson, K.S.: A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Can. J. Psychiatry 58(7), 376–385 (2013). http://journals.sagepub.com/doi/10.1177/070674371305800702

    Article  Google Scholar 

  8. Beck, A.T., Rush, A., Shaw, B., Emery, G.: Cognitive Therapy of Depression, 425 p. Guilford Press, New York (1979)

    Google Scholar 

  9. Dimidjian, S., Hollon, S.D., Dobson, K.S., Schmaling, K.B., Kohlenberg, R.J., Addis, M.E., et al.: Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. J. Consult. Clin. Psychol. 74(4), 658–670 (2006). http://doi.apa.org/getdoi.cfm?doi=10.1037/0022-006X.74.4.658

    Article  Google Scholar 

  10. Spates, C.R., Pagoto, S.L., Kalata, A.: A qualitative and quantitative review of behavioral activation treatment of major depressive disorder. Behav. Anal. Today 7(4), 508–521 (2006)

    Article  Google Scholar 

  11. Jacobson, N.S.: Contextualism is dead: long live contextualism. Fam. Process 33(1), 97–100 (1994)

    Article  Google Scholar 

  12. Pérez Álvarez, M., Fernández Rodríguez, C., Amigo, I.: Guía de tratamientos psicológicos eficaces I, pp. 161–196 (2003)

    Google Scholar 

  13. Kazdin, A.E.: Mediators and mechanisms of change in psychotherapy research. Annu. Rev. Clin. Psychol. 3(1), 1–27 (2007). http://www.annualreviews.org/doi/10.1146/annurev.clinpsy.3.022806.091432

    Article  Google Scholar 

  14. Kazdin, A.E.: Understanding how and why psychotherapy leads to change. Psychother. Res. 19(4–5), 418–428 (2009). https://www.tandfonline.com/doi/full/10.1080/10503300802448899

    Article  Google Scholar 

  15. Ruini, C.: Positive Psychology in the Clinical Domains. Springer, Cham (2017). https://doi.org/10.1007/978-3-319-52112-1

    Book  Google Scholar 

  16. Watson, D., Naragon-Gainey, K.: On the specificity of positive emotional dysfunction in psychopathology: evidence from the mood and anxiety disorders and schizophrenia/schizotypy. Clin. Psychol. Rev. 30(7), 839–848 (2010). https://doi.org/10.1016/j.cpr.2009.11.002

    Article  Google Scholar 

  17. Bolier, L., Haverman, M., Westerhof, G.J., Riper, H., Smit, F., Bohlmeijer, E.: Positive psychology interventions: a meta-analysis of randomized controlled studies. BMC Public Health 13(1), 119 (2013)

    Article  Google Scholar 

  18. Sin, N.L., Lyubomirsky, S.: Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: a practice-friendly meta-analysis. J. Clin. Psychol. 65(5), 467–487 (2009). http://www.ncbi.nlm.nih.gov/pubmed/19301241

    Article  Google Scholar 

  19. Pressman, S.D., Jenkins, B.N., Moskowitz, J.T.: Positive affect and health: what do we know and where next should we go? Annu. Rev. Psychol. 70(1), 627–650 (2019). https://www.annualreviews.org/doi/10.1146/annurev-psych-010418-102955

    Article  Google Scholar 

  20. Werner-Seidler, A., Banks, R., Dunn, B.D., Moulds, M.L.: An investigation of the relationship between positive affect regulation and depression. Behav. Res. Ther. 51(1), 46–56 (2013). https://linkinghub.elsevier.com/retrieve/pii/S0005796712001623

    Article  Google Scholar 

  21. Borkovec, T.D., Castonguay, L.G.: What is the scientific meaning of empirically supported therapy? J. Consult. Clin. Psychol. 66(1), 136–142 (1998)

    Article  Google Scholar 

  22. Bell, E.C., Marcus, D.K., Goodlad, J.K.: Are the parts as good as the whole? A meta-analysis of component treatment studies. J. Consult. Clin. Psychol. 81(4), 722–736 (2013)

    Article  Google Scholar 

  23. Kazdin, A.E., Blase, S.L.: Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspect. Psychol. Sci. 6(1), 21–37 (2011). http://journals.sagepub.com/doi/10.1177/1745691610393527

    Article  Google Scholar 

  24. Kazdin, A.E.: Technology-based interventions and reducing the burdens of mental illness: perspectives and comments on the special series. Cogn. Behav. Pract. 22(3), 359–366 (2015). https://linkinghub.elsevier.com/retrieve/pii/S1077722915000292

    Article  Google Scholar 

  25. Johansson, R., Andersson, G.: Internet-based psychological treatments for depression. Expert Rev. Neurother. 12(7), 861–870 (2012)

    Article  Google Scholar 

  26. Karyotaki, E., Riper, H., Twisk, J., Hoogendoorn, A., Kleiboer, A., Mira, A., et al.: 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 (2017)

    Article  Google Scholar 

  27. Karyotaki, E., Kemmeren, L., Riper, H., Twisk, J., Hoogendoorn, A., Kleiboer, A., et al.: Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis. Psychol Med. 48(15), 2456–2466 (2018). https://www.cambridge.org/core/product/identifier/S0033291718000648/type/journal_article

    Article  Google Scholar 

  28. Botella, C., Mira, A., Moragrega, I., García-Palacios, A., Bretón-López, J., Castilla, D., et al.: An internet-based program for depression using activity and physiological sensors: efficacy, expectations, satisfaction, and ease of use. Neuropsychiatr. Dis. Treat. 12, 393 (2016). https://www.dovepress.com/an-internet-based-program-for-depression-using-activity-and-physiologi-peer-reviewed-article-NDT

    Article  Google Scholar 

  29. Mira, A., Bretón-López, J., García-Palacios, A., Quero, S., Baños, R.M., Botella, C.: An internet-based program for depressive symptoms using human and automated support: a randomized controlled trial. Neuropsychiatr. Dis. Treat. 13, 987 (2017)

    Article  Google Scholar 

  30. Montero-Marín, J., Araya, R., Pérez-Yus, M.C., Mayoral, F., Gili, M., Botella, C., et al.: An internet-based intervention for depression in primary care in Spain: a randomized controlled trial. J. Med. Internet Res. 18(8), e231 (2016). http://www.ncbi.nlm.nih.gov/pubmed/27565118. Accessed 20 Oct 2018

    Article  Google Scholar 

  31. Vazquez, F.L., Torres, A., Di-az, O., Otero, P., Blanco, V., Hermida, E.: Protocol for a randomized controlled dismantling study of a brief telephonic psychological intervention applied to nonprofessional caregivers with symptoms of depression. BMC Psychiatry 15(1), 1–9 (2015). https://doi.org/10.1186/s12888-015-0682-8

    Article  Google Scholar 

  32. Cuijpers, P., Cristea, I.A., Karyotaki, E., Reijnders, M., Hollon, S.D.: Component studies of psychological treatments of adult depression: a systematic review and meta-analysis. Psychother. Res. 29(1), 15–29 (2019). https://doi.org/10.1080/10503307.2017.1395922

    Article  Google Scholar 

  33. Moher, D., Schulz, K.F., Altman, D.G.: The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Med. Res. Methodol. 1(1), 2 (2001). http://bmcmedresmethodol.biomedcentral.com/articles/10.1186/1471-2288-1-2

    Article  Google Scholar 

  34. Moher, D., Hopewell, S., Schulz, K.F., Montori, V., Gøtzsche, P.C., Devereaux, P.J., et al.: CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ 340 (2010)

    Article  Google Scholar 

  35. Eysenbach, G., CONSORT-EHEALTH Group: CONSORT-EHEALTH: improving and standardizing evaluation reports of web-based and mobile health interventions. J. Med. Internet Res. 13(4) (2011)

    Article  Google Scholar 

  36. Chan, A., Tetzlaff, J.M., Gøtzsche, P.C., Altman, D.G., Mann, H., Berlin, J.A., et al.: Research methods and reporting SPIRIT 2013 explanation and elaboration : guidance for protocols of clinical trials. BMJ Res. Methods Rep. 1–42 (2013)

    Google Scholar 

  37. Chan, A.-W., Tetzlaff, J.M., Altman, D.G., Laupacis, A., Gøtzsche, P.C., Krleža-Jerić, K., et al.: SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann. Intern. Med. 158(3), 200 (2013). http://www.ncbi.nlm.nih.gov/pubmed/23295957

    Article  Google Scholar 

  38. Mira, A., Bretón-López, J., Enrique, Á., Castilla, D., García-Palacios, A., Baños, R., et al.: Exploring the incorporation of a positive psychology component in a cognitive behavioral internet-based program for depressive symptoms results throughout the intervention process. Front Psychol. 9, 2360 (2018). http://www.ncbi.nlm.nih.gov/pubmed/30555384

    Article  Google Scholar 

  39. Sheehan, D.V., Lecrubier, Y., Sheehan, K.H., Amorim, P., Janavs, J., Weiller, E., et al.: The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J. Clin. Psychiatry. 59(Suppl 2:22–33), 34–57 (1998)

    Google Scholar 

  40. Ferrando, L., Bobes, J., Gibert, J.: MINI. Mini International Neuropsychiatric Interview. Versión en Español 5.0.0 DSM-IV. Instrumentos detección y orientación diagnóstica. 2–26 (2000). http://www.fundacionforo.com/pdfs/mini.pdf

  41. Beck, A.T., Steer, R.A., Brown, G.K.: Manual for the Beck Depression Inventory-II. Psychological Corporation, San Antonio (1996)

    Google Scholar 

  42. Sanz Fernández, J., Navarro, M.E., Vázquez Valverde, C.: Adaptación española del inventario para la depresión de Beck-II: 1. Propiedades psicométricas en estudiantes universitarios. Análisis y Modif Conduct. 29(124), 239–288 (2003)

    Google Scholar 

  43. Sandín, B., Chorot, P., Lostao, L., Joiner, T.E., Santed, M.E., Valiente, R.: Escalas PANAS de afecto positivo y negativo: validación factorial y convergencia transcultural. Psicothema 11(1), 37–51 (1999)

    Google Scholar 

  44. Connor, K.M., Davidson, J.R.T.: Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 18(2), 76–82 (2003). http://doi.wiley.com/10.1002/da.10113

    Article  Google Scholar 

  45. Yu, X., Zhang, J.: Factor analysis and psychometric evaluation of the Connor-Davidson Resilience Scale (CD-RISC) With Chinese people. Soc. Behav. Personal. Int. J. 35(1), 19–30 (2007). http://openurl.ingenta.com/content/xref?genre=article&issn=0301-2212&volume=35&issue=1&spage=19

    Article  MathSciNet  Google Scholar 

  46. Singh, K., Yu, X.: Psychometric evaluation of the Connor-Davidson Resilience Scale (CD-RISC) in a sample of Indian students. J. Psychol. 1(1), 23–30 (2010). https://www.tandfonline.com/doi/full/10.1080/09764224.2010.11885442

    Article  Google Scholar 

  47. Hill, C.E., Knox, S., Thompson, B.J., Williams, E.N., Hess, S.A.: Consensual qualitative research: an update. J. Couns. Psychol. 52, 196 (2005)

    Article  Google Scholar 

  48. Knox, S., Burkard, A.W.: Qualitative research interviews. Psychother. Res. 19(4–5), 566–575 (2009)

    Article  Google Scholar 

  49. Faul, F., Erdfelder, E., Lang, A.-G., Buchner, A.: G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav. Res. Methods 39(2), 175–191 (2007)

    Article  Google Scholar 

  50. Jacobson, N.S., Truax, P.: Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J. Consult. Clin. Psychol. 59(1), 12–19 (1991). http://www.ncbi.nlm.nih.gov/pubmed/2002127

    Article  Google Scholar 

  51. Kupfer, D.J.: Long-term treatment of depression. J. Clin. Psychiatry 52, 28–34 (1991). http://www.ncbi.nlm.nih.gov/pubmed/1903134

    Google Scholar 

  52. Andersson, G., Cuijpers, P.: Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cogn. Behav. Ther. 38(4), 196–205 (2009). http://www.tandfonline.com/doi/full/10.1080/16506070903318960

    Article  Google Scholar 

  53. Fredrickson, B.L.: The role of positive emotions in positive psychology. The broaden-and-build theory of positive emotions. Am. Psychol. 56(3), 218–226 (2001)

    Article  Google Scholar 

  54. Lopez-Gomez, I., Chaves, C., Hervas, G., Vazquez, C.: Comparing the acceptability of a positive psychology intervention versus a cognitive behavioural therapy for clinical depression. Clin. Psychol. Psychother. 24(5), 1029–1039 (2017). http://doi.wiley.com/10.1002/cpp.2129

    Article  Google Scholar 

  55. Ryff, C.D.: Psychological well-being revisited: advances in the science and practice of eudaimonia. Psychother. Psychosom. 83(1), 10–28 (2014). https://www.karger.com/Article/FullText/353263

    Article  Google Scholar 

  56. Seligman, M.E.P., Rashid, T., Parks, A.C.: Positive psychotherapy. Am. Psychol. 61(8), 774–788 (2006). http://doi.apa.org/getdoi.cfm?doi=10.1037/0003-066X.61.8.774

    Article  Google Scholar 

  57. Southwick, S.M., Bonanno, G.A., Masten, A.S., Panter-Brick, C., Yehuda, R.: Resilience definitions, theory, and challenges: interdisciplinary perspectives. Eur. J. Psychotraumatol. 5(1), 25338 (2014). http://www.eurojnlofpsychotraumatol.net

    Article  Google Scholar 

  58. Furukawa, T.A., Imai, H., Horikoshi, M., Shimodera, S., Hiroe, T., Funayama, T., et al.: Behavioral activation: is it the expectation or achievement, of mastery or pleasure that contributes to improvement in depression? J. Affect. Disord. 238, 336–341 (2018). https://www.sciencedirect.com/science/article/pii/S0165032718300338?via%3Dihub

    Article  Google Scholar 

  59. Hill, C.E., Thompson, B.J., Williams, E.N.: A guide to conducting consensual qualitative research. Couns. Psychol. 25(4), 517–572 (1997). http://journals.sagepub.com/doi/10.1177/0011000097254001

    Article  Google Scholar 

  60. Fernández-Álvarez, J., Díaz-García, A., González-Robles, A., Baños, R., García-Palacios, A., Botella, C.: Dropping out of a transdiagnostic online intervention: a qualitative analysis of client’s experiences. Internet Interv. 10, 29–38 (2017)

    Article  Google Scholar 

Download references

Acknowledgments

CIBERobn, an initiative of Institute of Health Carlos III (ISCIII); UJI-A2016-14 Program, Project 16I336.01/1 (Universitat Jaume I).

Author information

Authors and Affiliations

  1. Department of Basic Psychology, Clinic and Psychobiology, Universitat Jaume I, Castellón, Spain

    Sonia Romero, Adriana Mira, Juana Bretón-Lopez, Amanda Díaz-García, Laura Díaz-Sanahuja, Azucena García-Palacios & Cristina Botella

  2. Department of Psychology and Sociology, Universidad de Zaragoza, Teruel, Spain

    Adriana Mira

  3. CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Santiago de Compostela, Spain

    Juana Bretón-Lopez, Azucena García-Palacios & Cristina Botella

Authors
  1. Sonia Romero
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adriana Mira
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Juana Bretón-Lopez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amanda Díaz-García
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Laura Díaz-Sanahuja
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Azucena García-Palacios
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Cristina Botella
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sonia Romero .

Editor information

Editors and Affiliations

  1. IRCCS Istituto Auxologico Italiano, Milan, Italy

    Pietro Cipresso

  2. Department of Clinical Neurosciences, University of Lausanne, Lausanne, Switzerland

    Silvia Serino

  3. Catholic University of the Sacred Heart, Milan, Italy

    Daniela Villani

Rights and permissions

Reprints and permissions

Copyright information

© 2019 ICST Institute for Computer Sciences, Social Informatics and Telecommunications Engineering

About this paper

Check for updates. Verify currency and authenticity via CrossMark

Cite this paper

Romero, S. et al. (2019). An Internet-Based Intervention for Depressive Symptoms: Preliminary Data on the Contribution of Behavioral Activation and Positive Psychotherapy Strategies. In: Cipresso, P., Serino, S., Villani, D. (eds) Pervasive Computing Paradigms for Mental Health. MindCare 2019. Lecture Notes of the Institute for Computer Sciences, Social Informatics and Telecommunications Engineering, vol 288. Springer, Cham. https://doi.org/10.1007/978-3-030-25872-6_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-25872-6_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-25871-9

  • Online ISBN: 978-3-030-25872-6

  • eBook Packages: Computer ScienceComputer Science (R0)

Publish with us

Policies and ethics

Search

Navigation