A Randomised Controlled Trial Comparing an Online Support Group to Expressive Writing for Depression and Anxiety
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.011 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.021 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".