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

E. Karyotaki; L. Kemmeren; H. Riper; J. Twisk; A. Hoogendoorn; A. Kleiboer; A. Mira; A. Mackinnon; B. Meyer; C. Botella; E. Littlewood; G. Andersson; H. Christensen; J.P. Klein; J. Schröder; J. Bretón-López; J. Scheider; K. Griffiths; L. Farrer; M.J.H. Huibers; R. Phillips; S. Gilbody; S. Moritz; T. Berger; V. Pop; V. Spek; P. Cuijpers

doi:10.1017/S0033291718000648

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

E. Karyotaki^*, L. Kemmeren, H. Riper, J. Twisk, A. Hoogendoorn, A. Kleiboer, A. Mira, A. Mackinnon, B. Meyer, C. Botella, E. Littlewood, G. Andersson, H. Christensen, J.P. Klein, J. Schröder, J. Bretón-López, J. Scheider, K. Griffiths, L. Farrer, M.J.H. HuibersR. Phillips, S. Gilbody, S. Moritz, T. Berger, V. Pop, V. Spek, P. Cuijpers

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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 language	English
Pages (from-to)	2456-2466
Journal	Psychological Medicine
Volume	48
Issue number	15
DOIs	https://doi.org/10.1017/S0033291718000648
Publication status	Published - 2018
Externally published	Yes

Bibliographical note

Funding Information:
European Commission's eventh Framework Program (grant 603098)

Publisher Copyright:
Copyright © Cambridge University Press 2018Â This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Funding

European Commission's eventh Framework Program (grant 603098)

Keywords

Depression
iCBT
internet-based treatment
self-guided psychotherapy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1017/S0033291718000648

Cite this

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, J. P., Schröder, J., Bretón-López, J., Scheider, J., Griffiths, K., Farrer, L., ... 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

@article{47378d969f1742379012660151a3a91e,

title = "Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful?: An individual participant data meta-Analysis",

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",

author = "E. Karyotaki and L. Kemmeren and H. Riper and J. Twisk and A. Hoogendoorn and A. Kleiboer and A. Mira and A. Mackinnon and B. Meyer and C. Botella and E. Littlewood and G. Andersson and H. Christensen and J.P. Klein and J. Schr{\"o}der and J. Bret{\'o}n-L{\'o}pez and J. Scheider and K. Griffiths and L. Farrer and M.J.H. Huibers and R. Phillips and S. Gilbody and S. Moritz and T. Berger and V. Pop and V. Spek and P. Cuijpers",

note = "Funding Information: European Commission's eventh Framework Program (grant 603098) Publisher Copyright: Copyright {\textcopyright} Cambridge University Press 2018{\^A} This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.",

year = "2018",

doi = "10.1017/S0033291718000648",

language = "English",

volume = "48",

pages = "2456--2466",

journal = "Psychological Medicine",

issn = "0033-2917",

publisher = "Cambridge University Press",

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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, Schröder, J, Bretón-López, 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

TY - JOUR

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

T2 - An individual participant data meta-Analysis

AU - Karyotaki, E.

AU - Kemmeren, L.

AU - Riper, H.

AU - Twisk, J.

AU - Hoogendoorn, A.

AU - Kleiboer, A.

AU - Mira, A.

AU - Mackinnon, A.

AU - Meyer, B.

AU - Botella, C.

AU - Littlewood, E.

AU - Andersson, G.

AU - Christensen, H.

AU - Klein, J.P.

AU - Schröder, J.

AU - Bretón-López, J.

AU - Scheider, J.

AU - Griffiths, K.

AU - Farrer, L.

AU - Huibers, M.J.H.

AU - Phillips, R.

AU - Gilbody, S.

AU - Moritz, S.

AU - Berger, T.

AU - Pop, V.

AU - Spek, V.

AU - Cuijpers, P.

N1 - Funding Information: European Commission's eventh Framework Program (grant 603098) Publisher Copyright: Copyright © Cambridge University Press 2018Â This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

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

UR - http://www.scopus.com/inward/record.url?scp=85044092192&partnerID=8YFLogxK

U2 - 10.1017/S0033291718000648

DO - 10.1017/S0033291718000648

M3 - Article

C2 - 29540243

AN - SCOPUS:85044092192

SN - 0033-2917

VL - 48

SP - 2456

EP - 2466

JO - Psychological Medicine

JF - Psychological Medicine

IS - 15

ER -