Review History

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  • The initial submission of this article was received on November 30th, 2012 and was peer-reviewed by 2 reviewers and the Academic Editor.
  • The Academic Editor made their initial decision on January 22nd, 2013.
  • The first revision was submitted on January 25th, 2013 and was reviewed by the Academic Editor.
  • The article was Accepted by the Academic Editor on January 26th, 2013.

Version 0.2 (accepted)

· Jan 26, 2013 · Academic Editor


The revision is nearly acceptable. There is just one issue to correct, which is very easy. On page 6, the TCI is still described as "revised TCI" when it is actually just TCI, and you note shortly thereafter that it is the true-false version. Just delete the word "revised". Since this is so minimal, you may just resubmit with this change authorized, and I'll notify the PeerJ staff that it is accepted already conditional on this change. Thank you for your reasonable and timely cooperation.

Version 0.1 (original submission)

· Jan 22, 2013 · Academic Editor

Minor Revisions

Please address the attached reviewer comments, which were based on the original submission. These reviewer comments involve minor revisions, but the clarification of statistics and more information about demographics will help clarify the study for the reader.

In addition, as you know we had an offline discussion regarding the description of the test you administered, as well as the copyright clearance for that test. As you address the reviewer's concerns, please also edit your submission to reflect the outcome of our discussions. This could mean updating the revision you worked on subsequent to the two reviews below. In particular many of the comments of Reviewer 2 require some further minor revisions to clarify statistics and add demographics. Most of the recommendations about the TCI from Reviewer 1 and 2 are already addressed in your reworked manuscript but you may find other elements helpful as well.

Reviewer 1 ·

Basic reporting

It is an interesting article were the authors report a study of depression and personality change after internet delivered cognitive behavior therapy. This focuses changes in BDI-II and personality based on Cloninger's Temperament and Character Inventory.
The introduction provides a good foundation and justification for the current analysis. The authors list 2 clear main hypotheses in the introduction. Subjects were selected from an online screening fulfilling quite strict criteria. Consistent with some previous literature, personality changes was mainly found in the dimensions of “HA” and “SD”.

Experimental design

The main short-coming in the article is the uncertainty about the TCI version used in the study. In materials and methods they describe the use of the revised TCI version but neither the description nor the results support that they have used the revised version.
A second short-coming is if they have included age and gender into the analysis since temperament and especially character dimensions are affected and has to be taken into account.

Validity of the findings

There is no description under Materials & Methods of the internet based version of the TCI they refer to which arouses questions about reliability and validity - as the authors also noted? However, they present new and interesting data about alternative treatment for people suffering from MDD.

Additional comments

In the summary the authors write “Results: There were significant changes on HA and SD after ICBT.” and “The changes in personality seem related to improvement in depression rather than a direct effect of ICBT.” This seems to be related to page 4, par 2, line 4: "The aims ... were twofold ... Secondly to compare differences in personality changes between treatment responders and non-responders.

1. My question is: Is there a correlation between "changes" and severity of MDD, and/or SD?
2. A minor comment: In order to make get a better agreement between the "second aim" here and "The secondary aim" on p. 11, par 1 I suggest something like this for the one on page 4: "to compare differences in changes in personality dimensions ..."

3. In Discussion par. 4 it says: “Larger effects than expected were found within the control group, with a substantial amount of responders (15.8%) and a decrease on 1.7 HA.” Maybe better with "a decrease of 1.7 raw scores on HA".


Basic reporting

It would be useful to have a table showing the demographic characteristics of the participants (age, sex etc), MADRS-S score at baseline, comorbidities and psychopharmacological treatment.

Experimental design

Please explain further how the F statistics for ICBT, response and their interaction have been calculated.

Validity of the findings

No observer rated depression symptom assessments were performed. This should be discussed as a limitation.
The lowest depression score to be included in the study on MADRS-S was 15. The participants have mild or moderate depression so the findings are only applicable to this group; another limitation that hasn’t been discussed.
Differences between the responders and non-responders regarding baseline BDI-II and MADRS-S should be reported and discussed.
The inclusion and exclusion criteria have not been discussed.

Additional comments

I have previously reviewed this paper for another journal. Many of the comments from myself and the other reviewer have been addressed but there are still some issues to be rectified.
I recommend that, in future studies, you use a more up-to-date version of the TCI.

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