Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies

2010 ◽  
Vol 40 (12) ◽  
pp. 1943-1957 ◽  
Author(s):  
P. Cuijpers ◽  
T. Donker ◽  
A. van Straten ◽  
J. Li ◽  
G. Andersson
Keyword(s):  
Anxiety Disorders ◽  
Meta Analysis ◽  
Routine Care ◽  
Drop Out ◽  
Depression And Anxiety ◽  
Face To Face ◽  
Self Help ◽  
Significant Difference ◽  
Post Test ◽  
The Difference

BackgroundAlthough guided self-help for depression and anxiety disorders has been examined in many studies, it is not clear whether it is equally effective as face-to-face treatments.MethodWe conducted a meta-analysis of randomized controlled trials in which the effects of guided self-help on depression and anxiety were compared directly with face-to-face psychotherapies for depression and anxiety disorders. A systematic search in bibliographical databases (PubMed, PsycINFO, EMBASE, Cochrane) resulted in 21 studies with 810 participants.ResultsThe overall effect size indicating the difference between guided self-help and face-to-face psychotherapy at post-test was d=−0.02, in favour of guided self-help. At follow-up (up to 1 year) no significant difference was found either. No significant difference was found between the drop-out rates in the two treatments formats.ConclusionsIt seems safe to conclude that guided self-help and face-to-face treatments can have comparable effects. It is time to start thinking about implementation in routine care.

Self-Help and Internet-Guided Interventions in Depression and Anxiety Disorders: A Systematic Review of Meta-Analyses

CNS Spectrums ◽  
2009 ◽  
Vol 14 (S3) ◽  
pp. 34-40 ◽  
Author(s):  
Edith van‘t Hof ◽  
Pim Cuijpers ◽  
Dan J. Stein
Keyword(s):  
Systematic Review ◽  
Anxiety Disorders ◽  
Common Mental Disorders ◽  
Effect Sizes ◽  
Depression And Anxiety ◽  
Face To Face ◽  
Self Help ◽  
Cochrane Database ◽  
Meta Analyses ◽  
Guided Therapy

AbstractThere is a growing database of research on self-help and Internet-guided interventions in the treatment of common mental disorders, and a number of meta-analyses have now been published. This article provides a systematic review of meta-analyses on the efficacy of self-help interventions, including Internet-guided therapy, for depression and anxiety disorders. Searches were conducted in PubMed, PsychINFO, EMBASE, and the Cochrane database for statistical meta-analyses of randomized, controlled trials of self-help or Internet-guided interventions for depression or anxiety disorders published in English. Reference lists were also used to find additional studies. Effect sizes were tabulated; 13 meta-analyses reported medium to large effect sizes for self-help interventions. Studies included in the meta-analyses differed in samples, type of self-help (eg, computer-aided, Internet-guided), control conditions, and study design. The meta-analyses indicate that self-help methods are effective in a range of different disorders, including depression and anxiety disorders. Most meta-analyses found relatively large effect sizes for self-help treatments, independent of the type of self-help, and comparable to effect sizes for face-to-face treatments. However, further research is needed to optimize the use of self-help methods.

scholarly journals Efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders: systematic review

2012 ◽  
Vol 200 (1) ◽  
pp. 15-21 ◽  
Author(s):  
Catrin Lewis ◽  
Jennifer Pearce ◽  
Jonathan I. Bisson
Keyword(s):  
Cost Effectiveness ◽  
Anxiety Disorders ◽  
Effect Size ◽  
Meta Analysis ◽  
Cochrane Collaboration ◽  
Waiting List ◽  
Self Help ◽  
Cost Effective Treatment ◽  
Significant Difference ◽  
Meta Analyses

BackgroundSelf-help interventions for psychiatric disorders represent an increasingly popular alternative to therapist-administered psychological therapies, offering the potential of increased access to cost-effective treatment.AimsTo determine the efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders.MethodRandomised controlled trials (RCTs) of self-help interventions for anxiety disorders were identified by searching nine online databases. Studies were grouped according to disorder and meta-analyses were conducted where sufficient data were available. Overall meta-analyses of self-helpv.waiting list and therapist-administered treatment were also undertaken. Methodological quality was assessed independently by two researchers according to criteria set out by the Cochrane Collaboration.ResultsThirty-one RCTs met inclusion criteria for the review. Results of the overall meta-analysis comparing self-help with waiting list gave a significant effect size of 0.84 in favour of self-help. Comparison of self-help with therapist-administered treatments revealed a significant difference in favour of the latter with an effect size of 0.34. The addition of guidance and the presentation of multimedia or web-based self-help materials improved treatment outcome.ConclusionsSelf-help interventions appear to be an effective way of treating individuals diagnosed with social phobia and panic disorder. Further research is required to evaluate the cost-effectiveness and acceptability of these interventions.

scholarly journals The level and prevalence of depression and anxiety among patients with different subtypes of irritable bowel syndrome: a network meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhichao Hu ◽  
Meixuan Li ◽  
Liang Yao ◽  
Yinshu Wang ◽  
Enkang Wang ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Anxiety And Depression ◽  
Healthy Controls ◽  
Depression And Anxiety ◽  
Significant Difference ◽  
Prevalence Of Depression ◽  
The Difference ◽  
Irritable Bowel

Abstract Background Irritable bowel syndrome (IBS) is a very common functional bowel disorder. However, the difference of depression and anxiety comorbidities among different IBS subtypes is still not well evaluated. This study aims to investigate the difference in the level and prevalence of depression and anxiety among healthy controls and patients with different subtypes of IBS. Methods PubMed, EMBASE and the Cochrane library were searched systematically until August 17, 2020. Studies that investigated depression and/or anxiety levels or prevalence among different IBS-subtype patients measured at baseline or the same point were included. Network meta-analysis was conducted to analyze standardized mean difference (SMD) of anxiety and depression levels, and single arm meta-analysis was performed for prevalence of anxiety and depression among different IBS subtypes. Results Eighteen studies involving 7095 participants were included. Network meta-analyses results showed healthy controls had a lower level of depression than IBS with mixed symptoms of constipation and diarrhea (IBS-M) [SMD =  − 1.57; 95% confidence interval (CI) − 2.21,  − 0.92], IBS with constipation (IBS-C) (SMD =  − 1.53; 95% CI − 2.13,  − 0.93) and IBS with diarrhea (IBS-D)(SMD =  − 1.41; 95% CI − 1.97,  − 0.85), while no significant difference was found between IBS unclassified (IBS-U) and healthy controls (SMD =  − 0.58; 95% CI  − 2.15, 1.00). There was also no significant difference in the level of depression among different IBS subtypes patients. The results of anxiety were similar to depression. Ranking probability showed that IBS-M was associated with the highest level of depression and anxiety symptoms, followed by IBS-C/IBS-D and IBS-U. Single-arm meta-analysis showed IBS-C had the highest prevalence of depression (38%) and anxiety (40%), followed by IBS-D, IBS-M and IBS-U. Conclusion The results indicated that IBS-M was more likely to be associated with a higher level of depression and anxiety, and the prevalence of depression and anxiety in IBS-C was highest. The psychological screening and appropriate psychotherapy are needed for patients with IBS-C, IBS-D and IBS-M instead of IBS-U.

scholarly journals The Effects of Blinding on the Outcomes of Psychotherapy and Pharmacotherapy for Adult Depression: a Meta-Analysis

2015 ◽  
Vol 30 (6) ◽  
pp. 685-693 ◽  
Author(s):  
P. Cuijpers ◽  
E. Karyotaki ◽  
G. Andersson ◽  
J. Li ◽  
R. Mergl ◽  
...  
Keyword(s):  
Randomized Trials ◽  
Psychological Treatment ◽  
Meta Analysis ◽  
Placebo Condition ◽  
Double Blind ◽  
Adult Depression ◽  
Significant Difference ◽  
Calculated Effect ◽  
Post Test ◽  
The Difference

AbstractBackgroundRandomized trials with antidepressants are often run under double blind placebo-controlled conditions, whereas those with psychotherapies are mostly unblinded. This can introduce bias in favor of psychotherapy when the treatments are directly compared. In this meta-analysis, we examine this potential source of bias.MethodsWe searched Pubmed, PsycInfo, Embase and the Cochrane database (1966 to January 2014) by combining terms indicative of psychological treatment and depression, and limited to randomized trials. We included 35 trials (with 3721 patients) in which psychotherapy and pharmacotherapy for adult depression were directly compared with each other. We calculated effect sizes for each study indicating the difference between psychotherapy and pharmacotherapy at post-test. Then, we examined the difference between studies with a placebo condition and those without in moderator analyses.ResultsWe did not find a significant difference between the studies with and those without a placebo condition. The studies in which a placebo condition was included indicated no significant difference between psychotherapy and pharmacotherapy (g = −0.07; NNT = 25). Studies in which no placebo condition was included (and patients and clinicians in both conditions were not blinded), resulted in a small, but significant difference between psychotherapy and pharmacotherapy in favor of pharmacotherapy (g = −0.13; NNT = 14).ConclusionsStudies comparing psychotherapy and pharmacotherapy in which both groups of patients (and therapists) are not blinded (no placebo condition is included) result in a very small, but significantly higher effect for pharmacotherapy.

scholarly journals DEPRESSION AND ANXIETY IN PARENTS OF CHILDREN WHO ARE CANDIDATES FOR LIVER TRANSPLANTATION

2016 ◽  
Vol 53 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Yasin SAHIN ◽  
Osman VIRIT ◽  
Bahadir DEMIR
Keyword(s):  
Liver Transplantation ◽  
Anxiety Disorders ◽  
Psychosocial Factors ◽  
Rating Scale ◽  
Routine Care ◽  
Psychiatric Disease ◽  
Depression And Anxiety ◽  
Primary Stress ◽  
Significant Difference ◽  
Prevalence Of Depression

ABSTRACT Background The primary stress factor for families in the pre-transplant period is reported as the waiting time for suitable organs, leading to anxiety, despair, and distress. Objective We investigated the psychosocial factors, anxiety and depression, in the parents of children who are candidates for liver transplantation. Methods Thirty-five pediatric liver transplantation candidates and their 38 parents, from February to August 2014, were included. Participants were evaluated using the Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), and Clinical Global Impression Scale (CGI). Results We found that a significant number of parents (n=25, 65.7%) were diagnosed with clinical psychiatric disease: 18.4% (n=7) with depression and 47.3% (n=18) with anxiety disorders. There was a significant difference in the examination scores of parents between genders (P <0.05). There was also a significant difference in CGI and HAM-D scores of parents relative to the history and presence of liver disease (P<0.05). Conclusion The rate of these disorders was high in relation to the prevalence of depression and anxiety disorders in the community reported in the literature. Therefore, it is necessary to evaluate psychosocial factors of parents of all transplant candidate children as a part of routine care so that the high-risk to family members and to enable early intervention.

scholarly journals A meta-analysis of effects of Internet CBT for anxiety disorders: open community versus clinical service recruitment (Preprint)

2018 ◽  
Author(s):  
Geke Romijn ◽  
Neeltje Batelaan ◽  
Robin Kok ◽  
Jeroen Koning ◽  
Anton van Balkom ◽  
...  
Keyword(s):  
Anxiety Disorders ◽  
Effect Size ◽  
Meta Analysis ◽  
Behavioural Therapy ◽  
Routine Care ◽  
Clinical Service ◽  
Effect Sizes ◽  
Current Evidence ◽  
Significant Difference ◽  
Small Effect Size

BACKGROUND Ample studies show the high potential of Internet-delivered cognitive behavioural therapy (iCBT) for anxiety disorders. However, evidence for its effectiveness in routine care is scarce. We conducted a meta-analysis to compare results obtained in trials with open recruitment to results obtained in trials with clinical service recruitment and updated previous findings. OBJECTIVE The present study thus aims 1) to update the current evidence on iCBT for anxiety disorders by assessing overall efficacy and 2) to assess whether open recruitment results are comparable to those with recruitment in a routine care context. METHODS Randomised controlled trials were included in which the effects of iCBT for anxiety disorders were compared to wait-list controls (WLC) or face-to-face (f2f) CBT controls. Pooled effect sizes based on anxiety measures (primary outcome), depression and quality of life measures (secondary outcomes) were computed. RESULTS We included 42 studies with 53 comparisons (43 open recruitment comparisons and 10 clinical recruitment comparisons). Overall effect size of (1) iCBT versus WLC was g=0.72 (p<.001) and (2) iCBT versus f2f CBT g=0.12 (p=0.11). Subgroup analyses revealed (3) iCBT clinical recruitment studies with WLC as comparator: g=0.29 (p<0.01), while iCBT open recruitment studies with WLC comparators showed a higher significant effect of g=0.76 (p<0.001). (4) Clinical recruitment studies comparing iCBT to f2f CBT revealed a non-significant and small effect size g=0.06 (p=0.51) while open recruitment studies comparing iCBT to f2f CBT showed an effect of g=0.19 (p=0.09). Comparing clinical recruitment trials with open recruitment trials showed a significant difference in effect size (p<.001) based on WLC comparators, and no significant difference (p=0.38) based on f2f CBT comparators. CONCLUSIONS iCBT is effective in samples recruited in routine clinical practice, but effect sizes are smaller than those found in open recruitment trials. More studies with routine care populations are needed to further validate these findings.

Dropout from an internet-delivered CBT Intervention for Adults with Depression and Anxiety: A Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Kate Lawler ◽  
Caroline Earley ◽  
Ladislav Timulak ◽  
Angel Enrique ◽  
Derek Richards
Keyword(s):  
Online Communication ◽  
Structured Interview ◽  
Routine Care ◽  
Drop Out ◽  
Group Differences ◽  
Dropping Out ◽  
Completion Rates ◽  
Depression And Anxiety ◽  
Lower Treatment ◽  
Perceived Change

BACKGROUND Treatment dropout continues to be reported from iCBT interventions and lower completion rates are generally associated with lower treatment effect sizes. However, evidence is emerging to suggest that completion of a pre-defined number of modules is not always necessary for clinical benefit nor considerate of the needs of each individual patient. OBJECTIVE The study aimed to carry out a qualitative analysis of patients’ experiences of an iCBT intervention in a routine care setting in order to achieve a deeper insight into the phenomenon of dropout. METHODS Fifteen purposively sampled participants (8 female) from a larger parent RCT were interviewed via telephone using a semi-structured interview schedule that was developed from the existing literature and research on dropout in iCBT. Data was analysed using the descriptive-interpretive approach. RESULTS The experience of treatment leading to dropout can be understood in terms of ten domains: Relationship to Technology, Motivation to Start, Background Knowledge and Attitudes towards iCBT, Perceived Change in Motivation, Usage of the Programme, Changes due to the Intervention, Engagement with Content, Experience Interacting with the Supporter, Experience of Online Communication and Termination of the Supported Period. CONCLUSIONS Patients who drop out of treatment can be distinguished in terms of their change in motivation: those who felt ready to leave treatment early and those who had negative reasons for dropping out. These two groups of participants have different treatment experiences, revealing potential attributes and non-attributes of dropout. The reported between group differences should be examined further to consider those attributes that are strongly descriptive of the experience and regarded with less importance those that have become loosely affiliated.

scholarly journals Pre-post effect sizes should be avoided in meta-analyses

2016 ◽  
Vol 26 (4) ◽  
pp. 364-368 ◽  
Author(s):  
P. Cuijpers ◽  
E. Weitz ◽  
I. A. Cristea ◽  
J. Twisk
Keyword(s):  
Comparison Group ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Behaviour Therapy ◽  
Natural Processes ◽  
Cognitive Behaviour ◽  
Post Test ◽  
The Difference ◽  
Meta Analyses ◽  
Highly Cited

AimsThe standardised mean difference (SMD) is one of the most used effect sizes to indicate the effects of treatments. It indicates the difference between a treatment and comparison group after treatment has ended, in terms of standard deviations. Some meta-analyses, including several highly cited and influential ones, use the pre-post SMD, indicating the difference between baseline and post-test within one (treatment group).MethodsIn this paper, we argue that these pre-post SMDs should be avoided in meta-analyses and we describe the arguments why pre-post SMDs can result in biased outcomes.ResultsOne important reason why pre-post SMDs should be avoided is that the scores on baseline and post-test are not independent of each other. The value for the correlation should be used in the calculation of the SMD, while this value is typically not known. We used data from an ‘individual patient data’ meta-analysis of trials comparing cognitive behaviour therapy and anti-depressive medication, to show that this problem can lead to considerable errors in the estimation of the SMDs. Another even more important reason why pre-post SMDs should be avoided in meta-analyses is that they are influenced by natural processes and characteristics of the patients and settings, and these cannot be discerned from the effects of the intervention. Between-group SMDs are much better because they control for such variables and these variables only affect the between group SMD when they are related to the effects of the intervention.ConclusionsWe conclude that pre-post SMDs should be avoided in meta-analyses as using them probably results in biased outcomes.

scholarly journals The Effectiveness of the Use of Animation in Arabic Language Learning

2017 ◽  
Vol 13 (10) ◽  
pp. 124 ◽  
Author(s):  
Norhayati Che Hat ◽  
Mohd Fauzi Abdul Hamid ◽  
Shaferul Hafes Sha'ari ◽  
Safawati Basirah Zaid
Keyword(s):  
Student Achievement ◽  
Language Learning ◽  
Language Teaching ◽  
Arabic Language ◽  
Control Group ◽  
Teaching Aid ◽  
Significant Difference ◽  
Post Test ◽  
The Difference ◽  
Experimental Group

Implementation of animation as an Arabic language teaching aid is an innovation in creating an atmosphere that can influence student achievement. This study aimed to identify the effectiveness of the use of animation in Arabic language teaching and learning among diploma students at Universiti Sultan Zainal Abidin (UniSZA), Terengganu, Malaysia. A total of 66 diploma students were randomly selected and divided into experimental group (n = 33) and control group (n = 33). The results obtained from the data collected from pre-and post-test for each group were analyzed using t-test in SPSS version 17.0. The results showed a significant difference of (t = 8789, df = 64, p <0.05) between the achievement of the experimental group and the control group in the post test. The difference in mean score of the experimental group and the control group was 33.03. This shows that there is significant improvement in Arabic language according to the groups. The difference prove that the use of animation in learning sessions contribute to the achievement of students in the Arabic language. This study advocate the idea that animation applications can be integrated as part of language teaching aid to positively improve student achievement, classroom learning environment and student motivation. 

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