For better or worse: An individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy.

Rozental, Alexander; Magnusson, Kristoffer; Boettcher, Johanna; Andersson, Gerhard; Carlbring, Per

doi:10.1037/ccp0000158

Cited by 116 publications

(122 citation statements)

References 126 publications

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“…Limitations to the present meta‐analysis must be considered. First, possible negative effects of smartphone interventions (e.g., deterioration rates) were not assessed, since they were not reported in the included studies. Future studies should examine these possible negative effects.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of app‐supported smartphone interventions for mental health problems: a meta‐analysis of randomized controlled trials

et al. 2019

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Although impressive progress has been made toward developing empirically-supported psychological treatments, the reality remains that a significant proportion of people with mental health problems do not receive these treatments. Finding ways to reduce this treatment gap is crucial. Since app-supported smartphone interventions are touted as a possible solution, access to up-to-date guidance around the evidence base and clinical utility of these interventions is needed. We conducted a meta-analysis of 66 randomized controlled trials of app-supported smartphone interventions for mental health problems. Smartphone interventions significantly outperformed control conditions in improving depressive (g=0.28, n=54) and generalized anxiety (g=0.30, n=39) symptoms, stress levels (g=0.35, n=27), quality of life (g=0.35, n=43), general psychiatric distress (g=0.40, n=12), social anxiety symptoms (g=0.58, n=6), and positive affect (g=0.44, n=6), with most effects being robust even after adjusting for various possible biasing factors (type of control condition, risk of bias rating). Smartphone interventions conferred no significant benefit over control conditions on panic symptoms (g=-0.05, n=3), post-traumatic stress symptoms (g=0.18, n=4), and negative affect (g=-0.08, n=5). Studies that delivered a cognitive behavior therapy (CBT)-based app and offered professional guidance and reminders to engage produced larger effects on multiple outcomes. Smartphone interventions did not differ significantly from active interventions (face-to-face, computerized treatment), although the number of studies was low (n≤13). The efficacy of app-supported smartphone interventions for common mental health problems was thus confirmed. Although mental health apps are not intended to replace professional clinical services, the present findings highlight the potential of apps to serve as a cost-effective, easily accessible, and low intensity intervention for those who cannot receive standard psychological treatment.

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Section: Discussionmentioning

confidence: 99%

The efficacy of app‐supported smartphone interventions for mental health problems: a meta‐analysis of randomized controlled trials

et al. 2019

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“…One example is a patient‐level meta‐analysis, which included 2,866 patients from 29 clinical trials of ICBT. Using the Reliable Change Index, the deterioration rate was 5.8% in the treatment and 17.4% in the control conditions (odds ratio=3.10, 95% CI: 2.21 to 4.34).…”

Section: Harmful Effectsmentioning

confidence: 99%

“…However, it is important to note that our methods for exploring negative effects are still limited and, for example, relatively little is known about the causes (e.g., the intervention itself, factors outside of the intervention) of the negative effects observed during Internet interventions. Negative effects other than symptom deterioration may also occur in ICBT and should be documented, for example by using open‐ended questions or self‐report measures covering adverse and unwanted events.…”

Section: Harmful Effectsmentioning

confidence: 99%

Internet‐delivered psychological treatments: from innovation to implementation

et al. 2019

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Internet interventions, and in particular Internet-delivered cognitive behaviour therapy (ICBT), have existed for at least 20 years. Here we review the treatment approach and the evidence base, arguing that ICBT can be viewed as a vehicle for innovation. ICBT has been developed and tested for several psychiatric and somatic conditions, and direct comparative studies suggest that therapist-guided ICBT is more effective than a waiting list for anxiety disorders and depression, and tends to be as effective as face-to-face CBT. Studies on the possible harmful effects of ICBT are also reviewed: a significant minority of people do experience negative effects, although rates of deterioration appear similar to those reported for face-to-face treatments and lower than for control conditions. We further review studies on change mechanisms and conclude that few, if any, consistent moderators and mediators of change have been identified. A recent trend to focus on knowledge acquisition is considered, and a discussion on the possibilities and hurdles of implementing ICBT is presented. The latter includes findings suggesting that attitudes toward ICBT may not be as positive as when using modern information technology as an adjunct to face-to-face therapy (i.e., blended treatment). Finally, we discuss future directions, including the role played by technology and machine learning, blended treatment, adaptation of treatment for minorities and non-Western settings, other therapeutic approaches than ICBT (including Internet-delivered psychodynamic and interpersonal psychotherapy as well as acceptance and commitment therapy), emerging regulations, and the importance of reporting failed trials.

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“…If the submitted responses to the screening battery raised any concerns regarding the psychiatric health and/or the safety of the participant, they were contacted and offered guidance regarding an appropriate psychiatric and/or somatic healthcare provider. Since there is an increasing body of research indicates that psychotherapy may have adverse side-effects (Boettcher, Rozental, Andersson, & Carlbring, 2014;Rozental, Magnusson, Boettcher, Andersson, & Carlbring, 2017), the psychiatric statuses of the participants were monitored. During Study II, III, and IV, the continuous measurements enabled monitoring of individual participants' current psychiatric state and if deemed necessary, the participants were guided to or offered acute and suitable psychiatric or somatic healthcare options.…”

Section: Safety Parametersmentioning

confidence: 99%

A Randomized Controlled Study of Group-Administered Cognitive Behavioral Therapy for Hypersexual Disorder in Men

Hallberg

Kaldo

Arver

et al. 2019

The Journal of Sexual Medicine

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Background Hypersexual disorder (HD) is defined as a condition in which the individual loses control over engagement in sexual behaviors, leading to distress and negative effects on key life areas. Cognitive behavioral therapy (CBT) has been proven to reduce symptoms of hypersexual behavior; however, no randomized controlled study of CBT interventions for HD has been reported previously. Aim To investigate the efficacy of group-administered CBT for HD. Methods Male participants (n = 137) diagnosed with HD, were randomized between 7 weeks of group-administered CBT (n = 70) and a waitlist control receiving the intervention after 8 weeks (n = 67). Measurements were administered at pre-, mid-, and posttreatment, with follow-up after 3 and 6 months. Outcomes The primary outcome was the Hypersexual Disorder: Current Assessment Scale (HD:CAS), and secondary outcomes were the Sexual Compulsivity Scale (SCS) and measures of depression (Montgomery–Åsberg Depression Rating Scale (MADRS-S), psychological distress (Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), and treatment satisfaction (CSQ-8). Results A significantly greater decrease in HD symptoms and sexual compulsivity, as well as significantly greater improvements in psychiatric well-being, were found for the treatment condition compared with the waitlist. These effects remained stable at 3 and 6 months after treatment. Clinical Implications CBT can ameliorate HD symptoms and psychiatric distress, suggesting that the CBT program may serve as a first-line treatment in clinical settings. Strengths & Limitations This is the first randomized controlled study evaluating the efficacy of a CBT program in a rather large sample of HD-specific diagnosed men. The long-term treatment effects are vague due to the low response rate on follow-up measurements, and the efficacy of this program for hypersexual women remains unknown. Conclusion This study supports the efficacy of a group-administered CBT program as a treatment option for HD; however, future studies should include women, comprise dismantling analysis of the constituting interventions, and evaluate other treatment formats, for example, administration via the Internet.

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For better or worse: An individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy.

Abstract: Deterioration among patients receiving ICBT or being in a control condition can occur and should be monitored by researchers to reverse and prevent a negative treatment trend. (PsycINFO Database Record

Cited by 116 publications

References 126 publications

The efficacy of app‐supported smartphone interventions for mental health problems: a meta‐analysis of randomized controlled trials

The efficacy of app‐supported smartphone interventions for mental health problems: a meta‐analysis of randomized controlled trials

Internet‐delivered psychological treatments: from innovation to implementation

A Randomized Controlled Study of Group-Administered Cognitive Behavioral Therapy for Hypersexual Disorder in Men

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