A Meta-Analysis of the Effects of Internet- and Computer-Based Cognitive-Behavioral Treatments for Anxiety

Madigan Army Medical Center and University of Washington School of Medicine, USA.
Journal of Clinical Psychology (Impact Factor: 2.12). 01/2009; 65(1):53-75. DOI: 10.1002/jclp.20536
Source: PubMed


Internet-and computer-based cognitive-behavioral treatments have been introduced as novel approaches to deliver standard, quality treatment that may reduce barriers to care. The purpose of this review is to quantitatively summarize the literature examining the treatment effects of Internet- or computer-based treatment (ICT) on anxiety. Nineteen randomized controlled ICT trials were identified and subjected to fixed and random effects meta-analytic techniques. Weighted mean effect sizes (Cohen's d) showed that ICT was superior to waitlist and placebo assignment across outcome measures (ds=.49-1.14). The effects of ICT also were equal to therapist-delivered treatment across anxiety disorders. However, conclusions were limited by small sample sizes, the rare use of placebo controls, and other methodological problems. In addition, the number of available studies limited the opportunity to conduct analyses by diagnostic group; there was preliminary support for the use of ICT for panic disorder and phobia. Large, well-designed, placebo-controlled trials are needed to confirm and extend the results of this meta-analysis.

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    • "Lastly the remaining papers were read fully and excluded if they were not eligible (for eligibility criteria see below). Finally, the reference lists of accepted papers and other reviews and meta-analysis (Andrews et al., 2010; Cuijpers et al., 2009; Przeworski & Newman, 2006; Reger & Gahm, 2009) were checked for further relevant papers. The process was conducted by the first two authors (DR, TR) and any disagreements that arose were discussed until a final decision was reached. "
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    ABSTRACT: Generalized Anxiety Disorder (GAD) is typically considered a chronic condition characterised by excessive worry. Lifetime prevalence is 4.3-5.9%, yet a small percentage seek treatment. GAD can be treated and in recent years online-delivered treatment interventions have shown promise. The paper aimed to systematically search for literature on online-delivered psychological interventions for the treatment of GAD and conduct a meta-analysis to examine their efficacy. The purpose of the paper is to inform the community of researchers in internet delivered interventions of the current state of the art and research gaps that require attention. A systematic search of the literature was conducted to find all studies for online-delivered treatments for GAD (N=20). Using Review Manager 5 all Randomized Controlled trials (RCTs; n = 11) that met our established eligibility criteria were included into a meta-analysis that calculated effect sizes via the standardised mean difference. Compared to the waiting-list controls, the results demonstrate positive outcomes for GAD symptoms (d = -0.91) and its central construct of pathological worry (d = -0.74). The meta-analysis supports the efficacy of online-delivered treatments for GAD including the use of disorder-specific (4 studies) and transdiagnostic treatment protocols (7 studies) delivered online. Caution is advised regarding the results as the data is limited and highly heterogeneous, but revealing of what future research might be needed.
    Internet Interventions 07/2015; In Press. DOI:10.1016/j.invent.2015.07.003
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    • "Primary mental illness was excluded because it has been covered substantially in previous reviews (Gerhard, 2009; Kaltenthaler et al., 2006; Reger & Gahm, 2009). "
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    ABSTRACT: Whilst cognitive behaviour therapy (CBT) has been shown to improve outcomes in patients with chronic physical illnesses, there are barriers to its implementation which computerised CBT (CCBT) may overcome. We reviewed all studies of CCBT for treating psychological distress (PD) in chronic physical illness populations. Systematic searches were undertaken in July, 2013. All articles about CCBT for PD secondary to physical illness were included. Twenty-nine studies (thirty papers) were included. Overall, the quality of evidence was poor. Studies about irritable bowel syndrome demonstrated the best evidence. The evidence for CCBT in the treatment of PD in physical illness patients is modest, perhaps due to the seldom use of PD screening. More robust research designs including longer follow up periods are required. Nevertheless, no studies reported a negative effect of CCBT on any outcome measures.
    Journal of Clinical Psychology in Medical Settings 02/2015; 22(1). DOI:10.1007/s10880-015-9420-0 · 1.49 Impact Factor
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    • "It has been proposed that self-help strategies may relieve some of the burden on health care services (Jorm & Griffiths, 2006) and, with the increasing use of internet and computer technologies, the computerisation of psychological interventions appears a logical step to achieve the provision of cost-effective help to all. There is a relatively large amount of research showing the effectiveness of computerised therapy for anxiety and depression in adults (Andersson & Cuijpers, 2009; Andrews, Cuijpers, Craske, McEvoy, & Titov, 2010; Reger & Gahm, 2009). Children and young people have shown favourable attitudes towards these types of intervention (Stallard, Velleman, & Richardson, 2010), but systematic reviews of internet-based therapies in children and young people do not include recent research and cover a limited range of computerised therapies (Calear & Christensen, 2010; Richardson, Stallard, & Velleman, 2010). "
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    ABSTRACT: One quarter of children and young people (CYP) experience anxiety and/or depression before adulthood, but treatment is sometimes unavailable or inadequate. Self-help interventions may have a role in augmenting treatment and this work aimed to systematically review the evidence for computerised anxiety and depression interventions in CYP aged 5-25 years old. Databases were searched for randomised controlled trials and 27 studies were identified. For young people (12-25 years) with risk of diagnosed anxiety disorders or depression, computerised CBT (cCBT) had positive effects for symptoms of anxiety (SMD -0.77, 95% CI -1.45 to -0.09, k = 6, N = 220) and depression (SMD -0.62, 95% CI -1.13 to -0.11, k = 7, N = 279). In a general population study of young people, there were small positive effects for anxiety (SMD -0.15, 95% CI -0.26 to -0.03; N = 1273) and depression (SMD -0.15, 95% CI -0.26 to -0.03; N = 1280). There was uncertainty around the effectiveness of cCBT in children (5-11 years). Evidence for other computerised interventions was sparse and inconclusive. Computerised CBT has potential for treating and preventing anxiety and depression in clinical and general populations of young people. Further program development and research is required to extend its use and establish its benefit in children. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Behaviour Research and Therapy 02/2015; 67C. DOI:10.1016/j.brat.2015.01.009 · 3.85 Impact Factor
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