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Meta-Analysis
. 2020 Aug 31;22(8):e18100.
doi: 10.2196/18100.

Effects of Internet-Based Cognitive Behavioral Therapy in Routine Care for Adults in Treatment for Depression and Anxiety: Systematic Review and Meta-Analysis

Anne Etzelmueller  1   2   3   4 , Christiaan Vis  3   4 , Eirini Karyotaki  3   5 , Harald Baumeister  6 , Nickolai Titov  7 , Matthias Berking  1 , Pim Cuijpers  3   4 , Heleen Riper  3   4   8 , David Daniel Ebert  1   2   3
Affiliations
Meta-Analysis

Effects of Internet-Based Cognitive Behavioral Therapy in Routine Care for Adults in Treatment for Depression and Anxiety: Systematic Review and Meta-Analysis

Anne Etzelmueller et al. J Med Internet Res. .

Abstract

Background: Although there is evidence for the efficacy of internet-based cognitive behavioral therapy (iCBT), the generalizability of results to routine care is limited.

Objective: This study systematically reviews effectiveness studies of guided iCBT interventions for the treatment of depression or anxiety.

Methods: The acceptability (uptake, participants' characteristics, adherence, and satisfaction), effectiveness, and negative effects (deterioration) of nonrandomized pre-post designs conducted under routine care conditions were synthesized using systematic review and meta-analytic approaches.

Results: A total of 19 studies including 30 groups were included in the analysis. Despite high heterogeneity, individual effect sizes of investigated studies indicate clinically relevant changes, with effect sizes ranging from Hedges' g=0.42-1.88, with a pooled effect of 1.78 for depression and 0.94 for anxiety studies. Uptake, participants' characteristics, adherence, and satisfaction indicate a moderate to high acceptability of the interventions. The average deterioration across studies was 2.9%.

Conclusions: This study provides evidence supporting the acceptability and effectiveness of guided iCBT for the treatment of depression and anxiety in routine care. Given the high heterogeneity between interventions and contexts, health care providers should select interventions that have been proven in randomized controlled clinical trials. The successful application of iCBT may be an effective way of increasing health care in multiple contexts.

Keywords: acceptability; anxiety; depression; effectiveness; internet-based interventions; routine care.

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Conflict of interest statement

Conflicts of Interest: Associate Prof DE reports to have received consultancy fees or served in the scientific advisory board for several companies such as Minddistrict, Sanofi, Lantern, and Schön Kliniken; German health insurance companies (BARMER and Techniker Krankenkasse); and chambers of psychotherapists. Dr DE is one of the stakeholders of the Institute for Health Training Online (GET.ON), which aims to implement scientific findings related to digital health interventions into routine care. AE is employed by the Institute for Health Training Online (GET.ON) as a research coordinator. Prof. NT is funded by the Australian Government to develop and provide a free national online and telephone-delivered treatment service. Prof. HB served in the e-mental health–associated scientific advisory boards, e-mental health interest groups, and task forces. All other authors do not report any conflicts of interest.

Figures

Figure 1
Figure 1
Study inclusion.
Figure 2
Figure 2
Risk of bias assessment.
Figure 3
Figure 3
Standardized Effects of iCBT treatments for depression in routine care. Full references are available in Multimedia Appendix 4. Combined: multiple measures for the main outcome have been combined in the analysis; Dep.: depression treatment; Mixed: mixed depression and anxiety treatment; NS: nonspecialized care; PHQ 8: Patient health Questionnaire – 8 Item version; PHQ 9: Patient Health Questionnaire; Plus: depression treatment for older adults; Spec.: specialized care.
Figure 4
Figure 4
Standardized Effects of iCBT treatments for anxiety in routine care. Marks (2003) is not providing an anxiety measure for the mixed depression and anxiety treatment; therefore, this study has not been included in the analysis. Full references are available in Multimedia Appendix 4. Combined: multiple measures for the main outcome have been combined in the analysis; GAD: generalized anxiety disorder; GP: general practitioner-guided; LSAS: Liebowitz Social Anxiety Scale; NS: nonspecialized care; OCD: obsessive-compulsive disorder; PDSS-SR: Panic Disorder Severity Scale-Self Report; PTSD: posttraumatic stress disorder; Spec.: specialized care; Th.: therapist-guided; YBOCS: Yale-Brown Obsessive Compulsive Scale.
See this image and copyright information in PMC

References

    1. Kessler RC, Bromet EJ. The epidemiology of depression across cultures. Annu Rev Public Health. 2013;34:119–38. doi: 10.1146/annurev-publhealth-031912-114409. http://europepmc.org/abstract/MED/23514317 - DOI - PMC - PubMed
    1. Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS, National Comorbidity Survey Replication The epidemiology of major depressive disorder: results from the national comorbidity survey replication (NCS-R) J Am Med Assoc. 2003 Jun 18;289(23):3095–105. doi: 10.1001/jama.289.23.3095. - DOI - PubMed
    1. Donohue JM, Pincus HA. Reducing the societal burden of depression: a review of economic costs, quality of care and effects of treatment. Pharmacoeconomics. 2007;25(1):7–24. doi: 10.2165/00019053-200725010-00003. - DOI - PubMed
    1. Whiteford H, Degenhardt L, Rehm J, Baxter A, Ferrari A, Erskine H, Charlson FJ, Norman RE, Flaxman AD, Johns N, Burstein R, Murray CJ, Vos T. Global burden of disease attributable to mental and substance use disorders: findings from the global burden of disease study 2010. Lancet. 2013 Nov 9;382(9904):1575–86. doi: 10.1016/S0140-6736(13)61611-6. - DOI - PubMed
    1. Cuijpers P, Karyotaki E, de Wit L, Ebert DD. The effects of fifteen evidence-supported therapies for adult depression: a meta-analytic review. Psychother Res. 2020 Mar;30(3):279–93. doi: 10.1080/10503307.2019.1649732. - DOI - PubMed