Abstract
BackgroundInternet-delivered cognitive behavioral therapy (ICBT) is an effective treatment that can overcome barriers to mental health care. Various research groups have suggested that unguided ICBT (ie, ICBT without therapist support) and other eHealth interventions can be designed to enhance user engagement and thus outcomes. The persuasive systems design framework captures most design recommendations for eHealth interventions, but there is little empirical evidence that persuasive design is related to clinical outcomes in unguided ICBT.ObjectiveThis study aims to provide an updated meta-analysis of randomized controlled trials of unguided ICBT for depression and anxiety, describe the frequency with which various persuasive design principles are used in such interventions, and use meta-regression to explore whether a greater number of persuasive design elements predicts efficacy in unguided ICBT for depression and anxiety.MethodsWe conducted a systematic review of 5 databases to identify randomized controlled trials of unguided ICBT for depression and anxiety. We conducted separate random effects meta-analyses and separate meta-regressions for depression and anxiety interventions. Each meta-regression included 2 steps. The first step included, as a predictor, whether each intervention was transdiagnostic. For the meta-regression of ICBT for depression, the first step also included the type of control condition. The number of persuasive design principles identified for each intervention was added as a predictor in the second step to reveal the additional variance in effect sizes explained by persuasive design.ResultsOf the 4471 articles we identified in our search, 46 (1.03%) were eligible for inclusion in our analyses. Our meta-analyses showed effect sizes (Hedges g) ranging from 0.22 to 0.31 for depression interventions, depending on the measures taken to account for bias in the results. We found a mean effect size of 0.45 (95% CI 0.33-0.56) for anxiety interventions, with no evidence that the results were inflated by bias. Included interventions were identified as using between 1 and 13 persuasive design principles, with an average of 4.95 (SD 2.85). The meta-regressions showed that a greater number of persuasive design principles predicted greater efficacy in ICBT for depression (R2 change=0.27; B=0.04; P=.02) but not anxiety (R2 change=0.05; B=0.03; P=.17).ConclusionsThese findings show wide variability in the use of persuasive design in unguided ICBT for depression and anxiety and provide preliminary support for the proposition that more persuasively designed interventions are more efficacious, at least in the treatment of depression. Further research is needed to clarify the role of persuasive design in ICBT.
Highlights
BackgroundDepression and anxiety are highly prevalent and represent the leading and the sixth leading causes of disability worldwide, respectively [1]
This study aims to (1) present a systematic review and meta-analysis of randomized controlled trials of unguided Internet-delivered cognitive behavioral therapy (ICBT) for depression and anxiety among adults, (2) systematically examine the frequency with which various persuasive design principles are used in such interventions, and (3) use meta-regression to examine the extent to which persuasive design could explain the variability in effect sizes identified through the meta-analysis
Study duration expressed in months was multiplied by 4.35. cSome studies reported data from multiple posttreatment time points; for such studies, the duration, as shown in this table, is the number of weeks between pretreatment and whichever posttreatment time point was selected for use in the analyses reported in this study. dICBT: internet-delivered cognitive behavioral therapy. eODIN: Overcoming Depression on the Internet. fData were not reported. gTodac Todac translates to “Tap Tap.” hSonreír es Divertido translates to “Smiling is Fun.” iAllesondercontrole translates to “all is under control.” jPAXPD: PAXonline Program for Panic Disorder. kÅngesthjälpen translates to “The Anxiety Help.”
Summary
BackgroundDepression and anxiety are highly prevalent and represent the leading and the sixth leading causes of disability worldwide, respectively [1]. Internet-delivered cognitive behavioral therapy (ICBT) is the most common type of internet intervention and an effective treatment for several common mental health problems, including depression and anxiety [7]. Unlike traditional cognitive behavioral therapy (CBT), ICBT enables users to access treatment materials privately at a time and location that is convenient for them, allowing it to be administered economically on a large scale and circumvent barriers to traditional forms of mental health care [8,9,10]. Guidance appears to improve adherence and clinical outcomes [11], but unguided ICBT is economical, highly scalable, and believed by many researchers to have considerable potential for improving public health [12,13,14,15]. Internet-delivered cognitive behavioral therapy (ICBT) is an effective treatment that can overcome barriers to mental health care. The persuasive systems design framework captures most design recommendations for eHealth interventions, but there is little empirical evidence that persuasive design is related to clinical outcomes in unguided ICBT
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
