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Research Design Critique Template Article Summary Notes Last name of researcher(s) and year of publication: Type of Study (Experiment, Factor Analysis, Survey, Meta-Analysis Main research question: Participants (#, age, sex): Main Dependent Variable(s): Main Independent Variable(s): Main hypothesis(es): Main Results: Study Limitations Implications of Results: 1. How did the researchers find the studies? 2. How many studies were included? 3. How effective is your approach? Back up your answer by analyzing the numbers in the article. Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=sbeh20 Cognitive Behaviour Therapy ISSN: 1650-6073 (Print) 1651-2316 (Online) Journal homepage: https://www.tandfonline.com/loi/sbeh20 Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis Per Carlbring, Gerhard Andersson, Pim Cuijpers, Heleen Riper & Erik Hedman-Lagerlöf To cite this article: Per Carlbring, Gerhard Andersson, Pim Cuijpers, Heleen Riper & Erik Hedman-Lagerlöf (2018) Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis, Cognitive Behaviour Therapy, 47:1, 1-18, DOI: 10.1080/16506073.2017.1401115 To link to this article: https://doi.org/10.1080/16506073.2017.1401115 © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group Published online: 07 Dec 2017. Submit your article to this journal Article views: 29073 View related articles View Crossmark data Citing articles: 273 View citing articles https://www.tandfonline.com/action/journalInformation?journalCode=sbeh20 https://www.tandfonline.com/loi/sbeh20 https://www.tandfonline.com/action/showCitFormats?doi=10.1080/16506073.2017.1401115 https://doi.org/10.1080/16506073.2017.1401115 https://www.tandfonline.com/action/authorSubmission?journalCode=sbeh20&show=instructions https://www.tandfonline.com/action/authorSubmission?journalCode=sbeh20&show=instructions https://www.tandfonline.com/doi/mlt/10.1080/16506073.2017.1401115 https://www.tandfonline.com/doi/mlt/10.1080/16506073.2017.1401115 http://crossmark.crossref.org/dialog/?doi=10.1080/16506073.2017.1401115&domain=pdf&date_stamp=2017-12-07 http://crossmark.crossref.org/dialog/?doi=10.1080/16506073.2017.1401115&domain=pdf&date_stamp=2017-12-07 https://www.tandfonline.com/doi/citedby/10.1080/16506073.2017.1401115#tabModule https://www.tandfonline.com/doi/citedby/10.1080/16506073.2017.1401115#tabModule Cognitive Behaviour therapy, 2018 voL. 47, no. 1, 1–18 https://doi.org/10.1080/16506073.2017.1401115 Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis Per Carlbringa , Gerhard Anderssonb,c , Pim Cuijpersd , Heleen Riperd,e,f,g and Erik Hedman-Lagerlöfh aDepartment of psychology, Stockholm university, Stockholm, Sweden; bDepartment of Behavioural Sciences and Learning, Swedish institute for Disability research, Linköping university, Linköping, Sweden; cDepartment of Clinical neuroscience, Division of psychiatry, Karolinska institutet, Stockholm, Sweden; dDepartment of Clinical, neuro and Developmental psychology, Section of Clinical psychology, vrije universiteit, amsterdam, the netherlands; evu university Medical Centre/ggZ ingeest, amsterdam, the netherlands; famsterdam public health research institute, amsterdam, the netherlands; gFaculty of health Science, telepsychiatric unit, university of Southern Denmark, university hospital, odense, Denmark; hDepartment of Clinical neuroscience, osher Center for integrative Medicine and Division of psychology, Karolinska institutet, Stockholm, Sweden ABSTRACT During the last two decades, Internet-delivered cognitive behavior therapy (ICBT) has been tested in hundreds of randomized controlled trials, often with promising results. However, the control groups were often waitlisted, care-as-usual or attention control. Hence, little is known about the relative efficacy of ICBT as compared to face-to-face cognitive behavior therapy (CBT). In the present systematic review and meta-analysis, which included 1418 participants, guided ICBT for psychiatric and somatic conditions were directly compared to face- to-face CBT within the same trial. Out of the 2078 articles screened, a total of 20 studies met all inclusion criteria. Results showed a pooled effect size at post-treatment of Hedges g = .05 (95% CI, −.09 to .20), indicating that ICBT and face-to-face treatment produced equivalent overall effects. Study quality did not affect outcomes. While the overall results indicate equivalence, there have been few studies of the individual psychiatric and somatic conditions so far, and for the majority, guided ICBT has not been compared against face-to-face treatment. Thus, more research, preferably with larger sample sizes, is needed to establish the general equivalence of the two treatment formats. Introduction The first treatment studies on Internet-delivered cognitive behavior therapy (ICBT) were carried out in the late 1990s (Andersson, Carlbring, & Lindefors, 2016). They were designed to mirror face-to-face treatments in terms of content and length. Since KEYWORDS guided internet-delivered cognitive behavior therapy; face-to-face therapy; anxiety and mood disorders; somatic disorders; meta-analysis ARTICLE HISTORY received 23 august 2017 accepted 1 november 2017 © 2017 the author(s). published by informa uK Limited, trading as taylor & Francis group. this is an open access article distributed under the terms of the Creative Commons attribution-nonCommercial-noDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. CONTACT per Carlbring
[email protected] Department of psychology, Stockholm university, Stockholm Se-10691, Sweden. OPEN ACCESS http://orcid.org/0000-0002-2172-8813 http://orcid.org/0000-0003-4753-6745 http://orcid.org/0000-0001-5497-2743 http://orcid.org/0000-0002-8144-8901 http://orcid.org/0000-0002-7939-9848 http://creativecommons.org/licenses/by-nc-nd/4.0/ mailto:
[email protected] http://www.tandfonline.com http://crossmark.crossref.org/dialog/?doi=10.1080/16506073.2017.1401115&domain=pdf 2 P. CARLBRING ET AL. then, more than 200 randomized controlled trials have been published, often with promising results indicating that ICBT is clinically effective when compared to controls (Andersson, Carlbring, & Hadjistavropoulos, 2017). Diagnoses targeted have typically included anxiety disorders and depression (Arnberg, Linton, Hultcrantz, Heintz, & Jonsson, 2014), but there are ample examples of subclinical problems, such as inter- ventions for procrastination (Rozental, Forsell, Svensson, Andersson, & Carlbring, 2015) and perfectionism (Shafran et al., 2017). ICBT can be successfully adapted to an internet-delivered format for psychiatric and somatic conditions even in children and adolescents (Vigerland et al., 2016). Treatment typically consists of a person first being screened or diagnosed in order to match a specific treatment program to the individual’s unique set of problems. For example, a patient presenting with panic disorder symptoms will receive a dedicated program specif- ically designed to target that particular problem. However, there are a few transdiagnostic programs in which this matching is less central (Păsărelu, Andersson, Bergman Nordgren, & Dobrean, 2017). Following the assessment phase, the patient is often allocated a therapist who, using encrypted asynchronous text messages, introduces the patient to the program and platform (cf. Vlaescu, Alasjö, Miloff, Carlbring, & Andersson, 2016). This is usually done by writing that the treatment will last for a predetermined number of weeks and that a new treatment module will be assigned each week. The modules mimic the treatment given in face-to-face therapy and consist of information and exercises (e.g. psychoeducation, thought records, and behavior experiments). Each module ends with essay questions that must be completed and sent to the therapist, who in turn will give personalized feedback on the patient’s progress. While there are variations in how much human interaction is included in the guidance (usually 1–15 min per week), research shows that the guidance of a human therapist is typically beneficial for a patient’s outcome (Baumeister, Reichler, Munzinger, & Lin, 2014). However, human guidance can possibly be, to some extent, replaced by smart computer-generated responses and automated personalized feedback (Titov et al., 2013). In addition to ICBT’s short-term effect sizes indicating equivalence to therapist-ad- ministered therapy (Andersson & Cuijpers, 2009; Andrews, Cuijpers, Craske, McEvoy, & Titov, 2010; Cuijpers, van Straten, & Andersson, 2008), a few long-term follow-up studies have shown that the ICBT effects are maintained for as long as five years post treatment (Hedman, Furmark, et al., 2011). In spite of the promising results in controlled trials, in which ICBT is often compared with waitlist control groups, an outstanding question has been how well guided ICBT compares against standard manualized face-to-face treatment. This was investigated in a meta-analysis by Andersson, Cuijpers, Carlbring, Riper, and Hedman (2014) that included a total of 13 studies (N = 1053) published up until June 2013. The results showed a pooled effect size at post-treatment of Hedges g = −.01 (95% CI, −.13 to .12), suggesting that ICBT and face-to-face treatment produce equivalent overall effects. However, since the field is moving forward rapidly and a considerable number of new studies have been published, an updated systematic review and meta-analysis is needed. The aim of this study was to reinvestigate the efficacy of ICBT compared to face-to- face cognitive behavior therapy (CBT) for psychiatric and somatic disorders, giving consideration to studies published in the past four years. COGNITIVE BEHAVIOUR THERAPY 3 Methods Design and selection of studies This was an updated systematic review and meta-analysis of original articles investigating the effect of ICBT compared to face-to-face treatment. We used the same methods as in the previously published systematic review (Andersson et al., 2014), which meant that, in order to be included, the studies had to (a) compare therapist-guided ICBT to face-to- face treatment using a randomized controlled design; (b) use interventions aimed at the treatment of psychiatric or somatic disorders (and not, for example, prevention or mere psychoeducation); (c) compare treatments that were similar in content in both treatment conditions; (d) investigate a form of ICBT wherein the internet treatment was the main component and not a secondary complement to other therapies; (e) investigate a form of full-length face-to-face treatment; (f) report outcome data from an adult patient sample; (g) report outcomes in terms of assessment of symptoms of the target problem; and (h) be written in English. We included only studies in which there was some therapist contact during the trial. We calculated effect sizes based on the primary outcome measure at post-treatment in each study. If no primary outcome measure was specified in the original study, a validated measure assessing target symptoms of the clinical problem was used, following the proce- dures generated by Thomson and Page (2007). Search methods To identify studies, systematic searches in PubMed (the MEDLINE database) were con- ducted using various search terms related to psychiatric and somatic disorders, including “depression,” “panic disorder,” “social phobia,” “social anxiety disorder,” “generalized anx- iety disorder,” “obsessive-compulsive disorder,” “post-traumatic stress disorder,” “specific phobia,” “hypochondriasis,” “bulimia,” “tinnitus,” “erectile dysfunction,” “chronic pain,” and “fatigue.” Each of these search terms was combined with each of the following: “Internet,” “computer,” and “computerized.” The search filter “randomized controlled trial” was used. Reference lists in the included studies were