How can optimized expectations help with internet-based interventions for depression?

Depression is one of the most common mental illnesses worldwide, with up to 20 percent of people being affected during their lifetime. It places a huge burden on the sufferer, often leads to a reduced earning capacity, and has enormous social costs. Despite the existence of effective treatment options in the form of antidepressant medication and psychotherapy, depression remains untreated in a large number of cases. Sufferers often fear being stigmatized by the diagnosis and worry about side effects. Moreover, accessing psychotherapy is often difficult. This is where internet-based interventions can help: In many cases, these self-help materials work just as well as psychotherapy. What is more, they are low-threshold, flexible, inexpensive, and can even be individualized.

Negative expectations are common in depression – and put a strain on therapy

Our aim in Project A16 is to show how internet-based interventions can be substantially improved even more. To help us, we are drawing on our findings from the first funding period of our Collaborative Research Centre, in which we investigated the illness beliefs of patients with depression and how these beliefs affect treatment expectations and treatment success. Many sufferers develop a fatalistic view of their illness (‘I'm sick, there's nothing we can do’), are sceptical about treatments (‘Nothing will help me anyway’), and stop believing that they can do something about their depression themselves (‘I can't do it anyway’). Such negative beliefs can significantly impair the effectiveness of both antidepressants and psychotherapies, and can lead patients to discontinue their treatment.

However, beliefs are not unchangeable. In Project A16, our research has already shown that empathic communication by the therapist and meaningful explanations of the illness and the planned therapy can help to improve patients’ treatment expectations, consequently leading to greater treatment success.

Can optimized self-help materials lead to more successful therapy?

In the second funding period of Project A16, we are investigating how this approach can also make internet-based interventions more successful. Can treatment expectations be improved through self-help materials in patients with depression? Does this actually make therapy more successful? And how do expectations change in interaction with other factors, such as previous experiences, the severity of depressive symptoms, or discussions with experts? Project A16 wants to use the answers to these questions to significantly improve treatment options for depression in the coming years.