web-based self-help programs for individuals with depressive symptoms are efficacious. Differences in effect sizes and adherence rates might be due to contextual factors. This randomized factorial trial investigated t...
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web-based self-help programs for individuals with depressive symptoms are efficacious. Differences in effect sizes and adherence rates might be due to contextual factors. This randomized factorial trial investigated the effects of four potentially supportive contextual factors on outcome and adherence. Two factors were provided through human contact (guidance and a diagnostic interview), and two factors were provided without human contact (a motivational interviewing module and automated emails). We recruited 316 adults with mild to moderate depressive symptoms (Patient Health Questionnaire-9 score: 5-14). All participants received access to a problem-solving therapy program. Participants were randomized across the four experimental factors (present or absent), resulting in a 16-condition design. The primary outcome was depressive symptoms 10 weeks after baseline. The secondary outcome was program adherence. Overall, results showed significant symptom reduction for the primary depression measure (Cohen's d = 0.38-0.91). Guided participants showed significantly less severe symptoms of depression at post-treatment (d = 0.15) and higher treatment adherence (d = 0.53). At follow-up, these differences were no longer present. The remaining three factors did not influence primary outcome and adherence. These findings indicate that guidance leads to a faster reduction of depressive symptoms and higher treatment adherence.
Guided web-based self-help programs for individuals with depressive symptoms have shown to be more effi-cacious than unguided programs. However, research has paid little attention to why guided interventions are super...
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Guided web-based self-help programs for individuals with depressive symptoms have shown to be more effi-cacious than unguided programs. However, research has paid little attention to why guided interventions are superior. The present study investigated whether working alliance and adherence to the program mediated the effect of guidance on depressive symptom *** study is a secondary analysis of a randomized factorial trial. In the trial, 302 adults with mild to moderate depressive symptoms (Patient Health Questionnaire-9 score: 5-14) were randomized to either a guided or an unguided group. All participants received access to a web-based self-help programbased on problem-solving therapy. Working alliance with the treatment providers was assessed using an adapted version of the Working Alliance Inventory for Guided Internet Interventions two weeks (early-treatment) and eight weeks (post -treat-ment) after pre-treatment. The primary outcome was depressive symptoms at *** total working alliance score was significantly higher for guided participants compared to unguided par-ticipants (at early-treatment: t248.6 = -3.36, p < .001, d = 0.42, at post-treatment: t194.9 = -4.77, p < .001, d = 0.66). The total working alliance score correlated significantly with the change in depressive symptoms for guided (rs = 0.16, 0.34) and unguided participants (rs = 0.26, 0.23). The WAI-I total score statistically mediated the relationship between guidance and outcome (at early-treatment: B = -0.028, at post-treatment: B = -0.053). Furthermore, the subscale tasks (at post-treatment: B = -0.051), the subscale goals (at early-treatment: B = -0.031 and at post-treatment: B = -0.052), and adherence to the program (B = -0.034) mediated the relationship between guidance and outcome. Finally, in a multiple mediation model both early-treatment working alliance and adherence to the program (B = -0.050) mediated the relationship between guidance and *** findings i
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