Compared to the 1, depressed patients in control groups - who received other treatments, care from a general practitioner, attention placebo or were put on a waiting list - people who used the iCBT websites were significantly more likely to show improvement.
Not surprisingly, patients who adhered best to the iCBT treatment and completed the online sessions did better than those who did not. When the researchers looked at the sociodemographic and clinical characteristics of the volunteers, they were unable to uncover any factors that increased the likelihood of a successful outcome, according to the report in JAMA Psychiatry.
Based on the success rates, Karyotaki and her team calculate that the intervention would need to be given to eight patients in order to achieve 50 percent symptom reduction in one patient. Five of the studies evaluated in the meta-analysis used the publicly-available iCBT program at deprexis. The programs they used required between five and 11 sessions.
The researchers caution that they were unable to assess whether how long a person had been depressed influenced the effectiveness of the iCBT treatment. And before the practice is widely adopted as routine care, limitations of the therapy, such as high dropout rates and the small effects compared to in-person or guided internet therapy need to be addressed, they write. We observed moderate to high heterogeneity. Unfortunately, the subgroup analyses did not provide any indication of which study-level variables are associated with the observed heterogeneity.
Moreover, our findings are at risk albeit low of availability bias because we could not access data from 3 eligible studies of the However, the results of the traditional meta-analysis indicated that the findings of these 3 unavailable trials did not differ from the findings of the included RCTs. Another limitation is that we could not examine duration of symptoms as a potential moderator of treatment outcome. Duration of symptoms is important because individuals with chronic depressive symptoms may not always respond rapidly to treatment.
Furthermore, most of the included trials recruited their self-referred participants through the community, thereby limiting our ability to generalize the present results to clinical samples. Finally, there was some indication of publication bias, suggesting that unpublished trials with negative findings might be missing from the present sample of studies.
Self-guided iCBT produces results that are encouraging. The absence of a significant difference in treatment outcomes associated with clinical and sociodemographic characteristics implies that self-guided iCBT can be used by most individuals with depressive symptoms regardless of the severity of their symptoms or their sociodemographic background.
Currently, antidepressant medications are widely used in the treatment of depressive symptoms, whereas psychotherapeutic interventions are provided to a lesser degree, despite many individuals with depressive symptoms preferring psychotherapy to antidepressants.
The findings of the present IPD meta-analysis suggest that self-guided iCBT may be a viable alternative to current first-step treatment approaches for symptoms of depression, particularly in those individuals who are not willing to have any therapeutic contact. This form of intervention seems to be valuable for patients with primary depressive problems and those with depressive symptoms in the context of a primary somatic problem. Although it is beyond the scope of this study, unguided iCBT has several limitations that should be addressed before it is disseminated as part of routine care eg, high dropout rates, small effects compared with face-to-face and guided internet interventions, and possible participant selection bias.
Given the effects found for treatment adherence, future research should focus on improving retention of participants in self-guided iCBT programs with the aim of maximizing positive therapeutic outcomes. Further research is also needed to examine additional moderators eg, sleep quality, cognitive performance, duration of symptoms , long-term outcomes, and the value of adding therapist or coach support to these treatments.
Internet-based Cognitive Behavioral Therapy for Depression: Current Progress & Future Directions
Finally, future studies should focus on the pragmatic effectiveness of iCBT in routine care settings. Published Online: February 22, Author Contributions: Ms Karyotaki had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Conflict of Interest Disclosures: Dr Klein reported receiving funding for clinical trials German Federal Ministry of Health, Servier , payments for presentations on internet interventions Servier , and payments for workshops and books Beltz, Elsevier and Hogrefe on psychotherapy for chronic depression and psychiatric emergencies.
No other disclosures were reported. The decision to submit the article for publication was a condition of the funding and was made before any results were available. Additional Contributions: Carmen Domnica Cotet, PhD, helped with data extraction and did not receive additional compensation in association with her work on this article. All Rights Reserved. Figure 1. View Large Download. Forest Plot of Traditional Meta-analysis. Table 1. Supplemental Methods eTable 1. Risk of Bias Assessment eTable 2.
Introduction and background
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Self-guided iCBT for depression: effective but still not sticky enough
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Data Collection and Data Items. Risk of Bias Assessment in Individual Studies. Traditional Meta-analysis. IPD Meta-analysis. Study and Participant Characteristics. Risk of Bias Assessment. Results of Traditional Meta-analysis. Strengths and Limitations. Back to top Article Information.