Internet-Delivered Psychological Treatments for Mood and Anxiety Disorders: A Systematic Review of Their Efficacy, Safety, and Cost-Effectiveness

Abstract

BackgroundGreater access to evidence-based psychological treatments is needed. This review aimed to evaluate whether internet-delivered psychological treatments for mood and anxiety disorders are efficacious, noninferior to established treatments, safe, and cost-effective for children, adolescents and adults.MethodsWe searched the literature for studies published until March 2013. Randomized controlled trials (RCTs) were considered for the assessment of short-term efficacy and safety and were pooled in meta-analyses. Other designs were also considered for long-term effect and cost-effectiveness. Comparisons against established treatments were evaluated for noninferiority. Two reviewers independently assessed the relevant studies for risk of bias. The quality of the evidence was graded using an international grading system.ResultsA total of 52 relevant RCTs were identified whereof 12 were excluded due to high risk of bias. Five cost-effectiveness studies were identified and three were excluded due to high risk of bias. The included trials mainly evaluated internet-delivered cognitive behavioral therapy (I-CBT) against a waiting list in adult volunteers and 88% were conducted in Sweden or Australia. One trial involved children. For adults, the quality of evidence was graded as moderate for the short-term efficacy of I-CBT vs. waiting list for mild/moderate depression (d = 0.83; 95% CI 0.59, 1.07) and social phobia (d = 0.85; 95% CI 0.66, 1.05), and moderate for no efficacy of internet-delivered attention bias modification vs. sham treatment for social phobia (d = −0.04; 95% CI −0.24, 0.35). The quality of evidence was graded as low/very low for other disorders, interventions, children/adolescents, noninferiority, adverse events, and cost-effectiveness.ConclusionsI-CBT is a viable treatment option for adults with depression and some anxiety disorders who request this treatment modality. Important questions remain before broad implementation can be supported. Future research would benefit from prioritizing adapting treatments to children/adolescents and using noninferiority designs with established forms of treatment.

The Efficacy and Acceptability of Third-Wave Behavioral and Cognitive eHealth Treatments: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…The paucity of research into the efficacy of eHealth treatments for children and adolescents is reflected in recent systematic reviews (e.g., Arnberg, Linton, Hultcrantz, Heintz, & Jonsson, 2014;Stephens & Allen, 2013). In accordance, future research should investigate the efficacy of thirdwave eHealth for children and adolescents in adequately powered randomized controlled trials that address the methodological limitations highlighted in this review.…”

A pilot study of user satisfaction and perceived helpfulness of the Swedish version of the mobile app PTSD Coach

“…Currently, there are a plethora of apps available for smartphone users that assert that they help people with their physical or mental health. Although there has been a rapid proliferation of psychological interventions delivered via the Internet for a range of mental health disorders (Andersson & Titov, 2014; Arnberg, Linton, Hultcrantz, Heintz, & Jonsson, 2014), most of these apps lack empirical support, i.e. their efficacy is unknown, and it is therefore important to evaluate mobile apps in scientific studies with rigorous designs (Olff, 2015).…”

Exploring the Use of Multiple Mental Health Apps Within a Platform: Secondary Analysis of the IntelliCare Field Trial (Preprint)

“…The vast majority of those experiencing these common mental health problems cannot access treatment due a variety of barriers including the lack of availability of services, time constraints, transportation problems, and cost [4,5]. A wide variety of web-based treatments have been developed and shown to be highly effective in the treatment of depression and anxiety, particularly when coupled with some human support to promote adherence and enhance outcomes [6,7]. These programs, leveraging the strengths of computer-accessed web programs in providing information, have strong psychoeducational components along with some interactional components that function much like worksheets [8].…”