Growing research points to expanding adoption of online cognitive behavioral therapies, both guided and unguided

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We are see­ing a num­ber of fas­ci­nat­ing meta-analy­ses com­par­ing the val­ue of A) face-to-face vs. Inter­net-based cog­ni­tive behav­ioral ther­a­pies and B) guid­ed vs unguid­ed inter­net-based cog­ni­tive behav­ioral ther­a­py, espe­cial­ly in the case of depression.

Here you have a cou­ple great exam­ples, sug­gest­ing a grow­ing adop­tion in the near future of web-based, and increas­ing­ly per­son­al­ized, interventions.

A) A com­par­i­son of elec­tron­i­cal­ly-deliv­ered and face to face cog­ni­tive behav­iour­al ther­a­pies in depres­sive dis­or­ders: A sys­tem­at­ic review and meta-analy­sis (Eclin­i­cal Med­i­cine). From the Abstract:

  • Back­ground: Cog­ni­tive behav­iour­al ther­a­py (CBT) is a wide­ly used treat­ment for depres­sion. How­ev­er, lim­it­ed resource avail­abil­i­ty pos­es sev­er­al bar­ri­ers to patients seek­ing access to care, includ­ing lengthy wait times and geo­graph­i­cal lim­i­ta­tions. This has prompt­ed health care ser­vices to intro­duce elec­tron­i­cal­ly deliv­ered CBT (eCBT) to facil­i­tate access … The pur­pose of this study is to eval­u­ate the effects of eCBT com­pared to face-to-face CBT through a sys­tem­at­ic review of the literature.
  • Meth­ods: To be eli­gi­ble for this review, stud­ies need­ed to be ran­dom­ized con­trolled tri­als eval­u­at­ing the clin­i­cal effec­tive­ness of any form of eCBT com­pared to face-to-face CBT. These encom­passed stud­ies eval­u­at­ing a wide range of out­comes includ­ing sever­i­ty of symp­toms, adverse out­comes, clin­i­cal­ly rel­e­vant out­comes, glob­al func­tion­al­i­ty, par­tic­i­pant sat­is­fac­tion, qual­i­ty of life, and afford­abil­i­ty. There were no restric­tions on par­tic­i­pant age or sex.
  • Find­ings: In total, we includ­ed 17 stud­ies in our analy­ses. Our results demon­strat­ed that eCBT was more effec­tive than face-to-face CBT at reduc­ing depres­sion symp­tom sever­i­ty … There were no sig­nif­i­cant dif­fer­ences between the two inter­ven­tions on par­tic­i­pant sat­is­fac­tion … One RCT report­ed eCBT to be less cost­ly than face-to-face CBT (GRADE: low qual­i­ty of evi­dence). Results did not dif­fer when strat­i­fied by sub­groups such as par­tic­i­pant age and study location.
  • Inter­pre­ta­tion: Although we found eCBT to have mod­er­ate evi­dence of effec­tive­ness in reduc­ing symp­toms of depres­sion, high het­ero­gene­ity among stud­ies pre­cludes defin­i­tive con­clu­sions for all out­comes. With the cur­rent reliance and acces­si­bil­i­ty of tech­nol­o­gy to increas­ing num­ber of peo­ple world­wide, seri­ous con­sid­er­a­tion in uti­liz­ing tech­nol­o­gy should be giv­en to max­i­mize acces­si­bil­i­ty for depres­sion treat­ments. Our results found eCBT is at least as effec­tive as face to face CBT, thus eCBT should be offered if pre­ferred by patients and therapists.

B) Inter­net-Based Cog­ni­tive Behav­ioral Ther­a­py for Depres­sion (JAMA Psy­chi­a­try). Key Points from the study:

  • Ques­tion: What are the patient-spe­cif­ic rel­a­tive out­comes of guid­ed vs unguid­ed inter­net-based cog­ni­tive behav­ioral ther­a­py (iCBT) for depres­sion over the short and the long term?
  • Find­ings: In this sys­tem­at­ic review and meta-analy­sis of 39 stud­ies com­pris­ing 9751 par­tic­i­pants, indi­vid­u­als with mild/subthreshold depres­sion was asso­ci­at­ed with lit­tle or no ben­e­fit from ther­a­peu­tic guid­ance, while guid­ed iCBT was asso­ci­at­ed with more effec­tive­ness in indi­vid­u­als with mod­er­ate and severe depres­sion. Both iCBT modal­i­ties out­per­formed the TAU regard­less of depres­sion severity.
  • Mean­ing: Although guid­ed iCBT was asso­ci­at­ed with greater improve­ment com­pared with unguid­ed iCBT on aver­age, many peo­ple with depres­sion may still ben­e­fit from the iCBT with­out ther­a­peu­tic guid­ance, and opti­miz­ing treat­ment assign­ment would con­sid­er­ably expand treat­ment cov­er­age worldwide.

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