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This study examined the efficacy of internet-delivered cognitive and behavioural interventions for adults with chronic pain AND explored the role of clinical and study characteristics as moderators of treatment effects. PubMed, Embase, PsycINFO, CENTRAL and CINAHL were searched to identify randomized controlled trials published up to October 2021. A meta-analysis of 36 studies (5778 participants) was conducted, which found small effect sizes for interference/disability (Hedges' g 5 0.28; 95% confidence interval [CI] 0.21-0.35), depression (g 5 0.43; 95% CI 0.33-0.54), anxiety (g 5 0.32; 95% CI 0.24-0.40), pain intensity (g 5 0.27; 95% CI 0.21-0.33), self-efficacy (g 5 0.39; 95% CI 0.27-0.52) and pain catastrophizing (g 5 0.31; 95% CI 0.22-0.39). Moderator analyses found that interventions which involved clinician guidance had significantly greater effect sizes for interference/disability (g 5 0.38), anxiety (g 5 0.39), and pain intensity (g 5 0.33) compared with those without (g 5 0.16, g 5 0.18, and g 5 0.20, respectively). Studies using an inactive control had greater effects for depression (g 5 0.46) compared with active control trials (g 5 0.22). No differences were found between treatments based on traditional cognitive behaviour therapy vs acceptance and commitment therapy. Sample size, study year, and overall risk of bias (Cochrane rating) did not consistently moderate treatment effects. Overall, the results support the use of internet-delivered cognitive and behavioural interventions as efficacious and suggest guided interventions are associated with greater clinical gains for several key pain management outcomes.

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<b><i>Introduction:</i></b> Psychological adjustment to chronic health conditions is important, as poor adjustment predicts a range of adverse medical and psychosocial outcomes. Psychological treatments demonstrate efficacy for people with chronic health conditions, but existing research takes a disorder-specific approach and they are predominately delivered in face-to-face contexts. The internet and remotely delivered treatments have the potential to overcome barriers to accessing traditional face-to-face treatment. <b><i>Objective:</i></b> The current study examined the efficacy and acceptability of an internet-delivered transdiagnostic psychological intervention to promote adjustment to illness, based on cognitive behaviour therapy principles. <b><i>Methods:</i></b> In a two-arm randomised controlled trial, participants (<i>n</i> = 676) were randomly allocated to the 8-week intervention or a waitlist control. Treatment included five core lessons, homework tasks, additional resources, and weekly contact with a psychologist. Primary outcomes included depression, anxiety, and disability, assessed at pre-treatment, post-treatment, 3-month follow-up, and 12-month follow-up. <b><i>Results:</i></b> The treatment group reported significantly greater improvements in depression (between-groups <i>d =</i> 0.47), anxiety (<i>d</i> = 0.32), and disability (<i>d</i> = 0.17) at post-treatment (all <i>ps</i> &#x3c;0.001). Improvements were sustained over the 3-month and 12-month follow-ups. High treatment completion rates (69%) and levels of satisfaction (86%) were reported by participants in treatment. The intervention required a mean clinician time of 56.70 min per participant. <b><i>Conclusions:</i></b> The findings provide preliminary and tentative support for the potential of internet-delivered transdiagnostic interventions to promote adjustment to chronic health conditions. Further research using robust control groups, and exploring the generalisability of findings, is needed before firm conclusions can be drawn.

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