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A Randomised Controlled Trial Comparing an Online Support Group to Expressive Writing for Depression and Anxiety

Background: The Internet enables people to help each other out with their problems, regardless of time or geographical location. Countless online forums or support groups exist, including for psychological problems. Objective: This study examined the efficacy of an online support group (OSG) in reducing depression and anxiety, and increasing perceived social support. Randomised controlled trials (RCTs) of online interventions face several challenges, including the choice of a control group. Our study compared an OSG with an online expressive writing task, where participants wrote about their thoughts and feelings, often upsetting ones, for a minimum of five minutes every two weeks over the course of the study. Participants submitted their writings, but received no feedback. Methods: 6-month RCT in which participants were directed either to (1) take part in an OSG (Psych Central); or (2) complete an online expressive writing task. 863 (628 female) UK, US and Canadian volunteers were recruited via the Internet. Using a 2:1 ratio, 568 were randomised to the OSG condition (at 6 months 103, 82% attrition) and 295 randomised to the expressive writing condition (at 6 months: 101, 65% attrition). Standard measures (Center for Epidemiologic Studies Depression Scale; Generalized Anxiety Disorder 7-item; Medical Outcomes Study Social Support Survey; Satisfaction with Life Scale) were administered at intake, 3 months and 6 months. Results: All four outcome variables showed a significant time effect (depression: F(2,201) = 35.00, p < 0.001; social support: F(2,201) = 12.29, p < 0.001; satisfaction with life: F(2,201) = 16.67, p < 0.001; anxiety: F(2,201) = 13.39, p < 0.001) but there were no significant interactions with group, thus showing no differences between conditions (depression: F(2,201) = 1.57, p = 0.21; social support: F(2,201) = 0.59, p = 0.56; satisfaction with life: F(2,201) = 0.19, p = 0.91; anxiety: F(2,201) = 1.09, p = 0.34). The expressive writing condition showed lower drop-out. Within the OSG condition, the mean number of times the OSG was accessed in the first fortnight was twice, and this fell to less than once in the final fortnight of the study period. We split the OSG group into low and high engagers, and compared just high engagers to the expressive writing condition: there were still no significant group effects. Engagement was predicted by high expectation of the intervention’s utility, but not demographic factors. Conclusions: Participants in both the OSG and expressive writing conditions showed similar improvements over time. The expressive writing condition, chosen as a control, was more effective than expected and participants reported it was highly acceptable. Engagement with the OSG was low, it had higher attrition and lower adherence, and it received mixed and often negative feedback. This raises questions about the effectiveness of OSGs for this population. While expressive writing has been demonstrated to have some efficacy over short periods (3-5 days), it has not been used in this manner previously and its use as an online intervention warrants further investigation.