Aim: During the last couple of decades research on the efficacy and effectiveness of psychological treatments has provided evidence for its use in alleviating mental distress and enhancing well-being. Meanwhile, novel ways of delivering evidence-based methods, such as, via the Internet or smartphone applications, have received increasing support, with the potential of becoming an important and widely used addition to the health care system. Internet-based cognitive behavior therapy (ICBT) has for instance been shown to be beneficial in relation to a number of psychiatric and somatic disorders. However, research has almost solely focused on the positive results, neglecting the fact that psychological treatments also might have negative effects. Investigations from face-to-face settings have found that 5-10% of all patients deteriorate, but whether this is true for ICBT has been unclear. Hence, in order to examine deterioration in cognitive behavior therapy delivered via the Internet, an individual patient data meta-analysis was performed.
Method: Patient-level data from 29 clinical trials of ICBT for depression, anxiety disorders, and other problems, e.g., pathological gambling and erectile dysfunction, were aggregated, totaling 2866 participants receiving either a treatment or control condition. Deterioration was assessed using the Reliable Change Index on each of the primary outcome measures. Participants identified as having deteriorated were subsequently analyzed using logistic regression to find potential predictors of a negative treatment outcome.
Results: Using only available data, a total of 89 participants (3.1%) were recognized as having reliably deteriorated from pre to post treatment assessment, with an additional 17 participants (0.6%) from pre treatment to follow-up assessment. In general, more participants (N = 56) diagnosed with an anxiety disorder deteriorated, compared to depression (N = 16), and other problems (N = 30). Results using imputed values for missing data and an exploration of predictors of deterioration will be available at the time of the conference.
Conclusion: Preliminary evidence indicates that deterioration among participants receiving ICBT afflicts approximately 3.1%, with higher rates for anxiety disorders than depression and other problems. A closer inspection could reveal potential predictors for deterioration, which, in turn, might be used to prevent or reverse a negative treatment outcome.
deterioration, internet-based cognitive behavior therapy, individual patient data meta-analysis
8th World Congress of Behavioural and Cognitive Therapies, Melbourne, Australia, 22-25 June 2016