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, Björn Meyer, Cristina Botella, Elizabeth Littlewood, Gerhard Andersson, Helen Christensen, Jan P. Klein, Johanna Schröder, Juana Bretón-López, Justine Scheider, Kathy Griffiths, Louise Farrer, Marcus J.H. HuibersRachel Phillips, Simon Gilbody, Steffen Moritz, Thomas Berger, Victor Pop, Viola Spek, Pim Cuijpers

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-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 languageEnglish
Pages (from-to)2456-2466
Number of pages11
JournalPsychological Medicine
Volume48
Issue number15
DOIs
Publication statusPublished - 15 Mar 2018

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