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

  • Eirini Karyotaki (a1), Lise Kemmeren (a2), Heleen Riper (a1), Jos Twisk (a3), Adriaan Hoogendoorn (a2), Annet Kleiboer (a1), Adriana Mira (a4) (a5), Andrew Mackinnon (a6) (a7), Björn Meyer (a8), Cristina Botella (a4) (a5), Elizabeth Littlewood (a9), Gerhard Andersson (a10) (a11), Helen Christensen (a6), Jan P. Klein (a12), Johanna Schröder (a13), Juana Bretón-López (a4) (a5), Justine Scheider (a14), Kathy Griffiths (a15), Louise Farrer (a16), Marcus J. H. Huibers (a1), Rachel Phillips (a17), Simon Gilbody (a9), Steffen Moritz (a13), Thomas Berger (a18), Victor Pop (a19), Viola Spek (a19) and Pim Cuijpers (a1)...
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.

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Copyright
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.
Corresponding author
Author for correspondence: Eirini Karyotaki, E-mail: e.karyotaki@vu.nl
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