Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis

Abstract

BackgroundLittle 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.MethodsRandomised 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.ResultsThirteen 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.ConclusionsSelf-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.

Internet‐delivered psychological treatments: from innovation to implementation

“…Another patient‐level meta‐analysis focused on self‐guided Internet treatments for depression, and found that, of the 3,805 participants analyzed, 5.8% in the treatment groups and 9.1% in the control groups had deteriorated (odds ratio=0.62, p<0.001). No examined moderators were significantly associated with the deterioration rate.…”

The World Health Organization World Mental Health International College Student initiative: An overview

“…However, these comparable effects for face‐to‐face and internet interventions are only true when the internet interventions are guided by professional therapists. If no therapist is involved, the effects of internet interventions are still significant, but considerably smaller, at least for depression (Karyotaki et al, ). For anxiety disorders, the difference between guided and unguided internet therapies are less clear (Haug et al, ).…”

“…Our intervention specialists are involved in interpreting these results with an eye toward determining the types of preventive interventions that might be most useful to implement based on the results of the risk targeting analyses. (Karyotaki et al, 2016). For anxiety disorders, the difference between guided and unguided internet therapies are less clear (Haug et al, 2012).…”

Talking sensibly about depression

“…The staging approach would recategorize these individuals as having a distress syndrome (typically, a mixture of mood, anxiety, and somatic symptoms). The majority of these individuals would do just as well with low-intensity interventions such as self-care, web-based psychological therapy, and social support as with clinical interventions [9]; indeed, baseline severity is the most consistent moderator of the effectiveness of clinical interventions, which are mostly effective for the severe forms of depression [10,11]. …”