A Meta-Analytic Review of Internet-Based Cognitive Behavioral Therapy for Patients with Chronic Somatic Conditions
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Abstract
Sylvia van Beugen1, MSc; Maaike Ferwerda1, MSc; Dane Hoeve, MSc; Maroeska Rovers, PhD2; Saskia Spillekom-van Koulil1,3, PhD; Henriët van Middendorp1, PhD; Andrea W.M. Evers1,3, PhD
Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
1 Department of Medical Psychology
2 Department of Epidemiology, Biostatistics and HTA
3 Department of Dermatology
Background: The Internet is increasingly being used to deliver guided cognitive behavioral therapy to patients with chronic somatic conditions. In order to determine whether ICBT is effective for chronic somatic conditions, the results of the increasing number of recent randomized controlled trials (RCTs) need to be systematically evaluated and quantitatively analyzed.
Objective: The current meta-analytic review describes guided Internet-based cognitive behavioral therapy (ICBT) interventions for chronic somatic conditions, and evaluates the effectiveness of these interventions.
Method: We searched Pubmed, PsychINFO and EMBASE from inception until February 2012, by combining search terms indicative of effect studies, Internet, and cognitive behavioral therapy. Three types of outcome were evaluated: generic psychological outcomes, disease-related physical outcomes, and disease-related impact outcomes. Standardized mean differences (SMDs) were calculated between intervention and control conditions for each outcome and, when appropriate, pooled using random effects models.
Results: A total of 23 trials were included. Guided ICBT was shown to improve all three outcome categories with small-to-moderate effect sizes for generic psychological outcomes (ES range=0.19-0.32) and occasionally larger effects for disease-specific physical outcomes (ES range=-0.04-1.15) and disease-related impact outcomes (ES range=0.21-1.09). Explorative analyses suggested that interventions with a longer treatment duration (>6 weeks) lead to more consistent effects on depression.
Conclusions: Guided ICBT appears to be a promising and effective treatment for chronic somatic conditions. Explorative analyses revealed that longer treatment length holds the promise of larger treatment effects. The most consistent improvements were found for disease-specific outcomes, which supports the possible relevance of tailoring interventions to specific patient groups.
Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
1 Department of Medical Psychology
2 Department of Epidemiology, Biostatistics and HTA
3 Department of Dermatology
Background: The Internet is increasingly being used to deliver guided cognitive behavioral therapy to patients with chronic somatic conditions. In order to determine whether ICBT is effective for chronic somatic conditions, the results of the increasing number of recent randomized controlled trials (RCTs) need to be systematically evaluated and quantitatively analyzed.
Objective: The current meta-analytic review describes guided Internet-based cognitive behavioral therapy (ICBT) interventions for chronic somatic conditions, and evaluates the effectiveness of these interventions.
Method: We searched Pubmed, PsychINFO and EMBASE from inception until February 2012, by combining search terms indicative of effect studies, Internet, and cognitive behavioral therapy. Three types of outcome were evaluated: generic psychological outcomes, disease-related physical outcomes, and disease-related impact outcomes. Standardized mean differences (SMDs) were calculated between intervention and control conditions for each outcome and, when appropriate, pooled using random effects models.
Results: A total of 23 trials were included. Guided ICBT was shown to improve all three outcome categories with small-to-moderate effect sizes for generic psychological outcomes (ES range=0.19-0.32) and occasionally larger effects for disease-specific physical outcomes (ES range=-0.04-1.15) and disease-related impact outcomes (ES range=0.21-1.09). Explorative analyses suggested that interventions with a longer treatment duration (>6 weeks) lead to more consistent effects on depression.
Conclusions: Guided ICBT appears to be a promising and effective treatment for chronic somatic conditions. Explorative analyses revealed that longer treatment length holds the promise of larger treatment effects. The most consistent improvements were found for disease-specific outcomes, which supports the possible relevance of tailoring interventions to specific patient groups.
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