![]() Online peer support networks are extremely popular and are known to naturally engage users. Ideally, individuals should be intrinsically motivated to engage with intervention technologies on their own, without prompting from outside clinicians, coaches, or researchers. Further, many individuals seek out Web-based treatments as an alternative to interacting with a clinician and may not be comfortable seeking support from other professionals, even trained coaches. ![]() Potential barriers to access include cost, availability of coaches, and scheduling logistics. While this approach holds promise, its ability to scale widely may be limited. Mohr et al, for example, found greater adherence to a self-guided depression intervention when participants were provided weekly 5-10 minute phone calls from an assigned coach. To address problems related to engagement and adherence, self-guided treatments can be augmented with external support from clinicians or coaches. Low levels of engagement can be especially problematic and might be one of the reasons that self-guided treatments produce smaller gains than supported methods. Open trials show even higher rates of attrition. A recent review of self-guided, Web-based treatments found a median completion rate of 56%. In practice, however, many self-guided interventions suffer from high attrition rates and low levels of engagement. Self-guided treatments, such as those delivered via the Web, show promise and have the potential to reduce many of the practical and emotional barriers that typically prevent depressed individuals from seeking traditional psychotherapy. To address a problem of this magnitude, innovative solutions are needed. In the United States alone, depression affects as many as 6.6%-10.3% of the population each year and creates a huge economic burden, costing tens of billions of dollars. Major depressive disorder is a debilitating and costly illness. Dropout rates were similar for the two platforms however, Panoply yielded significantly more usage activity ( P<.001) and significantly greater user experience scores ( P<.001). Changes in reappraisal mediated the effects of Panoply, but not the expressive writing platform, for both outcomes of depression (ab=-1.04, SE 0.58, 95% CI -2.67 to -.12) and perseverative thinking (ab=-1.02, SE 0.61, 95% CI -2.88 to -.20). Individuals with baseline reappraisal deficits showed greater comparative benefit from Panoply for depression ( P=.002) and perseverative thinking ( P=.002). Individuals with elevated depression symptoms showed greater comparative benefit from Panoply for depression ( P=.02) and perseverative thinking ( P=.008). We also found significant group by treatment interactions. The two groups did not diverge significantly at post-test on measures of depression or perseverative thinking, though Panoply users had significantly higher reappraisal scores ( P=.02) than expressive writing. The expressive writing platform yielded significant pre to post improvements for depression ( P=.02) and perseverative thinking ( P<.001), but not reappraisal ( P=.45). The Panoply platform produced significant improvements from pre to post for depression ( P=.001), reappraisal ( P<.001), and perseverative thinking ( P<.001).
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