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, Bjoern Meyer, Cristina Botella, Elizabeth Littlewood, Gerhard Andersson, Helen Christensen, Jan P. Klein, Johanna Schroeder, Juana Breton-Lopez, Justine Scheider, Kathy Griffiths, Louise Farrer, Marcus J. H. Huibers & 7 others Rachel Phillips, Simon Gilbody, Steffen Moritz, Thomas Berger, Victor Pop, Viola Spek, Pim Cuijpers

Research output: Contribution to JournalReview articleAcademicpeer-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 languageEnglish
Pages (from-to)2456-2466
Number of pages11
JournalPsychological Medicine
Volume48
Issue number15
Early online date15 Mar 2018
DOIs
Publication statusPublished - Nov 2018

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Cognitive Therapy
Internet
Meta-Analysis
Depression
Watchful Waiting
General Practice
Randomized Controlled Trials
Demography
Safety
Control Groups

Keywords

  • Depression
  • iCBT
  • internet-based treatment
  • self-guided psychotherapy

Cite this

Karyotaki, Eirini ; Kemmeren, Lise ; Riper, Heleen ; Twisk, Jos ; Hoogendoorn, Adriaan ; Kleiboer, Annet ; Mira, Adriana ; Mackinnon, Andrew ; Meyer, Bjoern ; Botella, Cristina ; Littlewood, Elizabeth ; Andersson, Gerhard ; Christensen, Helen ; Klein, Jan P. ; Schroeder, Johanna ; Breton-Lopez, Juana ; Scheider, Justine ; Griffiths, Kathy ; Farrer, Louise ; Huibers, Marcus J. H. ; Phillips, Rachel ; Gilbody, Simon ; Moritz, Steffen ; Berger, Thomas ; Pop, Victor ; Spek, Viola ; Cuijpers, Pim. / Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis. In: Psychological Medicine. 2018 ; Vol. 48, No. 15. pp. 2456-2466.
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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.",
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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, Schroeder, J, Breton-Lopez, 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

Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis. / Karyotaki, Eirini; Kemmeren, Lise; Riper, Heleen; Twisk, Jos; Hoogendoorn, Adriaan; Kleiboer, Annet; Mira, Adriana; Mackinnon, Andrew; Meyer, Bjoern; Botella, Cristina; Littlewood, Elizabeth; Andersson, Gerhard; Christensen, Helen; Klein, Jan P.; Schroeder, Johanna; Breton-Lopez, Juana; Scheider, Justine; Griffiths, Kathy; Farrer, Louise; Huibers, Marcus J. H.; Phillips, Rachel; Gilbody, Simon; Moritz, Steffen; Berger, Thomas; Pop, Victor; Spek, Viola; Cuijpers, Pim.

In: Psychological Medicine, Vol. 48, No. 15, 11.2018, p. 2456-2466.

Research output: Contribution to JournalReview articleAcademicpeer-review

TY - JOUR

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

AU - Botella, Cristina

AU - Littlewood, Elizabeth

AU - Andersson, Gerhard

AU - Christensen, Helen

AU - Klein, Jan P.

AU - Schroeder, Johanna

AU - Breton-Lopez, 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

Y1 - 2018/11

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 - Depression

KW - iCBT

KW - internet-based treatment

KW - self-guided psychotherapy

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SP - 2456

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JO - Psychological Medicine

JF - Psychological Medicine

SN - 0033-2917

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ER -