Internet-based and mobile-based cognitive behavioral therapy for chronic diseases: a systematic review and meta-analysis

Abstract

Positive adjustment to chronic diseases reduces psychiatric comorbidity and enhances quality of life. Very little is known about the benefit of internet-based and mobile-based Cognitive Behavioral Therapy (IM-CBT) on physical outcomes and its reciprocal interactions with psychiatric outcomes, the active therapeutic elements, and effect moderators among people with major chronic medical conditions. In this systematic review and meta-analysis (PROSPERO: CRD42022265738), CINAHL of Systematic Reviews, MEDLINE, PsycINFO, PubMed, Web of Science are systematically searched up to 1 June 2022, for randomized controlled trials (RCTs) comparing IM-CBT against non-CBT control condition(s) among people with chronic disease(s). Primary outcomes include improvements in psychiatric symptoms (depressive, anxiety, PTSD symptoms, general psychological distress) from baseline to post-intervention and follow-ups. Secondary outcomes include improvements in physical distress (physical symptoms, functional impairment, self-rated ill health, objective physiological dysfunction). Among 44 RCTs (5077 patients with seven different chronic diseases), IM-CBT improves depressive symptoms, anxiety symptoms, and general psychological distress at post-intervention and across follow-ups, and improves physical distress and functional impairment at post-intervention. Preliminary evidence suggests that behavioral modification and problem-solving could be necessary components to reduce psychiatric symptoms in IM-CBT, whereas cognitive restructuring, psychoeducation, and mindfulness elements relate to reduced physical distress. IM-CBT shows stronger benefits in chronic pain, cancer, arthritis, and cardiovascular disease, relative to other conditions. Changes in psychiatric symptoms and physical distress prospectively predict each other over time. IM-CBT is an effective intervention for comprehensive symptom management among people with chronic diseases.

Mind-body internet and mobile-based interventions for depression and anxiety in adults with chronic physical conditions: A systematic review of RCTs

“…Effect sizes for depression (SMD = -0.33 [-0.40, -0.26], p<0.001) and anxiety (SMD = -0.26 [-0.36, -0.17], p<0.001) were statistically significant and moderate in magnitude. These effect sizes are consistent with those from another review comparing face-to-face CBT to IMI CBT [107], and a review by Tao and colleagues (2023) focusing solely on CBT-based IMIs (depression SMD = -0.45; anxiety SMD = -0.33) [24]. Notably, the effect sizes in this review are also comparable to pharmacotherapeutic approaches for anxiety [108] and depression [109,110].…”

“…This allows reach to a broader group of people across geographic barriers [19,20]. However, despite several reviews reporting positive impacts of mindbody IMIs, these have been limited by the inclusion of: i) specific-mind body techniques (i.e., CBT only, yoga only) [21][22][23][24]; ii) specific chronic conditions [25][26][27][28]; iii) both chronic mental and physical health conditions despite unique etiologies and symptoms [29]; iv) healthy populations [23,30]; v) non-randomized trial designs [31] or vi) the inclusion of different levels of personnel-facilitation or mixture of in-person and online intervention delivery components within a single study [32]. The latter point is of importance as a high degree of personnel support or the requirement for an in-person delivery component to IMI interventions, while suitable for constrained research projects or high-risk patients, can limit real-world applicability and scale.…”

Current practices of psychoeducation interventions with persons with bipolar disorders: a literature review

“…For example, Yu et al (118) conducted a systematic review to assess internet-based psychoeducation programs for caregivers of persons with dementia and showed the effects of the intervention on self-efficacy, anxiety, burden, and QoL remained inconclusive. By comparison, Tao et al (119) conducted a systematic review of internet-based and mobile-based cognitive behavioral therapy for chronic disorders and showed that it was an effective intervention for comprehensive symptom management among people with major chronic medical conditions.…”

Internet-delivered therapist-assisted cognitive behavioral therapy for gambling disorder: a randomized controlled trial

“…Internet-delivered CBT (ICBT) consisting of “modules” including text, questionnaires, and different exercises delivered to patients each week over the course of treatment has proved effective for a number of different psychiatric disorders such as depression ( 15–17 ), anxiety disorders ( 18 , 19 ), and insomnia ( 20 ). In addition, it has also been found effective at reducing distress and functional impairment in various chronic somatic conditions ( 21 ), further establishing the relevance of the treatment format. In addition, in direct comparisons of ICBT with CBT delivered face-to-face, ICBT has generally performed equally well as its more traditional face-to-face counterpart for a large number of different disorders such as depression, anxiety disorders, post-traumatic stress disorder, insomnia, eating disorders, and several somatic conditions ( 22 , 23 ).…”