Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful?

An individual participant data meta-analysis

Eirini Karyotaki*, Lise Kemmeren, Heleen Riper, Jos Twisk, Adriaan Hoogendoorn, Annet Kleiboer, Adriana Mira, Andrew Mackinnon, Bjoern Meyer, Cristina Botella, Elizabeth Littlewood, Gerhard Andersson, Helen Christensen, Jan P. Klein, Johanna Schroeder, Juana Breton-Lopez, Justine Scheider, Kathy Griffiths, Louise Farrer, Marcus J. H. Huibers & 7 others Rachel Phillips, Simon Gilbody, Steffen Moritz, Thomas Berger, Victor Pop, Viola Spek, Pim Cuijpers

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

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Abstract

Background. 

Little 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.

Methods. 

Randomised 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.

Results. 

Thirteen 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.

Conclusions. 

Self-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.

Original languageEnglish
Pages (from-to)2456-2466
JournalPsychological Medicine
Volume48
Issue number15
DOIs
Publication statusPublished - 2018

Keywords

  • Depression
  • iCBT
  • internet-based treatment
  • self-guided psychotherapy
  • RANDOMIZED CONTROLLED-TRIAL
  • DEPRESSIVE SYMPTOMS
  • PRIMARY-CARE
  • PSYCHOTHERAPY
  • INTERVENTIONS
  • DISORDER
  • ANXIETY
  • HELP
  • EFFICACY
  • SUPPORT

Cite this

Karyotaki, E., Kemmeren, L., Riper, H., Twisk, J., Hoogendoorn, A., Kleiboer, A., ... Cuijpers, P. (2018). Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis. Psychological Medicine, 48(15), 2456-2466. https://doi.org/10.1017/S0033291718000648
Karyotaki, Eirini ; Kemmeren, Lise ; Riper, Heleen ; Twisk, Jos ; Hoogendoorn, Adriaan ; Kleiboer, Annet ; Mira, Adriana ; Mackinnon, Andrew ; Meyer, Bjoern ; Botella, Cristina ; Littlewood, Elizabeth ; Andersson, Gerhard ; Christensen, Helen ; Klein, Jan P. ; Schroeder, Johanna ; Breton-Lopez, Juana ; Scheider, Justine ; Griffiths, Kathy ; Farrer, Louise ; Huibers, Marcus J. H. ; Phillips, Rachel ; Gilbody, Simon ; Moritz, Steffen ; Berger, Thomas ; Pop, Victor ; Spek, Viola ; Cuijpers, Pim. / Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis. In: Psychological Medicine. 2018 ; Vol. 48, No. 15. pp. 2456-2466.
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abstract = "Background. Little 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.Methods. Randomised 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.Results. Thirteen 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.Conclusions. Self-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.",
keywords = "Depression, iCBT, internet-based treatment, self-guided psychotherapy, RANDOMIZED CONTROLLED-TRIAL, DEPRESSIVE SYMPTOMS, PRIMARY-CARE, PSYCHOTHERAPY, INTERVENTIONS, DISORDER, ANXIETY, HELP, EFFICACY, SUPPORT",
author = "Eirini Karyotaki and Lise Kemmeren and Heleen Riper and Jos Twisk and Adriaan Hoogendoorn and Annet Kleiboer and Adriana Mira and Andrew Mackinnon and Bjoern Meyer and Cristina Botella and Elizabeth Littlewood and Gerhard Andersson and Helen Christensen and Klein, {Jan P.} and Johanna Schroeder and Juana Breton-Lopez and Justine Scheider and Kathy Griffiths and Louise Farrer and Huibers, {Marcus J. H.} and Rachel Phillips and Simon Gilbody and Steffen Moritz and Thomas Berger and Victor Pop and Viola Spek and Pim Cuijpers",
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Karyotaki, E, Kemmeren, L, Riper, H, Twisk, J, Hoogendoorn, A, Kleiboer, A, Mira, A, Mackinnon, A, Meyer, B, Botella, C, Littlewood, E, Andersson, G, Christensen, H, Klein, JP, Schroeder, J, Breton-Lopez, J, Scheider, J, Griffiths, K, Farrer, L, Huibers, MJH, Phillips, R, Gilbody, S, Moritz, S, Berger, T, Pop, V, Spek, V & Cuijpers, P 2018, 'Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis', Psychological Medicine, vol. 48, no. 15, pp. 2456-2466. https://doi.org/10.1017/S0033291718000648

Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis. / Karyotaki, Eirini; Kemmeren, Lise; Riper, Heleen; Twisk, Jos; Hoogendoorn, Adriaan; Kleiboer, Annet; Mira, Adriana; Mackinnon, Andrew; Meyer, Bjoern; Botella, Cristina; Littlewood, Elizabeth; Andersson, Gerhard; Christensen, Helen; Klein, Jan P.; Schroeder, Johanna; Breton-Lopez, Juana; Scheider, Justine; Griffiths, Kathy; Farrer, Louise; Huibers, Marcus J. H.; Phillips, Rachel; Gilbody, Simon; Moritz, Steffen; Berger, Thomas; Pop, Victor; Spek, Viola; Cuijpers, Pim.

In: Psychological Medicine, Vol. 48, No. 15, 2018, p. 2456-2466.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful?

T2 - An individual participant data meta-analysis

AU - Karyotaki, Eirini

AU - Kemmeren, Lise

AU - Riper, Heleen

AU - Twisk, Jos

AU - Hoogendoorn, Adriaan

AU - Kleiboer, Annet

AU - Mira, Adriana

AU - Mackinnon, Andrew

AU - Meyer, Bjoern

AU - Botella, Cristina

AU - Littlewood, Elizabeth

AU - Andersson, Gerhard

AU - Christensen, Helen

AU - Klein, Jan P.

AU - Schroeder, Johanna

AU - Breton-Lopez, Juana

AU - Scheider, Justine

AU - Griffiths, Kathy

AU - Farrer, Louise

AU - Huibers, Marcus J. H.

AU - Phillips, Rachel

AU - Gilbody, Simon

AU - Moritz, Steffen

AU - Berger, Thomas

AU - Pop, Victor

AU - Spek, Viola

AU - Cuijpers, Pim

PY - 2018

Y1 - 2018

N2 - Background. Little 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.Methods. Randomised 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.Results. Thirteen 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.Conclusions. Self-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.

AB - Background. Little 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.Methods. Randomised 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.Results. Thirteen 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.Conclusions. Self-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.

KW - Depression

KW - iCBT

KW - internet-based treatment

KW - self-guided psychotherapy

KW - RANDOMIZED CONTROLLED-TRIAL

KW - DEPRESSIVE SYMPTOMS

KW - PRIMARY-CARE

KW - PSYCHOTHERAPY

KW - INTERVENTIONS

KW - DISORDER

KW - ANXIETY

KW - HELP

KW - EFFICACY

KW - SUPPORT

U2 - 10.1017/S0033291718000648

DO - 10.1017/S0033291718000648

M3 - Article

VL - 48

SP - 2456

EP - 2466

JO - Psychological Medicine

JF - Psychological Medicine

SN - 0033-2917

IS - 15

ER -