Feeling down, weak or listless are feelings everyone can relate to. It’s normal to have a “bad day” from time to time. However, if you are affected by additional symptoms and the “bad day” turns into a longer period of time, you might be suffering from a depression. Approximately 13 to 20 percent of the German population will suffer at least once from a depression during their lifetime, says Prof. Dr. Matthias Berking, head of chair of clinical psychology and psychotherapy. Depression is one of the most widespread and serious illnesses of our time, and affected individuals need support from psychiatrists, neurologists and psychotherapists. General practitioners also play an important role. They are often the first contact person as they have treated their patients for a long period of time, states Prof. Berking.

First stop general practitioner

There is another reason general practitioners act as a primary point of contact. There is currently a lack of psychotherapeutic treatment, there are not enough treatment spots for all affected individuals. In other words, currently about four million people in Germany are suffering from symptoms of depression, however, only few of these are receiving effective therapy, states research associate and psychologist Ingrid Titzler. Half of the individuals affected by depression are being treated by their general practitioner with pharmaceuticals, a method they commonly feel most comfortable with.

Some patients, however, wish for more than pharmaceuticals. This is where internet-based online therapy can add to classical treatment concepts. Online treatment offers low threshold help, with reduced waiting time which is independent of time and location, explains researcher Titzler. And this is where the blended care E-COMPARED research project, funded by the European Commision, comes in. It is an internet-supported therapy which aims to improve the treatment of patients with depression in family practices – it is the first of its kind. The main goal is the evaluation of the efficacy and cost-effectiveness of blended care.

A European project with eight involved countries

E-Compared is an interdisciplinary project and the lead of the German trial site is under Prof. Dr. Matthias Berking and Dr. David Daniel Ebert, and it involves institutions of psychology, health technology, communication- and information technology, and healthcare. Scientist teams from 8 different countries are comparing regular depression treatment of general practitioners (treatment as usual) with blended care, regular treatment combined with web-based therapy, which also includes a smartphone app.

An online platform and a smartphone app in addition to normal therapy meetings – the first results show that patients appreciate this treatment modality

Patients using the web-based therapy have access to an online platform secured with an individual password to work through certain modules which help dealing with depression. Participants learn on screen what depression actually is, how the disorder can impact life so that they are better able to assess their own state of feeling. By working through these modules participants can improve their understanding of their symptoms and gain a feeling of control by actively doing something against their depression. The platform provides interactive exercises, videos and tasks that help patients to cope with their illness and to integrate the strategies they learned into their daily life. Other modules deal with setting positive goals, problem solving and becoming active in life.

The smartphone app is called Moodbuster and patients use it to rate their mood regularly which makes it possible to monitor changes. In addition, users receive motivating messages. Prof. Berking explains, the app is very close to life and it helps the therapists to identify specific patterns of behavior. Especially patterns such as sudden decrease in mood. Patients receive feedback messages about their therapy progress on the online platform where they can also receive additional support. In contrast, the second part of the therapy consists of face-to-face meetings with their psychotherapist.

It takes about 13 weeks

This blended care therapy normally takes about ten to thirteen weeks during which patients alternately work through the online modules and go to face-to-face therapy sessions at the outpatient clinic of the Friedrich-Alexander University in Erlangen.

The research has not been analyzed yet, but the scientists involved already noticed that patients like this way of therapy and the quick availability, especially through the combination of personal contact and online modules. This impression is supported by previous studies which found that web-based therapy was more effective not only delivered online.

The status quo is that only a few health insurance companies in Germany provide internet-based interventions for their members, but this kind of treatment is not part of standard care and not available for everyone. However, the scientist team at the FAU is sure that they can help improve the treatment of depression and integrate blended care in routine primary care in the long run.

Author: Ilona Hörath

The article was originally published in alexander – a magazine informing about news at the Friedrich-Alexander University Erlangen-Nürnberg in Germany, where the German E-Compared team is belonging to

https://www.fau.de/files/2016/10/FAU-Magazin_alexander_103.pdf