Manual Guided Internet-Based Treatments in Psychiatry

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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 Finally, there was some indication of publication bias, suggesting that unpublished trials with negative findings might be missing from the present sample of studies.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

Studies Characteristics eTable 4. Psychological treatment of depression: results of a series of meta-analyses. Nord J Psychiatry. PubMed Google Scholar Crossref. The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons. World Psychiatry. Combining pharmacotherapy and psychotherapy or monotherapy for major depression?

J Affect Disord.

Therapist-guided internet treatment for alcohol use disorders

The long-term efficacy of acute-phase psychotherapy for depression: a meta-analysis of randomized trials. Depress Anxiety. Barriers to psychotherapy among depressed and nondepressed primary care patients. Ann Behav Med. Internet-delivered psychotherapy for depression in adults. Curr Opin Psychiatry. Exploring the nature of stigmatising beliefs about depression and help-seeking: implications for reducing stigma.

BMC Public Health.


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Prevalence, comorbidity, disability and service utilization: overview of the Australian National Mental Health Survey. Br J Psychiatry. Acta Psychiatr Scand.

About this book

Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cogn Behav Ther. Effects of an internet intervention Deprexis on severe depression symptoms: randomized controlled trial. Internet Interventions. Google Scholar Crossref. Effects of a psychological internet intervention in the treatment of mild to moderate depressive symptoms: results of the EVIDENT Study, a randomized controlled trial. Psychother Psychosom. Randomized controlled trial of computerized cognitive behavioural therapy for depressive symptoms: effectiveness and costs of a workplace intervention.

Psychol Med. Influence of initial severity of depression on effectiveness of low intensity interventions: meta-analysis of individual patient data. Psychological treatment of depression: a meta-analytic database of randomized studies. BMC Psychiatry. Cognitive therapy of depression: pretreatment patient predictors of outcome. Clin Psychol Rev. Assessing risk of bias in included studies. London, England: The Cochrane Collaboration; Statistical Power Analysis for the Behavioral Sciences. The CES-D scale a self-report depression scale for research in the general population. Appl Psychol Meas. Arch Gen Psychiatry.

The PHQ validity of a brief depression severity measure. J Gen Intern Med. Multiple Imputation for Nonresponse in Surveys. Individual participant data meta-analysis for a binary outcome: one-stage or two-stage? PLoS One. Meta-analysis of the literature or of individual patient data: is there a difference? Meta-analysis of individual participant data: rationale, conduct, and reporting. Internet-based treatment of depression: a randomized controlled trial comparing guided with unguided self-help. Delivering interventions for depression by using the internet: randomised controlled trial.

Clinical effectiveness of online computerised cognitive-behavioural therapy without support for depression in primary care: randomised trial. Internet-based CBT for depression with and without telephone tracking in a national helpline: randomised controlled trial. A randomized controlled trial on the role of support in Internet-based problem solving therapy for depression and anxiety.

Self-guided iCBT for depression: effective but still not sticky enough

Behav Res Ther. Effectiveness of a novel integrative online treatment for depression Deprexis : randomized controlled trial. J Med Internet Res. An internet-based program for depressive symptoms using human and automated support: a randomized control trial. Neuropsychiatr Dis Treat. In press.


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Google Scholar. A randomized controlled trial of internet-based therapy in depression. Internet-based cognitive behavioural therapy for subthreshold depression in people over 50 years old: a randomized controlled clinical trial. Overcoming depression on the Internet ODIN : a randomized controlled trial of an Internet depression skills intervention program. Overcoming Depression on the Internet ODIN 2 : a randomized trial of a self-help depression skills program with reminders.

Randomized effectiveness trial of an Internet, pure self-help, cognitive behavioral intervention for depressive symptoms in young adults. Computer-based psychological treatments for depression: a systematic review and meta-analysis. A systematic review of the impact of adherence on the effectiveness of e-therapies. Evaluations of Web-based psychological interventions need to avoid the re-test artefact. Aust N Z J Psychiatry. Gen Hosp Psychiatry. An online programme to reduce depression in patients with multiple sclerosis: a randomised controlled trial.

Lancet Psychiatry. Efficacy of a psychological online intervention for depression in people with epilepsy: a randomized controlled trial. Save Preferences. Privacy Policy Terms of Use. This Issue. Views 46, Citations View Metrics. Original Investigation. Eligibility Criteria. Study Identification and Selection Process.

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.