The Efficacy and Effectiveness of Online CBT - Jeroen Ruwaard

3.1. Treatment 37contrast to most programmes, this intervention includes scheduled therapist guidance.The treatment protocol specifies the timing, nature, and frequency of therapist feedback.In this respect, the treatment is similar to the programme studied by Anderssonet al. (2005). However, there are clear strategic differences. Andersson et al. (2005)aimed to provide guided self-help. In contrast, we aimed to transform manualisedface-to-face CBT into an Internet intervention. As such, the treatment includes morefrequent therapist feedback. Further, our programme includes explicit techniques thatserve to support the therapists in providing the treatment.We present the treatment and the results of a randomised controlled trial in whichwe compared the effects of this treatment with those of a waiting-list control condition.In addition, we report the results of an 18-month follow-up study. In light of previousresearch (Andersson, Bergström, Holländare, Ekselius, & Carlbring, 2004; Spek etal., 2007), we examined several predictors of treatment outcome, including baselinedepression intensity, gender, educational level, number of depressive episodes, andmedication. We hypothesised that, in comparison to the waiting-list condition, thetreatment would reduce depressive symptoms more, and that the improvements wouldbe sustained over time.3.1 TreatmentThe treatment involves strategies from Cognitive Therapy (CT) and BehaviouralActivation (Beck, Rush, Shaw, & Emery, 1979; Lewinsohn, Biglan, & Zeiss, 1976). Inthe cognitive interventions, clients learn to recognise maladaptive, negative thoughtsand to substitute these for more realistic, constructive thoughts. In the behaviouralinterventions, clients are encouraged to engage in behaviours that either elicit positivereinforcement, avoid negative reinforcement from the environment and generallyenhance feelings of self-respect (Cuijpers, van Straten, & Warmerdam, 2007; Hopko,Lejuez, Ruggiero, & Eifert, 2003).Similar to manualised face-to-face CBT, the treatment comprises a balanced setof homework assignments and scheduled therapeutic sessions in which assignmentsare explained and adapted to the needs of the client. In web-based CBT, the homeworkassignments are based on web pages, which implement a personal interactive