Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful?: An individual participant data meta-analysis

Eirini Karyotaki; Lise Kemmeren; Heleen Riper; Jos Twisk; Adriaan Hoogendoorn; Annet Kleiboer; Adriana Mira; Andrew Mackinnon; Björn Meyer; Cristina Botella; Elizabeth Littlewood; Gerhard Andersson; Helen Christensen; Jan P Klein; Johanna Schröder; Juana Bretón-López; Justine Scheider; Kathy Griffiths; Louise Farrer; Marcus J H Huibers; Rachel Phillips; Simon Gilbody; Steffen Moritz; Thomas Berger; Victor Pop; Viola Spek; Pim Cuijpers

doi:10.1017/S0033291718000648

Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis

Eirini Karyotaki, Lise Kemmeren, Heleen Riper, Jos Twisk, Adriaan Hoogendoorn, Annet Kleiboer, Adriana Mira, Andrew Mackinnon, Björn Meyer, Cristina Botella, Elizabeth Littlewood, Gerhard Andersson, Helen Christensen, Jan P Klein, Johanna Schröder, Juana Bretón-López, Justine Scheider, Kathy Griffiths, Louise Farrer, Marcus J H HuibersRachel Phillips, Simon Gilbody, Steffen Moritz, Thomas Berger, Victor Pop, Viola Spek, Pim Cuijpers

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Little is known about potential harmful effects as a consequence of self-guided internet-based cognitive behaviour therapy (iCBT), such as symptom deterioration rates. Thus, safety concerns remain and hamper the implementation of self-guided iCBT into clinical practice. We aimed to conduct an individual participant data (IPD) meta-analysis to determine the prevalence of clinically significant deterioration (symptom worsening) in adults with depressive symptoms who received self-guided iCBT compared with control conditions. Several socio-demographic, clinical and study-level variables were tested as potential moderators of deterioration.

METHODS: Randomised controlled trials that reported results of self-guided iCBT compared with control conditions in adults with symptoms of depression were selected. Mixed effects models with participants nested within studies were used to examine possible clinically significant deterioration rates.

RESULTS: Thirteen out of 16 eligible trials were included in the present IPD meta-analysis. Of the 3805 participants analysed, 7.2% showed clinically significant deterioration (5.8% and 9.1% of participants in the intervention and control groups, respectively). Participants in self-guided iCBT were less likely to deteriorate (OR 0.62, p < 0.001) compared with control conditions. None of the examined participant- and study-level moderators were significantly associated with deterioration rates.

CONCLUSIONS: Self-guided iCBT has a lower rate of negative outcomes on symptoms than control conditions and could be a first step treatment approach for adult depression as well as an alternative to watchful waiting in general practice.

Original language	English
Pages (from-to)	2456-2466
Number of pages	11
Journal	Psychological Medicine
Volume	48
Issue number	15
Early online date	15 Mar 2018
DOIs	https://doi.org/10.1017/S0033291718000648
Publication status	Published - 1 Nov 2018

Bibliographical note

Keywords

Journal Article
self-guided psychotherapy
internet-based treatment
Depression
iCBT
Telemedicine
Depressive Disorder/therapy
Humans
Depression/therapy
Cognitive Behavioral Therapy
Internet
Outcome Assessment (Health Care)/statistics & numerical data

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10.1017/S0033291718000648

Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis
© Cambridge University Press 2018.
Final published version, 350 KBLicence: CC BY

Cite this

Karyotaki, E., Kemmeren, L., Riper, H., Twisk, J., Hoogendoorn, A., Kleiboer, A., Mira, A., Mackinnon, A., Meyer, B., Botella, C., Littlewood, E., Andersson, G., Christensen, H., Klein, J. P., Schröder, J., Bretón-López, J., Scheider, J., Griffiths, K., Farrer, L., ... Cuijpers, P. (2018). Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis. Psychological Medicine, 48(15), 2456-2466. https://doi.org/10.1017/S0033291718000648

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title = "Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful?: An individual participant data meta-analysis",

abstract = "BACKGROUND: Little is known about potential harmful effects as a consequence of self-guided internet-based cognitive behaviour therapy (iCBT), such as symptom deterioration rates. Thus, safety concerns remain and hamper the implementation of self-guided iCBT into clinical practice. We aimed to conduct an individual participant data (IPD) meta-analysis to determine the prevalence of clinically significant deterioration (symptom worsening) in adults with depressive symptoms who received self-guided iCBT compared with control conditions. Several socio-demographic, clinical and study-level variables were tested as potential moderators of deterioration.METHODS: Randomised controlled trials that reported results of self-guided iCBT compared with control conditions in adults with symptoms of depression were selected. Mixed effects models with participants nested within studies were used to examine possible clinically significant deterioration rates.RESULTS: Thirteen out of 16 eligible trials were included in the present IPD meta-analysis. Of the 3805 participants analysed, 7.2% showed clinically significant deterioration (5.8% and 9.1% of participants in the intervention and control groups, respectively). Participants in self-guided iCBT were less likely to deteriorate (OR 0.62, p < 0.001) compared with control conditions. None of the examined participant- and study-level moderators were significantly associated with deterioration rates.CONCLUSIONS: Self-guided iCBT has a lower rate of negative outcomes on symptoms than control conditions and could be a first step treatment approach for adult depression as well as an alternative to watchful waiting in general practice.",

keywords = "Journal Article, self-guided psychotherapy, internet-based treatment, Depression, iCBT, Telemedicine, Depressive Disorder/therapy, Humans, Depression/therapy, Cognitive Behavioral Therapy, Internet, Outcome Assessment (Health Care)/statistics & numerical data",

author = "Eirini Karyotaki and Lise Kemmeren and Heleen Riper and Jos Twisk and Adriaan Hoogendoorn and Annet Kleiboer and Adriana Mira and Andrew Mackinnon and Bj{\"o}rn Meyer and Cristina Botella and Elizabeth Littlewood and Gerhard Andersson and Helen Christensen and Klein, {Jan P} and Johanna Schr{\"o}der and Juana Bret{\'o}n-L{\'o}pez and Justine Scheider and Kathy Griffiths and Louise Farrer and Huibers, {Marcus J H} and Rachel Phillips and Simon Gilbody and Steffen Moritz and Thomas Berger and Victor Pop and Viola Spek and Pim Cuijpers",

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doi = "10.1017/S0033291718000648",

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Karyotaki, E, Kemmeren, L, Riper, H, Twisk, J, Hoogendoorn, A, Kleiboer, A, Mira, A, Mackinnon, A, Meyer, B, Botella, C, Littlewood, E, Andersson, G, Christensen, H, Klein, JP, Schröder, J, Bretón-López, J, Scheider, J, Griffiths, K, Farrer, L, Huibers, MJH, Phillips, R, Gilbody, S, Moritz, S, Berger, T, Pop, V, Spek, V & Cuijpers, P 2018, 'Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis', Psychological Medicine, vol. 48, no. 15, pp. 2456-2466. https://doi.org/10.1017/S0033291718000648

TY - JOUR

T1 - Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful?

T2 - An individual participant data meta-analysis

AU - Karyotaki, Eirini

AU - Kemmeren, Lise

AU - Riper, Heleen

AU - Twisk, Jos

AU - Hoogendoorn, Adriaan

AU - Kleiboer, Annet

AU - Mira, Adriana

AU - Mackinnon, Andrew

AU - Meyer, Björn

AU - Botella, Cristina

AU - Littlewood, Elizabeth

AU - Andersson, Gerhard

AU - Christensen, Helen

AU - Klein, Jan P

AU - Schröder, Johanna

AU - Bretón-López, Juana

AU - Scheider, Justine

AU - Griffiths, Kathy

AU - Farrer, Louise

AU - Huibers, Marcus J H

AU - Phillips, Rachel

AU - Gilbody, Simon

AU - Moritz, Steffen

AU - Berger, Thomas

AU - Pop, Victor

AU - Spek, Viola

AU - Cuijpers, Pim

PY - 2018/11/1

Y1 - 2018/11/1

N2 - BACKGROUND: Little is known about potential harmful effects as a consequence of self-guided internet-based cognitive behaviour therapy (iCBT), such as symptom deterioration rates. Thus, safety concerns remain and hamper the implementation of self-guided iCBT into clinical practice. We aimed to conduct an individual participant data (IPD) meta-analysis to determine the prevalence of clinically significant deterioration (symptom worsening) in adults with depressive symptoms who received self-guided iCBT compared with control conditions. Several socio-demographic, clinical and study-level variables were tested as potential moderators of deterioration.METHODS: Randomised controlled trials that reported results of self-guided iCBT compared with control conditions in adults with symptoms of depression were selected. Mixed effects models with participants nested within studies were used to examine possible clinically significant deterioration rates.RESULTS: Thirteen out of 16 eligible trials were included in the present IPD meta-analysis. Of the 3805 participants analysed, 7.2% showed clinically significant deterioration (5.8% and 9.1% of participants in the intervention and control groups, respectively). Participants in self-guided iCBT were less likely to deteriorate (OR 0.62, p < 0.001) compared with control conditions. None of the examined participant- and study-level moderators were significantly associated with deterioration rates.CONCLUSIONS: Self-guided iCBT has a lower rate of negative outcomes on symptoms than control conditions and could be a first step treatment approach for adult depression as well as an alternative to watchful waiting in general practice.

AB - BACKGROUND: Little is known about potential harmful effects as a consequence of self-guided internet-based cognitive behaviour therapy (iCBT), such as symptom deterioration rates. Thus, safety concerns remain and hamper the implementation of self-guided iCBT into clinical practice. We aimed to conduct an individual participant data (IPD) meta-analysis to determine the prevalence of clinically significant deterioration (symptom worsening) in adults with depressive symptoms who received self-guided iCBT compared with control conditions. Several socio-demographic, clinical and study-level variables were tested as potential moderators of deterioration.METHODS: Randomised controlled trials that reported results of self-guided iCBT compared with control conditions in adults with symptoms of depression were selected. Mixed effects models with participants nested within studies were used to examine possible clinically significant deterioration rates.RESULTS: Thirteen out of 16 eligible trials were included in the present IPD meta-analysis. Of the 3805 participants analysed, 7.2% showed clinically significant deterioration (5.8% and 9.1% of participants in the intervention and control groups, respectively). Participants in self-guided iCBT were less likely to deteriorate (OR 0.62, p < 0.001) compared with control conditions. None of the examined participant- and study-level moderators were significantly associated with deterioration rates.CONCLUSIONS: Self-guided iCBT has a lower rate of negative outcomes on symptoms than control conditions and could be a first step treatment approach for adult depression as well as an alternative to watchful waiting in general practice.

KW - Journal Article

KW - self-guided psychotherapy

KW - internet-based treatment

KW - Depression

KW - iCBT

KW - Telemedicine

KW - Depressive Disorder/therapy

KW - Humans

KW - Depression/therapy

KW - Cognitive Behavioral Therapy

KW - Internet

KW - Outcome Assessment (Health Care)/statistics & numerical data

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U2 - 10.1017/S0033291718000648

DO - 10.1017/S0033291718000648

M3 - Article

C2 - 29540243

SN - 0033-2917

VL - 48

SP - 2456

EP - 2466

JO - Psychological Medicine

JF - Psychological Medicine

IS - 15

ER -

Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis

Abstract

Bibliographical note

Keywords

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