Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis
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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, Björn; Botella, Cristina; Littlewood, Elizabeth; Andersson, Gerhard; Christensen, Helen; Klein, Jan P; Schröder, Johanna; Bretón-López, 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: PSYCHOL MED, Vol. 48, No. 15, 11.2018, p. 2456-2466.Research output: SCORING: Contribution to journal › SCORING: Review article › Research
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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, 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
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 - Journal Article
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
U2 - 10.1017/S0033291718000648
DO - 10.1017/S0033291718000648
M3 - SCORING: Review article
C2 - 29540243
VL - 48
SP - 2456
EP - 2466
JO - PSYCHOL MED
JF - PSYCHOL MED
SN - 0033-2917
IS - 15
ER -