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.
News in Context:
- The landscape of digital mental health apps: huge unmet needs, quality concerns, app stores asked to ensure transparency
- Digital mental health start-up Koa Health raises €30M to accelerate growth in Europe and the US
- Startup Big Health raises $39M to universalize access to cognitive behavioral therapy (CBT) for anxiety and poor sleep
- CVS Health: Cognitive behavioral therapy (CBT) apps may help you more than sleeping pills
- The National Academy of Medicine (NAM) shares discussion paper to help empower 8 billion minds via the ethical adoption of digital mental health and neurotech