Internet-delivered cognitive behaviour therapy for chronic health conditions: a systematic review and meta-analysis

Swati Mehta,Vanessa A Peynenburg,Heather D Hadjistavropoulos

doi:10.1007/s10865-018-9984-x

Swati Mehta, Vanessa A Peynenburg + Show 1 more

Open Access

https://doi.org/10.1007/s10865-018-9984-x

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Journal: Journal of Behavioral Medicine	Publication Date: Nov 1, 2018
Citations: 110	License type: open-access

Affiliation: University of Regina

Abstract

This systematic review and meta-analysis aims to evaluate the effectiveness of internet-delivered cognitive behavioural therapy (ICBT) on anxiety and depression among persons with chronic health conditions. A systematic database search was conducted of MEDLINE, CINAHL, PsycInfo, EMBASE, and Cochrane for relevant studies published from 1990 to September 2018. A study was included if the following criteria were met: (1) randomized controlled trial involving an ICBT intervention; (2) participants experienced a chronic health condition; (3) participants ≥ 18 years of age; and (4) effects of ICBT on anxiety and/or depression were reported. The Cochrane Risk of Bias tool was used to assess the risk of bias on the included studies. Pooled analysis was conducted on the primary and condition specific secondary outcomes. Twenty-five studies met inclusion criteria and investigated the following chronic health conditions: tinnitus (n = 6), fibromyalgia (n = 3), pain (n = 7), rheumatoid arthritis (n = 3), cardiovascular disease (n = 2), diabetes (n = 1), cancer (n = 1), heterogeneous chronic disease population (n = 1), and spinal cord injury (n = 1). Pooled analysis demonstrated small effects of ICBT in improving anxiety and depression. Moderate effects of therapist-guided approach were seen for depression and anxiety outcomes; while, self-guided approaches resulted in small effects for depression and moderate effects in anxiety outcomes. ICBT shows promise as an alternative to traditional face-to-face interventions among persons with chronic health conditions. Future research on long-term effects of ICBT for individuals with chronic health conditions is needed.Trial Registration PROSPERO registration number: CRD42018087292.

Highlights

There is growing interest in the use of internet-delivered cognitive behaviour therapy (ICBT) as an alternative to face-to-face cognitive behaviour therapy (CBT) (Andersson & Titov, 2014)
The current meta-analysis evaluated the efficacy of internet-delivered cognitive behavioural therapy (ICBT) on anxiety and depression among those with chronic health conditions including pain, tinnitus, fibromyalgia, RA, cardiovascular disease, cancer, diabetes, spinal cord injury, and mixed chronic conditions
Pooled analysis of all 25 studies found that ICBT resulted in significant improvements in overall anxiety and depressive symptoms

Summary

Introduction

There is growing interest in the use of internet-delivered cognitive behaviour therapy (ICBT) as an alternative to face-to-face cognitive behaviour therapy (CBT) (Andersson & Titov, 2014). In ICBT, patients have access to online treatment materials that are based on CBT self-help manuals and designed to provide the same information that is provided in face-to-face CBT (e.g., psychoeducation on the cognitive behavioural model, cognitive restructuring, behavioural skills, relapse prevention). As reviewed by Andersson (2016), the nature of the ICBT materials varies in the research literature, but often includes text and images and sometimes audiovisual content. Treatment duration in ICBT is similar to face-to-face CBT, with patients partaking in the program for a duration of 5–15 weeks (Andersson, 2016)

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