Abstract
BackgroundAlthough there is evidence for the efficacy of internet-based cognitive behavioral therapy (iCBT), the generalizability of results to routine care is limited.ObjectiveThis study systematically reviews effectiveness studies of guided iCBT interventions for the treatment of depression or anxiety.MethodsThe acceptability (uptake, participants’ characteristics, adherence, and satisfaction), effectiveness, and negative effects (deterioration) of nonrandomized pre-post designs conducted under routine care conditions were synthesized using systematic review and meta-analytic approaches.ResultsA total of 19 studies including 30 groups were included in the analysis. Despite high heterogeneity, individual effect sizes of investigated studies indicate clinically relevant changes, with effect sizes ranging from Hedges’ g=0.42-1.88, with a pooled effect of 1.78 for depression and 0.94 for anxiety studies. Uptake, participants’ characteristics, adherence, and satisfaction indicate a moderate to high acceptability of the interventions. The average deterioration across studies was 2.9%.ConclusionsThis study provides evidence supporting the acceptability and effectiveness of guided iCBT for the treatment of depression and anxiety in routine care. Given the high heterogeneity between interventions and contexts, health care providers should select interventions that have been proven in randomized controlled clinical trials. The successful application of iCBT may be an effective way of increasing health care in multiple contexts.
Highlights
Depressive and anxiety disorders are common mental health problems associated with significant suffering, impairment, and reduction in the quality of life [1,2]
This study aims to examine the acceptability, effects on symptom change, and negative effects of guided internet-based cognitive behavioral therapy (iCBT) interventions in treating depression and anxiety in routine care
With regard to randomized pragmatic trials conducted under routine care conditions, Andrews et al [15] examined a sample of 64 papers reporting results of randomized controlled trial (RCT) on the effectiveness of iCBT for the treatment of depression, panic disorder, generalized anxiety disorder, and social phobia in comparison with control groups in routine practice
Summary
Depressive and anxiety disorders are common mental health problems associated with significant suffering, impairment, and reduction in the quality of life [1,2]. In a recent meta-analysis, Romijn et al [13] showed that iCBT interventions for anxiety disorders can have significant effects obtained in trials implemented in clinical care. They found that effects were smaller in samples recruited in clinical practice than in samples recruited with an open recruitment method compared with waitlist-control groups [13], which raises the question of the effects of iCBT when implemented in routine practice. Conclusions: This study provides evidence supporting the acceptability and effectiveness of guided iCBT for the treatment of depression and anxiety in routine care. The successful application of iCBT may be an effective way of increasing health care in multiple contexts
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