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Therapy for Depression: Computer program can assist much like psychotherapy face-to-face

Computer programs and apps can help meet growing demand for mental health services

Freiburg, Dec 13, 2021

In a large meta-analysis of studies on digital interventions for treating mild to moderate depression, researchers have found that specialized computer programs or apps can be as effective as face-to-face psychotherapy in treating depression. According to Dr. Lasse B. Sander from the Department of Psychology at the University of Freiburg, human support is still needed to ensure that patients adhere to treatment. Together with a team of scientists from the University of Helsinki in Finland, the University of Ulm, the Vrije Universiteit Amsterdam in Holland and the University of Pavia in Italy, Sander conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) on digital interventions for the treatment of depression from 1990 to 2020. In total, the researchers included 83 studies involving 15,530 people in the analysis. The team published their results in the current issue of the renowned journal Psychological Bulletin.

Further research required for smartphone apps

The research group also identified major research gaps in some areas. “The vast majority of scientific studies refer to self-help programs developed together with experts, which are used by patients in weekly sessions on their PCs and which instruct them to change their behavior in everyday life,” says Sander. The Freiburg scientist said that smartphone apps are one area in which more research is urgently needed. Although more than 10,000 smartphone mental health apps are available for download, the researchers found only four carefully conducted randomized control trials to evaluate their effectiveness. “Psychological programs accessed on a PC via a browser typically require about 60-90 minutes of processing time per session,” explains Sander. “In contrast, the attention span for smartphone apps is only a few minutes.”

Lack of trained therapists

“The COVID-19 pandemic is having a strong negative impact on mental health worldwide, especially through containment measures,” says Sander. “Modeling predicts that depression will be the leading cause of years of life lost to illness by 2030. At the same time, however, fewer than one in five sufferers receive adequate treatment. A major reason for this is the lack of trained therapists to meet demand.” As digital interventions, in which psychotherapeutic content is realized in a computer program or mobile app, are increasingly adopted by many people, the researchers wanted to find out whether these services can augment or even replace traditional face-to-face therapy, and what role human support plays.

Human support required

Despite the high effectiveness of digital interventions, it is still necessary for treatment to be accompanied by human support, among other things to maintain motivation for therapy. Digital interventions with minimal human support could achieve comparable results to face-to-face therapy, Sander says. But while human support is necessary to achieve effective results, the researchers found that it makes no difference whether the support is provided by trained therapists or those without formal qualifications. “That opens up a lot of possibilities to expand treatment to include trained support staff,” explains Sander.

Using technology as a preventative measure

Artificial intelligence, machine learning and new technological devices may also play a key role in preventing mental illness in the future: Smartphone and other wearable devices produce a continuous stream of data about a person's behavior and physiology. “Thanks to new methods for using this data, we can determine if someone is at risk for developing a mental illness. Based on this data, patients and their healthcare professionals can then take personalized measures at an early stage to prevent symptoms from worsening,” says Isaac Moshe, a PhD student at the University of Helsinki in Finland, who conducted the study.


Original publication:
Moshe, I., Terhorst, Y., Philippi, P., Domhardt, M., Cuijpers, P., Cristea, I., Pulkki-Råback, L., Baumeister, H., Sander, L.B. (2021): Digital interventions for the treatment of depression: A meta-analytic review. In: Psychological Bulletin.
DOI: 10.1037/bul0000334


Dr. Lasse B. Sander
Department of Psychology – Section for Rehabilitation Psychology and Psychotherapy
University of Freiburg
Tel.: 0761/203-3049

Annette Kollefrath-Persch
Office of University and Science Communications
University of Freiburg
Tel.: 0761/203-8909