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Internet-based cognitive behavioural therapy for subthreshold depression in people over 50 years old: a randomized controlled clinical trial

  • VIOLA SPEK (a1) (a2), IVAN NYKLÍČEK (a1), NIELS SMITS (a3), PIM CUIJPERS (a3), HELEEN RIPER (a4), JULES KEYZER (a2) and VICTOR POP (a1) (a2)...

Subthreshold depression is a highly prevalent condition and a risk factor for developing a major depressive episode. Internet-based cognitive behaviour therapy may be a promising approach for the treatment of subthreshold depression. The current study had two aims: (1) to determine whether an internet-based cognitive behaviour therapy intervention and a group cognitive behaviour therapy intervention are more effective than a waiting-list control group; and (2) to determine whether the effect of the internet-based cognitive behaviour therapy differs from the group cognitive behaviour therapy intervention.


A total of 191 women and 110 men with subthreshold depression were randomized into internet-based treatment, group cognitive behaviour therapy (Lewinsohn's Coping With Depression course), or a waiting-list control condition. The main outcome measure was treatment response after 10 weeks, defined as the difference in pre- and post-treatment scores on the Beck Depression Inventory (BDI). Missing data, a major limitation of this study, were imputed using the Multiple Imputation (MI) procedure Data Augmentation.


In the waiting-list control group, we found a pre- to post-improvement effect size of 0·45, which was 0·65 in the group cognitive behaviour therapy condition and 1·00 within the internet-based treatment condition. Helmert contrasts showed a significant difference between the waiting-list condition and the two treatment conditions (p=0·04) and no significant difference between both treatment conditions (p=0·62).


An internet-based intervention may be at least as effective as a commonly used group cognitive behaviour therapy intervention for subthreshold depression in people over 50 years of age.

Corresponding author
*Address for correspondence: Viola Spek, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands. (Email:
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Psychological Medicine
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