Efficacy of Self-guided Internet-Based Cognitive Behavioral Therapy in the Treatment of Depressive Symptoms

Abstract

IMPORTANCE Self-guided internet-based cognitive behavioral therapy (iCBT) has the potential to increase access and availability of evidence-based therapy and reduce the cost of depression treatment.OBJECTIVES To estimate the effect of self-guided iCBT in treating adults with depressive symptoms compared with controls and evaluate the moderating effects of treatment outcome and response.DATA SOURCES A total of 13 384 abstracts were retrieved through a systematic literature search in PubMed, Embase, PsycINFO, and Cochrane Library from database inception to January 1, 2016.STUDY SELECTION Randomized clinical trials in which self-guided iCBT was compared with a control (usual care, waiting list, or attention control) in individuals with symptoms of depression. DATA EXTRACTION AND SYNTHESISPrimary authors provided individual participant data from 3876 participants from 13 of 16 eligible studies. Missing data were handled using multiple imputations. Mixed-effects models with participants nested within studies were used to examine treatment outcomes and moderators. MAIN OUTCOMES AND MEASURESOutcomes included the Beck Depression Inventory, Center for Epidemiological Studies-Depression Scale, and 9-item Patient Health Questionnaire scores. Scales were standardized across the pool of the included studies. RESULTSOf the 3876 study participants, the mean (SD) age was 42.0 (11.7) years, 2531 (66.0%) of 3832 were female, 1368 (53.1%) of 2574 completed secondary education, and 2262 (71.9%) of 3146 were employed. Self-guided iCBT was significantly more effective than controls on depressive symptoms severity (β = −0.21; Hedges g = 0.27) and treatment response (β = 0.53; odds ratio, 1.95; 95% CI, 1.52-2.50; number needed to treat, 8). Adherence to treatment was associated with lower depressive symptoms (β = −0.19; P = .001) and greater response to treatment (β = 0.90; P < .001). None of the examined participant and study-level variables moderated treatment outcomes.CONCLUSIONS AND RELEVANCE Self-guided iCBT is effective in treating depressive symptoms. The use of meta-analyses of individual participant data provides substantial evidence for clinical and policy decision making because self-guided iCBT can be considered as an evidence-based first-step approach in treating symptoms of depression. Several limitations of the iCBT should be addressed before it can be disseminated into routine care. M any studies [1][2][3][4] have found that depressive symptoms can be effectively treated with psychotherapy, pharmacotherapy, or both. Nevertheless, many people with depressive symptoms do not seek help, and even well-resourced health care systems find it difficult to marshal enough qualified therapists to offer psychological interventions. Access barriers to psychotherapy include limited availability of trained clinicians, high cost of treatment, and fear of stigmatization.5-8 As a consequence, a significant number of individuals with depressive symptoms remain untreated.9,10Self-guided internet-based cognitive behavioral therapy (iCBT) wi...

A secondary analysis of internet-delivered cognitive-behaviour treatment for adults with severe depressive symptoms (Preprint)

“…As was the case in this study, implementing a iCBT intervention with support ensures sufficient monitoring and the potential to intervene if necessary with a vulnerable population at greater risk than those with mild and moderate depression [21]. It is relatively unknown whether individuals with severe depression benefit more, or less from support than those in the mild to moderate range, though recent analyses has suggested that there is no difference in how different populations of severity benefit [39]. Further research would be helpful to delineate mechanisms associated with internet-delivered interventions and how they fluctuate depending on the population and severity.…”

The Generalizability of Randomized Controlled Trials of Self-Guided Internet-Based Cognitive Behavioral Therapy for Depressive Symptoms: Systematic Review and Meta-Regression Analysis (Preprint)

“…Randomized controlled trials (RCTs) exploring the efficacy of self-guided iCBT for depression in adults were obtained by referencing the latest meta-analysis of self-guided iCBT for depression [16]. These authors consulted a database of psychological treatments for depression which was constructed from a systematic literature search of PubMed, Embase, PsycINFO, and Cochrane Library updated until January 1, 2016.…”

“…A major advancement in the study of treatments for depression is the discovery that selfguided internet-based cognitive-behavioral therapy (iCBT) can be more effective than control conditions [16]. In these interventions, patients complete interactive online programs based on the principles of cognitive-behavioral therapy (CBT) with no therapeutic support, though technical support is sometimes available.…”

“…We did this by coding the studies from the latest meta-analysis of self-guided iCBT [16]. In addition to reporting the overall frequency with which specific criteria were used, we sought to explore the relationship between the specific entry criteria and the study-level outcome.…”

Expert Consensus Survey on Digital Health Tools for Patients With Serious Mental Illness: Optimizing for User Characteristics and User Support (Preprint)

“…Interest in applying digital technologies to psychiatric practice has been increasing since the early 2000s, and recommendations for future research in this area were issued in 2013 by a technical expert panel convened by the Agency for Healthcare Research and Quality and the National Institute of Mental Health [10][11][12]. Examples of interventions that have used DHTs in patients with SMI include ecological momentary assessment and treatment interventions [13], computerized psychotherapies [14], cognitive remediation [15,16], family psychoeducation interventions [17], and interventions specifically targeting medication adherence [18].…”