Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/26415
Title: Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data.
Austin Authors: Furukawa, Toshi A;Suganuma, Aya;Ostinelli, Edoardo G;Andersson, Gerhard;Beevers, Christopher G;Shumake, Jason;Berger, Thomas;Boele, Florien Willemijn;Buntrock, Claudia;Carlbring, Per;Choi, Isabella;Christensen, Helen;Mackinnon, Andrew;Dahne, Jennifer;Huibers, Marcus J H;Ebert, David D;Farrer, Louise;Forand, Nicholas R;Strunk, Daniel R;Ezawa, Iony D;Forsell, Erik;Kaldo, Viktor;Geraedts, Anna;Gilbody, Simon;Littlewood, Elizabeth;Brabyn, Sally;Hadjistavropoulos, Heather D;Schneider, Luke H;Johansson, Robert;Kenter, Robin;Kivi, Marie;Björkelund, Cecilia;Kleiboer, Annet;Riper, Heleen;Klein, Jan Philipp;Schröder, Johanna;Meyer, Björn;Moritz, Steffen;Bücker, Lara;Lintvedt, Ove;Johansson, Peter;Lundgren, Johan;Milgrom, Jeannette ;Gemmill, Alan W ;Mohr, David C;Montero-Marin, Jesus;Garcia-Campayo, Javier;Nobis, Stephanie;Zarski, Anna-Carlotta;O'Moore, Kathleen;Williams, Alishia D;Newby, Jill M;Perini, Sarah;Phillips, Rachel;Schneider, Justine;Pots, Wendy;Pugh, Nicole E;Richards, Derek;Rosso, Isabelle M;Rauch, Scott L;Sheeber, Lisa B;Smith, Jessica;Spek, Viola;Pop, Victor J;Ünlü, Burçin;van Bastelaar, Kim M P;van Luenen, Sanne;Garnefski, Nadia;Kraaij, Vivian;Vernmark, Kristofer;Warmerdam, Lisanne;van Straten, Annemieke;Zagorscak, Pavle;Knaevelsrud, Christine;Heinrich, Manuel;Miguel, Clara;Cipriani, Andrea;Efthimiou, Orestis;Karyotaki, Eirini;Cuijpers, Pim
Affiliation: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
Aragon Institute for Health Research, Miguel Servet University Hospital, Zaragoza, Spain; Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain
Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
University of Dublin, Trinity College, School of Psychology, E-mental Health Research Group, Dublin, Ireland
SilverCloud Health, Clinical Research & Innovation, Dublin, Ireland
Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.
Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
School of Applied Psychology, Fontys University of Applied Science, Eindhoven, Netherlands
Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands
Klinikum Osnabrück, Osnabrück, Germany
National Health Care Institute, Diemen, Netherlands
Soulve Innovations, Utrecht, Netherlands
Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
Norwegian Center for E-health research, Tromsø, Norway
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Research Department, GAIA AG, Hamburg, Germany
Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Department of Psychiatry and Psychotherapy, Luebeck University, Luebeck, Germany
Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
Department for Sport and Health Sciences, Chair for Psychology & Digital Mental Health Care, Technical University Munich, Germany
Private practice, Vancouver, BC, Canada
Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW, Australia
School of Psychology, University of New South Wales at the Black Dog Institute, Sydney, NSW, Australia
Department of Psychology, Faculty of Science, The University of New South Wales, Sydney, NSW, Australia
Black Dog Institute and University of New South Wales, Prince of Wales Hospital, Sydney, NSW, Australia
Parent-Infant Research Institute
Centre for Mental Health Research, The Australian National University, Canberra, Australia
Central Clinical School, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, Austin, TX, USA
Patient Centred Outcomes Research Group, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
Department of Psychology, The Ohio State University, Columbus, OH, USA
Oregon Research Institute, Eugene, OR, USA
McLean Hospital, Belmont, MA, USA
Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
Imperial Clinical Trials Unit, Imperial College London, London, UK
School of Sociology & Social Policy and Institute of Mental Health, University of Nottingham, Nottingham, UK
Faculty of Medicine, School of Public Health, Imperial College London, London, UK
Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
Department of Health Sciences, University of York, York, UK
Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
Anxiety Treatment and Research Clinic, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
Department of Psychology, University of Regina, Regina, SK, Canada
Department of Clinical Psychology, Leiden University, Leiden, Netherlands
Amsterdam University Medical Centre, Amsterdam, Netherlands
PsyQ Online, Haarlem, Netherlands
Department of Medical & Clinical Psychology, Tilburg University, Tilburg, Netherlands
Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
Department of Psychology, Stockholm University, Stockholm, Sweden
Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
Department of Psychology, Stockholm University, Stockholm, Sweden
Department of Psychology, University of Gothenburg, Gothenburg, Sweden
Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
Melbourne School of Psychological Sciences, University of Melbourne, VIC, Australia
Austin Health
Issue Date: Jun-2021
Date: 2021-05-03
Publication information: The Lancet. Psychiatry 2021; 8(6): 500-511
Abstract: Internet cognitive behavioural therapy (iCBT) is a viable delivery format of CBT for depression. However, iCBT programmes include training in a wide array of cognitive and behavioural skills via different delivery methods, and it remains unclear which of these components are more efficacious and for whom. We did a systematic review and individual participant data component network meta-analysis (cNMA) of iCBT trials for depression. We searched PubMed, PsycINFO, Embase, and the Cochrane Library for randomised controlled trials (RCTs) published from database inception to Jan 1, 2019, that compared any form of iCBT against another or a control condition in the acute treatment of adults (aged ≥18 years) with depression. Studies with inpatients or patients with bipolar depression were excluded. We sought individual participant data from the original authors. When these data were unavailable, we used aggregate data. Two independent researchers identified the included components. The primary outcome was depression severity, expressed as incremental mean difference (iMD) in the Patient Health Questionnaire-9 (PHQ-9) scores when a component is added to a treatment. We developed a web app that estimates relative efficacies between any two combinations of components, given baseline patient characteristics. This study is registered in PROSPERO, CRD42018104683. We identified 76 RCTs, including 48 trials contributing individual participant data (11 704 participants) and 28 trials with aggregate data (6474 participants). The participants' weighted mean age was 42·0 years and 12 406 (71%) of 17 521 reported were women. There was suggestive evidence that behavioural activation might be beneficial (iMD -1·83 [95% credible interval (CrI) -2·90 to -0·80]) and that relaxation might be harmful (1·20 [95% CrI 0·17 to 2·27]). Baseline severity emerged as the strongest prognostic factor for endpoint depression. Combining human and automated encouragement reduced dropouts from treatment (incremental odds ratio, 0·32 [95% CrI 0·13 to 0·93]). The risk of bias was low for the randomisation process, missing outcome data, or selection of reported results in most of the included studies, uncertain for deviation from intended interventions, and high for measurement of outcomes. There was moderate to high heterogeneity among the studies and their components. The individual patient data cNMA revealed potentially helpful, less helpful, or harmful components and delivery formats for iCBT packages. iCBT packages aiming to be effective and efficient might choose to include beneficial components and exclude ones that are potentially detrimental. Our web app can facilitate shared decision making by therapist and patient in choosing their preferred iCBT package. Japan Society for the Promotion of Science.
URI: https://ahro.austin.org.au/austinjspui/handle/1/26415
DOI: 10.1016/S2215-0366(21)00077-8
Journal: The Lancet. Psychiatry
PubMed URL: 33957075
Type: Journal Article
Appears in Collections:Journal articles

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