Guided and unguided internet-based cognitive behavioral therapy (iCBT) was effective in treating patients with depression, according to the results of a meta-analysis published in JAMA Psychiatry.
Harvard Medical School researchers searched publication databases through January 2019 for randomized clinical trials (RCTs) of guided or unguided iCBT for adults with depression.
A total of 42 studies with 9,751 participants in 12 countries in Europe, North America and China were included. The studies compared guided iCBT (n = 13) or unguided iCBT (n = 15) with control conditions of usual care (n = 15) or waiting list (n = 22). Guided and unguided iCBT were compared directly in 5 studies.
iCBT ranged from 5-18 (mean 8.0; standard deviation [SD], 2.8) Online sessions for 5-14 (mean 9; SD, 2.5) weeks. Among the guided therapy studies, guidance was provided by clinical psychology students (n = 14), paraprofessional or lay therapists (n = 6), or licensed psychologists or psychotherapists (n = 5).
Patient Health Questionnaire 9 (PHQ-9) results showed that guided iCBT was more effective than non-guided iCBT at improving symptoms of depression (mean difference) [MD]-0.8; 95% CI, -1.4 to -0.2) as well as the control conditions of the usual care (MD, -1.7; 95% CI, -2.3 to -1.1) or waiting list (MD, -3, 3; 95% CI, -3.9) to -2.6). Undirected iCBT reduced symptoms of depression compared to control conditions of usual care (MD, -0.9; 95% CI, -1.5 to -0.3) or waiting list (MD, -2.5; 95% CI , -3.2 to -1.8).
Among the studies with adequate long-term observation, no significant differences were found between guided and unguided iCBT in 6 (MD, -0.2; 95% CI, -0.8 to 0.3) or 12 (MD, 0.1; 95% CI ,) observed. -0.4 to 0.6) months.
Treatment response was reported by nearly half (48%) of guided iCBT recipients and over a third (37%) of non-guided iCBT recipients. Stratified by the severity of depression symptoms at baseline, 46% of moderate and 55% of severe patients responded to guided iCBT, compared with 39% and 40%, respectively, to unguided iCBT.
This study was limited by not considering data on comorbidities, duration of depressive symptoms, or number of previous episodes, all of which may have affected patients’ response to therapy.
These data showed that both guided and unguided iCBT were able to reduce symptoms of depression for up to 12 months in many patients. This inexpensive therapy can be a viable treatment option for those with moderate symptoms of depression and can improve access to care.
Disclosure: Several authors have declared their affiliations with the industry. For a full list of details, see the original article.
Karyotaki E., Efthimiou O., Miguel C. et al. Internet-based cognitive behavior therapy for depression. A systematic review and meta-analysis of the individual patient data network. JAMA psychiatry. Published online January 20, 2021. doi: 10.1001 / jamapsychiatry.2020.4364.
This article originally appeared on Psychiatry Advisor