Benefits Of A Multimodal Digital Psychotherapy Platform In The Reduction Of Depressive Symptoms

A 2019 study by the Department of Psychology at Berkeley explored the effectiveness of a multimodal digital psychotherapy platform in reducing symptoms of depressive disorders. In the 21st century, more studies are exploring the potential benefits of these interventions, citing their accessibility, convenience, and cost-effectiveness. To understand the possibility of online treatments for depression, it may be valuable to explore this study’s methods, results, and conclusions.

Major depressive disorder (MDD) is one of several depressive disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). To be diagnosed, the DSM-5 specifies an individual must be experiencing at least five of the following symptoms, plus a lack of pleasure and a prolonged low mood:

• Significant unintentional weight loss or gain
• Appetite changes
• Sleep disturbances (insomnia or hypersomnia)
• Psychomotor changes, such as agitation or physical slowness
• Exhaustion, fatigue, or tiredness
• Thoughts of worthlessness or hopelessness
• Recurrent thoughts of death
• Difficulty thinking, concentrating, and making decisions

For depression to be diagnosed, an individual’s symptoms must last at least two weeks every day for most of the day. In addition, the symptoms cannot be caused by another psychiatric disorder, substance use, the use of medication, complex grief, or a medical condition.

For those experiencing suicidal thoughts or urges, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to someone over SMS. Support is available 24/7. For those struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources.

The Berkeley Department of Psychology studied the possibility of online therapy in treating major depressive disorder and other forms of depression. Because major depressive disorder impacts millions of Americans, multiple forms of treatment are being discovered to support individuals in symptom management.

Multimodal psychotherapy platforms offered online give clients an opportunity to find support from a licensed therapist from any location with an internet connection. Because depression can limit one’s ability to attend in-person sessions, online therapy may be a more accessible option.

The study authors report that one in four adults in the US is in need of counseling services. Treatment gaps caused by barriers to in-person options can be challenging for those living with a mental illness. Multimodal psychotherapy platforms offer video, phone, and chat sessions with therapists, which can allow more options for those who are uncomfortable with or unable to attend face-to-face sessions.

This study aimed to investigate the “initial effectiveness of delivering psychotherapy via BetterHelp, a multimodal internet—and mobile-based psychotherapy service provider.” It was designed using a naturalistic and quasi-experimental method and examined the responses of adult clients to online therapy services for depression.

Study objectives and participants

In the study, researchers interviewed 318 clients of an online therapy platform aged 18 and up seeking to improve their quality of life. Adolescents and children were excluded from participation. Others that were excluded from the study included:

• Individuals with thoughts of hurting themselves or others
• Individuals in crisis or emergency situations
• Individuals diagnosed with severe mental illness
• Those advised to be or currently in psychological supervision or care
• Those required to undergo therapy due to a court order or authority

Individuals could participate in the study if they reported a concern of “feelings of overwhelming sadness, grief, or depression.” If their levels of depression fell below significance based on the Patient Health Questionnaire (PHQ-9) screening, they were excluded. People with mild to severe depression were included in the study. The ages of participants ranged from 19 to 72.

The objective of the study was to monitor symptom severity before, during, and after using the online platform to see whether online therapy through a multimodal digital psychotherapy platform could be effective in reducing depression symptoms.

Study procedure

To start, clients were asked to complete questionnaires about the severity of their symptoms, personal history, and motives for seeking therapy. Afterward, clients were matched with an available counselor who best fit their objectives. Clients could choose between phone, video, or chat sessions with their therapist.

In the data collection phase, researchers met with the participants again after they had used the BetterHelp platform for three months. They examined the data to determine whether users exhibited “established markers of clinical improvement, as determined by changes in PHQ-9 scores.”

In addition, researchers looked at financial status, health status, and prior exposure to therapy as variables to understand symptom severity. These results were reviewed by the Institutional Review Board and Office for the Protection of Human Subjects at the University of California, Berkeley.

Study results and statistics

In the study, 28.6% of the clients using the online intervention did not have prior exposure to counseling. 37.1% of clients rated their health as “good,” and 15.4% rated their financial status as “good.”

Before attending therapy, 0 participants met the criteria for minimal depression, 119 met the criteria for mild depression, 91 had moderate depression, 75 had moderately severe depression, and 33 had severe depression. After three months of therapy, the researchers concluded that 63 participants met the criteria for minimal depression, 141 mild depression, 66 moderate depression, 40 moderately severe depression, and 0 severe depression, showing a complete decrease in cases of severe depression from the beginning of the study.

The outcomes of the study did not vary by age. In addition, individuals new to therapy were more likely to experience positive results from treatment. Treatment outcomes did not differ by financial status.

Conclusions and limitations

The study authors conclude that “multimodal digital psychotherapy may be an effective treatment for adult depression.” The study's results were significant, with 120 clients experiencing clinically substantial improvement. Those who had previously used face-to-face therapy had less improvement than first-time users, showing that online therapy may be more effective for people who are new to therapy. However, researchers believe this factor may be due to people having received therapy in the past for more chronic or significant depressive symptoms.

All participants used the live chat feature when using therapy at one point. Most used one type of therapy for the duration of treatment, with one participant using all four options, including SMS-text-based therapy. Future studies may look at the motives behind modality choices that clients made in the study.

One limitation of the study is the lack of a control group. Study authors recommend future studies using a control group for a more valid result, as there may be a sample bias. In addition, those who chose to enroll in the study may have had a more positive view of BetterHelp, as they already used the platform.

Despite these limitations, researchers suggest that online therapy can be an effective treatment for depression, and further studies showcase this result, with one meta-analysis finding that online therapy was effective in treating depression in 17 studies, with some results being more effective than in-person therapy.

Internet therapy can be a beneficial option for clients living with major depressive disorder and other depressive disorders. The above study by the University of California, Berkeley Psychology Department showcases how significant improvements can be made with three months of therapy through a multimodal digital psychotherapy platform.

Through a platform like BetterHelp, clients can be matched with a therapist based on their sign-up questionnaire responses, often within 48 hours. In addition, online therapy may be more cost-effective than traditional insurance or paying out of pocket for treatment, allowing more individuals to access support.

Further studies showcase the benefit of online interventions. In a 2018 study, online therapy was found to be more effective than face-to-face options in treating major depression, with clients reporting increased quality of life and reduced symptom severity. In addition, the modality was more cost-effective.

Takeaway

Based on a 2019 Berkeley Psychology study, online interventions may be a promising treatment for adult depression, with significant symptom improvements seen in many participants. Major depressive disorder can make it difficult for clients to access in-person care. For this reason, online therapy may be a helpful way to receive support. To learn more, consider reaching out to a therapist online.