HU team finds that depression can be treated effectively by online cognitive behavioral therapy

Many people suffering from depression are ashamed to come to a psychiatric facility to be treated. Now, a new study at the Hebrew University of Jerusalem has studied the effects of guided internet-based cognitive behavioral therapy (CBT) from afar for the treatment of this mood disorder, focusing on the therapeutic alliance and attachment styles. 

The study, whose findings deepen our understanding of how depression can be treated through internet-based interventions, found significant improvements in depression and insomnia symptoms over time. These underscore the crucial role of the therapeutic alliance and the broader benefits of this form of therapy.

The research has just been published in the journal Psychotherapy Research titled “Interpersonal Factors in Internet-based Cognitive Behavioral Therapy for depression: Attachment Style and Alliance with the Program and with the Therapist.”

Depression is one of the most prevalent psychiatric conditions, with a lifetime prevalence of 10.6% worldwide and 9.8% in Israel. Untreated depression has become an even more pressing issue since the COVID-19 pandemic, which has both exacerbated difficulties in providing mental health services and intensified losses, distress, and financial struggles for individuals – and the Hamas terrorist massacre on October 7 and the military confrontations in the south and north.

What is cognitive behavioral therapy (CBT)

CBT is a talking therapy provided by specially trained psychologists and social workers to help people manage their problems by changing how they think and behave. While it’s most often used to treat anxiety and depression, but can be useful for phobias, obsessive behavior, and other mental and physical health problems.

A new study led by Dr. Dina Zalaznik from HU Prof. Jonathan Huppert's laboratory for the treatment and study of mental health and wellbeing has shown significant benefits in the online treatment of depression. 

Participants were recruited through ads for a free trial and underwent screening, including online surveys and a phone interview. Thirty-nine participants, mostly female (59%), with an average age of 37.9 years, were included. 

The internet-based CBT program consisted of six modules covering psychoeducation, cognitive work, behavioral activation, challenging thoughts, optional cognitive behavioral therapy for insomnia, and the prevention of relapses. Treatment was provided by supervised doctoral students, with weekly guidance and homework assignments. Dropout rates and treatment adherence were also followed.

One of the key findings of the study was the importance of the partnership between the therapist and the patient and with the program in predicting adherence and dropout rates. While both partnerships played a role in treatment outcomes, only the alliance with the therapist was significantly related to symptom improvement. This highlights the unique contributions of each aspect of the alliance in the effectiveness of internet-based cognitive behavioral therapy.

The study also involved the role of attachment styles in internet-based CBT, with results indicating that avoidant attachment style scores improved significantly during internet-based cognitive behavioral therapy, whereas anxious attachment did not show significant improvement. This finding suggests that even though the focus of internet-based cognitive behavioral therapy is not on interpersonal relationships and the therapist’s involvement is limited, the emotional and cognitive components of attachment can still have a positive impact. 

Results from the study demonstrate the effectiveness of a culturally adapted Hebrew version of guided internet-based cognitive behavioral therapy for depression and insomnia. Depression symptoms and insomnia improved significantly over time, with noticeable and meaningful changes observed for all variables.

This study suggests that in internet-based therapy, the relationship between the therapist and the program is crucial for maintaining motivation and commitment to the treatment. Clinicians should consider using a weekly questionnaire to track these relationships and make necessary improvements. Future studies should explore factors influencing these relationships further, the team recommended.