The Efficacy and Acceptability of Third-Wave Behavioral and Cognitive eHealth Treatments: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

eHealth is an innovative method of delivering therapeutic content with the potential to improve access to third-wave behaviural and cognitive therapies. This systematic review and meta-analysis aimed to determine the efficacy and acceptability of third-wave eHealth treatments in improving mental health outcomes. A comprehensive search of electronic bibliographic databases including PubMed, PsycINFO, Web of Science, and CENTRAL was conducted to identify randomized controlled trials of third-wave treatments in which eHealth was the main component. Twenty-one studies were included in the review. Meta-analyses revealed that thirdwave eHealth significantly outperformed inactive control conditions in improving anxiety, depression, and quality-oflife outcomes and active control conditions in alleviating anxiety and depression with small to medium effect sizes. No statistically significant differences were found relative to comparison interventions. Findings from a narrative synthesis of participant evaluation outcomes and meta-analysis of participant attrition rates provided preliminary support for the acceptability of third-wave eHealth.Third-wave eHealth treatments are efficacious in improving mental health outcomes including anxiety, depression, and quality of life, but not more so than comparison interventions. Preliminary evidence from indices of participant evaluation and attrition rates supports the acceptability of these treatments.

Novel ACT-based eHealth psychoeducational intervention for students with mental distress: a study protocol for a mixed-methodology pilot trial

“…It is anticipated that this will be completed within a 2-year period, with approximately 70% of participants retained (30% attrition). This is in line with similar eHealth studies where one meta-analysis reported a 23% dropout overall for eHealth interventions57 and another which reported a weighted average attrition of 35% for online interventions 71. For ACT-specific studies, longer, intensive online interventions (eg, 45 min each session, 6 sessions) have reported a 45% attrition,33 while shorter ACT online studies (eg, 15 min per session, 3 sessions) have reported as little as 8% attrition 31.…”

“…We also assumed an attrition rate of 30% (ACT intervention and waitlist control) and separated by three time periods (see figure 1). The attrition rates predicted are in line with reported rates in similar eHealth studies57 71 (see the Feasibility section for more details). From this sample, we intend to recruit at least 15 participants in at least three focus groups (5 in each group) to determine the acceptability of the intervention itself and the feasibility of the pilot trial design.…”

“…A recent meta-analysis by O’Connor et al 57 gives some clues as to how to go about improving delivery of an ACT-based psychoeducation such as AYL with high attrition rates. The review investigated the efficacy and acceptability of third-wave behavioural and cognitive eHealth interventions for individuals with anxiety and depression, and identified 21 randomised controlled trials (RCTs) including CBT, ACT and mindfulness-based interventions.…”

Cognitive flexibility in critical CHD: a target for intervention

“…97 Both acceptance and commitment therapy and mindfulness-based interventions have also shown promise in the treatment of anxiety and depression, with evidence that either is more efficacious than waitlist conditions and at least as efficacious as other well-validated psychotherapeutic interventions (e.g., cognitive behavioural therapy). [98][99][100][101] Finally, data from a randomised controlled effectiveness trial comparing Unstuck and On Target (a cognitive behavioural intervention) versus social skills intervention highlighted improvements in flexibility, rule-following, ability to make transitions, problem-solving, and planning/organisation skills among school-age children with autism spectrum disorders. 84 To date, neither acceptance and commitment therapy nor Unstuck and On Target have not been tested in children/adolescents with CHD.…”

Examining mediators of change in wellbeing, stress, and depression in a blended, Internet-based, ACT intervention for university students

“…Support for the effectiveness of ACT has been established for a wide range of psychological problems as well as for improving mental health ( A-Tjak et al, 2015 ; French et al, 2017 ; Ruiz, 2012 ). In addition, some meta-analyses on Internet-based third-wave mindfulness and acceptance treatments have shown to be effective in improving wellbeing and mental health outcomes including depression, anxiety, and stress, among others ( Brown et al, 2016 ; O'Connor et al, 2017 ; Spijkerman et al, 2016 ). ACT-based Internet interventions targeting the university student population, which is the focus of this paper, have also been shown to be effective in enhancing wellbeing and alleviating the effects of most common psychological problems experienced by students ( Hunt and Eisenberg, 2010 ), such as stress, anxiety, and depression ( Levin et al, 2017 ; Levin et al, 2016 ; Räsänen et al, 2016 ; Viskovich and Pakenham, 2018 ).…”