Efficacy of cognitive behavioural therapy delivered over the Internet for depressive symptoms: A systematic review and meta-analysis

2017 ◽  
Vol 24 (8) ◽  
pp. 527-539 ◽  
Author(s):  
Dina M Sztein ◽  
Charles E Koransky ◽  
Leah Fegan ◽  
Seth Himelhoch
Keyword(s):  
Depressive Symptoms ◽  
Confidence Interval ◽  
Cognitive Behavioural Therapy ◽  
Meta Analysis ◽  
Behavioural Therapy ◽  
Mean Difference ◽  
The Internet ◽  
Moderate Depression ◽  
Cognitive Behavioural ◽  
Standardized Mean Difference

Introduction Cognitive behavioural therapy has been shown to improve depressive symptoms in adults with mild to moderate depression. To overcome many of the barriers associated with delivering this treatment, attempts have been made to deliver cognitive behavioural therapy via the Internet. The objective of this meta-analysis is to assess whether Internet-based cognitive behavioural therapy delivered to adults with depressive symptoms leads to a reduction in these symptoms as compared to those who receive no therapy. Methods In September 2015, the Cochrane, PubMed and PsycInfo databases were searched; studies were also found through bibliography searches. Studies were included if they were randomized controlled trials published in English between 2005–2015 conducted with adults >18 years of age experiencing mild to moderate depression where study subjects received Internet-based cognitive behavioural therapy, and the control group was placed on a wait-list. The search yielded 257 articles; 14 of these were included in the meta-analysis. Results Internet delivered cognitive behavioural therapy had a medium effect on reducing depressive symptoms at the end of the study period (standardized mean difference: 0.74, confidence interval: 0.62–0.86, p < 0.001). Internet-delivered cognitive behavioural therapy also has a large sustained effect in maintaining reduction of depressive symptoms in follow-up measures done 3–6 months after the conclusion of the therapy (standardized mean difference: 0.83, confidence interval: 0.69–0.99, p < 0.001). There was no publication bias and low heterogeneity. Discussion Cognitive behavioural therapy delivered over the Internet leads to immediate and sustained reduction in depressive symptoms; thus, it may be a good treatment modality for individuals unable or unwilling to access traditional face-to-face therapy.

scholarly journals Combined treatment with cognitive–behavioural therapy in adolescent depression: meta-analysis

2010 ◽  
Vol 197 (6) ◽  
pp. 433-440 ◽  
Author(s):  
Bernadka Dubicka ◽  
Rachel Elvins ◽  
Chris Roberts ◽  
Greg Chick ◽  
Paul Wilkinson ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Cognitive Behavioural Therapy ◽  
Adolescent Depression ◽  
Antidepressant Treatment ◽  
Meta Analysis ◽  
Combined Treatment ◽  
Behavioural Therapy ◽  
Response To Treatment ◽  
Global Improvement ◽  
Cognitive Behavioural

BackgroundThe treatment of adolescent depression is controversial and studies of combined treatment (antidepressants and cognitive–behavioural therapy, CBT) have produced conflicting findings.AimsTo address the question of whether CBT confers additional benefit to antidepressant treatment in adolescents with unipolar depression for depressive symptoms, suicidality, impairment and global improvement.MethodMeta-analysis of randomised controlled trials (RCTs) of newer-generation antidepressants and CBT in adolescent depression.ResultsThere was no evidence of a statistically significant benefit of combined treatment over antidepressants for depressive symptoms, suicidality and global improvement after acute treatment or at follow-up. There was a statistically significant advantage of combined treatment for impairment in the short-term (at 12 weeks) only. There was some evidence of heterogeneity between studies.ConclusionsAdding CBT to antidepressants confers limited advantage for the treatment of an episode of depression in adolescents. The variation in sampling and methodology between studies, as well as the small number of trials, limits the generalisability of the findings and any conclusions that can be drawn. Future studies should examine predictors of response to treatment as well as clinical components that may affect outcome.

scholarly journals Trajectories and associations between depression and physical activity in patients with cardiovascular disease during participation in an internet-based cognitive behavioural therapy programme

2020 ◽  
pp. 147451512094725
Author(s):  
Peter Johansson ◽  
Erland Svensson ◽  
Gerhard Andersson ◽  
Johan Lundgren
Keyword(s):  
Physical Activity ◽  
Cardiovascular Disease ◽  
Depressive Symptoms ◽  
Cognitive Behavioural Therapy ◽  
Therapy Group ◽  
Behavioural Therapy ◽  
The Internet ◽  
Online Discussion Forum ◽  
Cognitive Behavioural

Background: There is a lack of knowledge about internet-based cognitive behavioural therapy in patients with cardiovascular disease, and its effects on depressive symptoms and physical activity. Aim: To examine trajectories of depressive symptoms and physical activity, and to explore if these trajectories are linked with the delivery of internet-based cognitive behavioural therapy. Methods: A secondary-analysis of data collected in a randomised controlled trial that evaluated the effects of a 9-week internet-based cognitive behavioural therapy programme compared to an online discussion forum on depressive symptoms in cardiovascular disease patients. Data were collected at baseline, once weekly during the 9-week intervention period and at the 9-week follow-up. The Montgomery Åsberg depression rating scale – self-rating (MADRS-S) was used to measure depressive symptoms. Two modified items from the physical activity questionnaire measuring frequency and length of physical activity were merged to form a physical activity factor. Results: After 2 weeks the internet-based cognitive behavioural therapy group had a temporary worsening in depressive symptoms. At 9-week follow-up, depressive symptoms ( P<0.001) and physical activity ( P=0.02) had improved more in the internet-based cognitive behavioural therapy group. Only in the internet-based cognitive behavioural therapy group, was a significant correlation ( r=–0.39, P=0.002) between changes in depressive symptoms and changes in physical activity found. Structural equation analyses revealed that internet-based cognitive behavioural therapy decreased depressive symptoms, and that a decrease in depression, in turn, resulted in an increase in physical activity. Conclusions: Internet-based cognitive behavioural therapy was more effective than an online discussion forum to decrease depressive symptoms and increase physical activity. Importantly, a decrease in depressive symptoms needs to precede an increase in physical activity.

scholarly journals Cognitive–behavioural therapy for depression in people with a somatic disease: meta-analysis of randomised controlled trials

2010 ◽  
Vol 197 (1) ◽  
pp. 11-19 ◽  
Author(s):  
Matthijs W. Beltman ◽  
Richard C. Oude Voshaar ◽  
Anne E. Speckens
Keyword(s):  
Depressive Symptoms ◽  
Cognitive Behavioural Therapy ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Behavioural Therapy ◽  
Controlled Trials ◽  
Somatic Disease ◽  
Cognitive Behavioural ◽  
Randomised Controlled ◽  
Somatic Diseases

BackgroundMeta-analyses on psychological treatment for depression in individuals with a somatic disease are limited to specific underlying somatic diseases, thereby neglecting the generalisability of the interventions.AimsTo examine the effectiveness of cognitive–behavioural therapy (CBT) for depression in people with a diversity of somatic diseases.MethodMeta-analysis of randomised controlled trials evaluating CBT for depression in people with a somatic disease. Severity of depressive symptoms was pooled using the standardised mean difference (SMD).ResultsTwenty-nine papers met inclusion criteria. Cognitive–behavioural therapy was superior to control conditions with larger effects in studies restricted to participants with depressive disorder (SMD =–0.83, 95% CI –1.36 to –0.31, P<0.001) than in studies of participants with depressive symptoms (SMD =–0.16, 95% CI –0.27 to –0.06, P = 0.001). Subgroup analyses showed that CBT was not superior to other psychotherapies.ConclusionsCognitive–behavioural therapy significantly reduces depressive symptoms in people with a somatic disease, especially in those who meet the criteria for a depressive disorder.

scholarly journals Predictors of depression relapse and recurrence after cognitive behavioural therapy: a systematic review and meta-analysis

2019 ◽  
Vol 47 (5) ◽  
pp. 514-529 ◽  
Author(s):  
Caroline Wojnarowski ◽  
Nick Firth ◽  
Megan Finegan ◽  
Jaime Delgadillo
Keyword(s):  
Systematic Review ◽  
Depressive Symptoms ◽  
Cognitive Behavioural Therapy ◽  
Meta Analysis ◽  
Behavioural Therapy ◽  
Personality Factors ◽  
Cognitive Reactivity ◽  
Targeted Interventions ◽  
Cognitive Behavioural ◽  
Increased Risk

AbstractBackground:Cognitive behavioural therapy (CBT) is an effective psychological treatment for major depressive disorder, although some patients experience a return of symptoms after finishing therapy. The ability to predict which individuals are more vulnerable to deterioration would allow for targeted interventions to prevent short-term relapse and longer-term recurrence.Aim:This systematic review and meta-analysis aimed to identify factors associated with an increased risk of relapse and/or recurrence (RR) after CBT for depression.Method:We reviewed 13 relevant papers, of which a small set of unique samples were eligible for meta-analysis (k = 5, N = 369). Twenty-six predictor variables were identified and grouped into seven categories: residual depressive symptoms; prior episodes of depression; cognitive reactivity; stressful life events; personality factors; clinical and diagnostic factors; demographics.Results:Meta-analyses indicated that residual depressive symptoms (r = 0.34 [0.10, 0.54], p = .01) and prior episodes (r = 0.19 [0.07, 0.30], p = .002) were statistically significant predictors of RR, but cognitive reactivity was not (r = 0.18 [−0.02, 0.36], p = .08). Other variables lacked replicated findings. On average, 33.4% of patients experienced RR after CBT.Conclusions:Patients with the above risk factors could be offered evidence-based continuation-phase interventions to enhance the longer-term effectiveness of CBT.

Therapist-guided internet-based cognitive-behavioural therapy for adult obsessive-compulsive disorder: A meta-analysis

2016 ◽  
Vol 33 (S1) ◽  
pp. s276-s277 ◽  
Author(s):  
A. Pozza ◽  
G. Andersson ◽  
D. Dèttore
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Meta Analysis ◽  
Behavioural Therapy ◽  
The Internet ◽  
Comorbid Depression ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
High Effect ◽  
Cognitive Behavioural

IntroductionCognitive-behavioural therapy (CBT) is the first-line psychological treatment for obsessive-compulsive disorder (OCD). However, most individuals suffering from OCD do not receive CBT. An innovative approach to improve access to evidence-based care is the use of the Internet to deliver effective treatments. Therapist-guided Internet-based cognitive-behavioural therapy (iCBT) involves the administration of structured online lessons that provide the same information and skills typically taught in clinician-administered CBT, often with email support from a therapist. Accumulating evidence on iCBT for OCD has been produced, but a meta-analysis has not been conducted.ObjectivesThrough meta-analytic methods, the present study summarized evidence on iCBT for OCD.AimsEfficacy on OCD symptoms and comorbid depression versus control conditions at post-treatment and follow-up was evaluated.MethodsA PRISMA meta-analysis was performed on randomized controlled trials. Treatments were classified as iCBT if they included CBT components for OCD (eg, exposure and response prevention) delivered through the Internet with or without email/phone support from a therapist.ResultsFour trials were included (n = 238), which were classified at low bias risk. At post-treatment iCBT outperformed control conditions with a high effect size on OCD symptoms (d = 0.85, P<.05) and a medium on comorbid depression (d = 0.52, P<.05). Treatment effects were stable at 4-month follow-up with a high effect size on OCD (d = 1.45, P<.05), but not on comorbid depression (d = 0.33, P<.05).ConclusionsiCBT seems a promising treatment modality for OCD. Further trials should assess log-term outcomes and effects on quality of life.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Personality Disorders and Their Relation to Treatment Outcomes in Cognitive Behavioural Therapy for Depression: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Harry Banyard ◽  
Alex J. Behn ◽  
Jaime Delgadillo
Keyword(s):  
Systematic Review ◽  
Cognitive Behavioural Therapy ◽  
Meta Analysis ◽  
Treatment Resistance ◽  
Behavioural Therapy ◽  
Risk Of Bias ◽  
Cognitive Behavioural ◽  
Primary Focus ◽  
Effect Of Pd ◽  
Evidence Based Care

Abstract Background Previous reviews indicate that depressed patients with a comorbid personality disorder (PD) tend to benefit less from psychotherapies for depression and thus personality pathology needs to be the primary focus of treatment. This review specifically focused on studies of Cognitive Behavioural Therapy (CBT) for depression examining the influence of comorbid PD on post-treatment depression outcomes. Methods This was a systematic review and meta-analysis of studies identified through PubMed, PsychINFO, Web of Science, and Scopus. A review protocol was pre-registered in the PROSPERO database (CRD42019128590). Results Eleven eligible studies (N = 769) were included in a narrative synthesis, and ten (N = 690) provided sufficient data for inclusion in random effects meta-analysis. All studies were rated as having “low” or “moderate” risk of bias and there was no significant evidence of publication bias. A small pooled effect size indicated that patients with PD had marginally higher depression severity after CBT compared to patients without PD (g = 0.26, [95% CI: 0.10, 0.43], p = .002), but the effect was not significant in controlled trials (p = .075), studies with low risk of bias (p = .107) and studies that adjusted for intake severity (p = .827). Furthermore, PD cases showed symptomatic improvements across studies, particularly those with longer treatment durations (16–20 sessions). Conclusions The apparent effect of PD on depression outcomes is likely explained by higher intake severity rather than treatment resistance. Excluding these patients from evidence-based care for depression is unjustified, and adequately lengthy CBT should be routinely offered.

scholarly journals Physical exercise and internet-based cognitive–behavioural therapy in the treatment of depression: Randomised controlled trial

2015 ◽  
Vol 207 (3) ◽  
pp. 227-234 ◽  
Author(s):  
Mats Hallgren ◽  
Martin Kraepelien ◽  
Agneta öjehagen ◽  
Nils Lindefors ◽  
Zangin Zeebari ◽  
...  
Keyword(s):  
Physical Exercise ◽  
Cognitive Behavioural Therapy ◽  
Controlled Trial ◽  
Medical Practitioner ◽  
Work Capacity ◽  
Behavioural Therapy ◽  
General Medical Practitioner ◽  
Treatment As Usual ◽  
Moderate Depression ◽  
Cognitive Behavioural

BackgroundDepression is common and tends to be recurrent. Alternative treatments are needed that are non-stigmatising, accessible and can be prescribed by general medical practitioners.AimsTo compare the effectiveness of three interventions for depression: physical exercise, internet-based cognitive–behavioural therapy (ICBT) and treatment as usual (TAU). A secondary aim was to assess changes in self-rated work capacity.MethodA total of 946 patients diagnosed with mild to moderate depression were recruited through primary healthcare centres across Sweden and randomly assigned to one of three 12-week interventions (trail registry: KCTR study ID: KT20110063). Patients were reassessed at 3 months (response rate 78%).ResultsPatients in the exercise and ICBT groups reported larger improvements in depressive symptoms compared with TAU. Work capacity improved over time in all three groups (no significant differences).ConclusionsExercise and ICBT were more effective than TAU by a general medical practitioner, and both represent promising non-stigmatising treatment alternatives for patients with mild to moderate depression.

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