Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data.

Furukawa, Toshi A; Suganuma, Aya; Ostinelli, Edoardo G; Andersson, Gerhard; Beevers, Christopher G; Shumake, Jason; Berger, Thomas; Boele, Florien Willemijn; Buntrock, Claudia; Carlbring, Per; Choi, Isabella; Christensen, Helen; Mackinnon, Andrew; Dahne, Jennifer; Huibers, Marcus J H; Ebert, David D; Farrer, Louise; Forand, Nicholas R; Strunk, Daniel R; Ezawa, Iony D; ... (2021). Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data. The Lancet. Psychiatry, 8(6), pp. 500-511. Elsevier 10.1016/S2215-0366(21)00077-8

[img] Text
Furukawa_LancetPsychiatry_2021_AAM.pdf - Accepted Version
Restricted to registered users only until 4 November 2021.
Available under License Publisher holds Copyright.

Download (789kB) | Request a copy
[img] Text
Furukawa_LancetPsychiatry_2021.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (365kB) | Request a copy

BACKGROUND

Internet cognitive behavioural therapy (iCBT) is a viable delivery format of CBT for depression. However, iCBT programmes include training in a wide array of cognitive and behavioural skills via different delivery methods, and it remains unclear which of these components are more efficacious and for whom.

METHODS

We did a systematic review and individual participant data component network meta-analysis (cNMA) of iCBT trials for depression. We searched PubMed, PsycINFO, Embase, and the Cochrane Library for randomised controlled trials (RCTs) published from database inception to Jan 1, 2019, that compared any form of iCBT against another or a control condition in the acute treatment of adults (aged ≥18 years) with depression. Studies with inpatients or patients with bipolar depression were excluded. We sought individual participant data from the original authors. When these data were unavailable, we used aggregate data. Two independent researchers identified the included components. The primary outcome was depression severity, expressed as incremental mean difference (iMD) in the Patient Health Questionnaire-9 (PHQ-9) scores when a component is added to a treatment. We developed a web app that estimates relative efficacies between any two combinations of components, given baseline patient characteristics. This study is registered in PROSPERO, CRD42018104683.

FINDINGS

We identified 76 RCTs, including 48 trials contributing individual participant data (11 704 participants) and 28 trials with aggregate data (6474 participants). The participants' weighted mean age was 42·0 years and 12 406 (71%) of 17 521 reported were women. There was suggestive evidence that behavioural activation might be beneficial (iMD -1·83 [95% credible interval (CrI) -2·90 to -0·80]) and that relaxation might be harmful (1·20 [95% CrI 0·17 to 2·27]). Baseline severity emerged as the strongest prognostic factor for endpoint depression. Combining human and automated encouragement reduced dropouts from treatment (incremental odds ratio, 0·32 [95% CrI 0·13 to 0·93]). The risk of bias was low for the randomisation process, missing outcome data, or selection of reported results in most of the included studies, uncertain for deviation from intended interventions, and high for measurement of outcomes. There was moderate to high heterogeneity among the studies and their components.

INTERPRETATION

The individual patient data cNMA revealed potentially helpful, less helpful, or harmful components and delivery formats for iCBT packages. iCBT packages aiming to be effective and efficient might choose to include beneficial components and exclude ones that are potentially detrimental. Our web app can facilitate shared decision making by therapist and patient in choosing their preferred iCBT package.

FUNDING

Japan Society for the Promotion of Science.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
07 Faculty of Human Sciences > Institute of Psychology > Clinical Psychology and Psychotherapy

UniBE Contributor:

Berger, Thomas and Efthimiou, Orestis

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

2215-0374

Publisher:

Elsevier

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

11 May 2021 19:15

Last Modified:

20 Jul 2021 13:07

Publisher DOI:

10.1016/S2215-0366(21)00077-8

PubMed ID:

33957075

Additional Information:

Efthimiou, Karyotaki and Cuijpers contributed equally to this work.

BORIS DOI:

10.48350/156324

URI:

https://boris.unibe.ch/id/eprint/156324

Actions (login required)

Edit item Edit item
Provide Feedback