MoodGym is a web-based program that utilizes the techniques of cognitive behavioral therapy for depression and anxiety. It is intended to be a self-directed program but it can also be used in conjunction with live psychotherapy and/or psychopharmacology sessions. The program is based on principles derived from traditional, therapist-directed cognitive behavioral therapy, for which there is considerable consensus on efficacy from controlled clinical trials.
MoodGym was launched in 2004 and is intended to help prevent depression and anxiety, especially in young people. The program was developed in Australia, where access to live therapists is often difficult in remote parts of the country. Since inception, MoodGym has acquired over 850,000 registered users according to its website.
Users are asked to work through a program of 5 modules. At the beginning and end of each module, users are asked to complete self-assessment instruments rating mood and anxiety. The results of these assessments are compared to normative data and are used to help guide certain aspects of each module. There are also several other detailed, and quite lengthy, assessment tools interspersed in the program. These are designed to help users better understand their automatic thoughts in response to stress and the types of activities that they can use as coping strategies.
Ease of Use and User Experience
To use MoodGym independently, the user is expected to have basic computer and internet skills and to have sufficient attention and motivation to work through a fairly extensive program. The modules and exercises can be suspended and saved, and the user will automatically be directed back to where they left off when restarting the program. One can also revisit modules, or sections of modules, to update assessments and to review material. It is easy to set up an account and to navigate through the various portions of the program.
The website is largely text-based; the format feels dated and is not mobile friendly. However, an updated version of MoodGym is expected soon and we will add to this review when the new version is available.
The instructions for each module are clear and easy to grasp, although there is quite a lot of Australian slang used, which may not be familiar to many international users. Feedback is given mainly in the form of comparing the results of assessment tools to normative data. This approach is scientifically valid, but feels a bit sterile. The program does not include a lot of positive feedback related to individual task completion, which sets it apart from some more contemporary programs. Therefore, user enjoyment and engagement may be somewhat less than what might be expected in newer app-based and game-based approaches.
Appropriateness of Content
At the start of the program, users are introduced to several characters that exemplify certain cognitive styles related to depression and anxiety. The user is then asked to work through the five modules of the program.
The first module is the “Feelings Module”, which uses the characters and various exercises to illustrate the kind of feeling states that certain automatic thoughts can provoke.
In the “Thoughts Module” the user is introduced to 10 types of “Warped Thoughts” that are automatic and create a bias towards depression or anxiety. These are derived from a work by David Burns called “Feeling Good: the New Mood Therapy”, published in 1980. Other types of automatic thoughts from the work of Aaron Beck are also illustrated. The user is taken through various exercises to identify these thought patterns in the characters and in self-generated examples. Exercises to help improve self-esteem are also proposed.
In the “Unwarping Module”, 6 other techniques to contest negative automatic thoughts are introduced. At this point, the amount of information contained in the program starts to seem quite large. Users will have to return to the program multiple times to digest the information. It may have been more effective to allow users to develop individualized tracks through the program that focus on fewer techniques.
In the “De-Stressing Module”, the user is asked to identify stressors and the types of stress response they normally use. There is an interesting section in this module related to parenting styles, which I think would be quite helpful for young adults. This module also contains some very nice “de-stressing” exercises including progressive relaxation, guided imagery, and meditation sections.
Finally, there is a “Relationship Module” in which users are asked to examine the types and qualities of relationships they tend to form. This module feels somewhat oversimplified and brief, as this is a vast area of inquiry that may be better addressed in real-time psychotherapy.
MoodGym is one of the best-studied digital applications for mental health that exists. The many references for the product are at: http://www.ehub.anu.edu.au/assist/about/research.php.
Multiple randomized controlled trials have been conducted with MoodGym. These tend to show modest efficacy that is comparable to other types of psychotherapy and better than a wait-list control condition. The effect size for these trials tends to be about 0.4, which means depression ratings in people using MoodGym are better than those in the control condition by about 0.4 standard deviations. This is considered a reasonable and meaningful degree of improvement in medical research, and is comparable to the effect seen in trials of antidepressants.
In addition to standard clinical trials, MoodGym has also been studied in several novel situations, including preventive studies in schools and workplace environments, and in depression associated with chronic medical illnesses such as traumatic brain injury, multiple sclerosis and fibromyalgia.
One of the biggest problems with MoodGym appears to be a high rate of non-adherence or drop out from the program. For example, in one review of 82,000 users it was found that 27% completed one module and only 10% completed 2 or more modules. Other studies suggest that adherence with MoodGym may be better when regular telephone tracking of use, or regular therapist contact, are employed. It remains to be seen if adherence can be improved with a more modern and mobile friendly platform, or if regular contact with in-person therapists will be required.
It is also not yet known how long the benefit of MoodGym might persist. Since depression is a chronic condition for many people, repeated study of the MoodGym modules may be necessary. I would guess that repeated study would also be more likely with a revised user interface.
There is no charge to use MoodGym. The Australian government funded the start-up and careful study of this technique.
Review date: August 2015