| 1. |
- Andersson, Gerhard, et al.
(författare)
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Internet-Based Vs. Face-To-Face Cognitive Behaviour Therapy for Psychiatric and Somatic Disorders : a Systematic Review and Meta-Analysis
- 2014
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Ingår i: Abstracts from the 44th Congress of the European Association for Behavioural & Cognitive Therapies. - Utrecht : EABCT.
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Konferensbidrag (refereegranskat)abstract
- Internet-delivered cognitive behaviour therapy (ICBT) has been tested in many research trials but to a lesser extent been directly compared against face-to-face delivered cognitive behaviour therapy (CBT). We conducted a systematic review and meta-analysis on trials in which guided ICBT was directly compared against face-to-face CBT within the same trial. Studies on psychiatric and somatic conditions were included. Systematic searches resulted in 13 studies (total N=1053) that met all review criteria and were included in the review. There were 3 studies on social anxiety disorder, 3 on panic disorder, 2 on depressive symptoms, 2 on body dissatisfaction, 1 on tinnitus, 1 on male sexual dysfunction, and 1 on spider phobia. Face-to-face CBT was either in the individual format (n=6 ) or in the group format (n=7). We also assessed quality and risk of bias. Results showed a pooled effect size at post-treatment across of Hedges g = -0.01 (95% CI, -0.13 to 0.12), indicating that ICBT and face-to-face treatment produce equivalent overall effects. Study quality did not affect outcomes. While the overall results indicate equivalence, there are still few studies for each psychiatric and somatic condition and many for which guided ICBT has not been compared against face-to-face treatment. Thus, more research is needed to establish equivalence of the two treatment formats.
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| 2. |
- Andersson, Gerhard, et al.
(författare)
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The contribution of active medication to combined treatments of psychotherapy and pharmacotherapy for adult depression : a meta-analysis.
- 2010
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Ingår i: Acta Psychiatrica Scandinavica. - : Wiley. - 0001-690X .- 1600-0447. ; 121:6, s. 415-23
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Although there is sufficient evidence that combined treatments of psychotherapy and pharmacotherapy are more effective for depression in adults than each of the treatments alone, it remains unclear what the exact contribution of active medication is to the overall effects of combined treatments. This paper examines the contribution of active medication to combined psychotherapy and pharmacotherapy treatments. METHOD: Meta-analysis of randomised controlled trials comparing the combination of psychotherapy and pharmacotherapy with the combination of psychotherapy and placebo. RESULTS: Sixteen identified studies involving 852 patients met our inclusion criteria. The standardised mean difference indicating the differences between the combination of psychotherapy and pharmacotherapy and the combination of psychotherapy and placebo was 0.25 (95% CI: 0.03-0.46), which corresponds to a numbers-needed-to-be-treated of 7.14. No significant differences between subgroups of studies were found. CONCLUSION: Active medication has a small but significant contribution to the overall efficacy of combined treatments.
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| 3. |
- Cuijpers, P, et al.
(författare)
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A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments
- 2013
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Ingår i: Canadian journal of psychiatry. Revue canadienne de psychiatrie. - : SAGE Publications. - 0706-7437. ; 58:7, s. 376-385
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Tidskriftsartikel (refereegranskat)abstract
- No recent meta-analysis has examined the effects of cognitive-behavioural therapy (CBT) for adult depression. We decided to conduct such an updated meta-analysis. Methods: Studies were identified through systematic searches in bibliographical databases (PubMed, PsycINFO, Embase, and the Cochrane library). We included studies examining the effects of CBT, compared with control groups, other psychotherapies, and pharmacotherapy. Results: A total of 115 studies met inclusion criteria. The mean effect size (ES) of 94 comparisons from 75 studies of CBT and control groups was Hedges g = 0.71 (95% CI 0.62 to 0.79), which corresponds with a number needed to treat of 2.6. However, this may be an overestimation of the true ES as we found strong indications for publication bias (ES after adjustment for bias was g = 0.53), and because the ES of higher-quality studies was significantly lower ( g = 0.53) than for lower-quality studies ( g = 0.90). The difference between high- and low-quality studies remained significant after adjustment for other study characteristics in a multivariate meta-regression analysis. We did not find any indication that CBT was more or less effective than other psychotherapies or pharmacotherapy. Combined treatment was significantly more effective than pharmacotherapy alone ( g = 0.49). Conclusions: There is no doubt that CBT is an effective treatment for adult depression, although the effects may have been overestimated until now. CBT is also the most studied psychotherapy for depression, and thus has the greatest weight of evidence. However, other treatments approach its overall efficacy.
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| 4. |
- Cuijpers, P., et al.
(författare)
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Comparison of psychotherapies for adult depression to pill placebo control groups: a meta-analysis
- 2014
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Ingår i: Psychological Medicine. - : Cambridge University Press (CUP). - 0033-2917 .- 1469-8978. ; 44:4, s. 685-695
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Forskningsöversikt (refereegranskat)abstract
- Background The effects of antidepressants for treating depressive disorders have been overestimated because of selective publication of positive trials. Reanalyses that include unpublished trials have yielded reduced effect sizes. This in turn has led to claims that antidepressants have clinically insignificant advantages over placebo and that psychotherapy is therefore a better alternative. To test this, we conducted a meta-analysis of studies comparing psychotherapy with pill placebo. Method Ten 10 studies comparing psychotherapies with pill placebo were identified. In total, 1240 patients were included in these studies. For each study, Hedges g was calculated. Characteristics of the studies were extracted for subgroup and meta-regression analyses. Results The effect of psychotherapy compared to pill placebo at post-test was g=0.25 [95% confidence interval (CI) 0.14-0.36, I (2)=0%, 95% CI 0-58]. This effect size corresponds to a number needed to treat (NNT) of 7.14 (95% CI 5.00-12.82). The psychotherapy conditions scored 2.66 points lower on the Hamilton Depression Rating Scale (HAMD) than the placebo conditions, and 3.20 points lower on the Beck Depression Inventory (BDI). Some indications for publication bias were found (two missing studies). We found no significant differences between subgroups of the studies and in meta-regression analyses we found no significant association between baseline severity and effect size. Conclusions Although there are differences between the role of placebo in psychotherapy and pharmacotherapy research, psychotherapy has an effect size that is comparable to that of antidepressant medications. Whether these effects should be deemed clinically relevant remains open to debate.
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| 5. |
- Cuijpers, P, et al.
(författare)
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Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies
- 2010
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Ingår i: PSYCHOLOGICAL MEDICINE. - : Cambridge University Press. - 0033-2917 .- 1469-8978. ; 40:12, s. 1943-1957
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Forskningsöversikt (refereegranskat)abstract
- Background. Although guided self-help for depression and anxiety disorders has been examined in many studies, it is not clear whether it is equally effective as face-to-face treatments. Method. We conducted a meta-analysis of randomized controlled trials in which the effects of guided self-help on depression and anxiety were compared directly with face-to-face psychotherapies for depression and anxiety disorders. A systematic search in bibliographical databases (PubMed, PsycINFO, EMBASE, Cochrane) resulted in 21 studies with 810 participants. Results. The overall effect size indicating the difference between guided self-help and face-to-face psychotherapy at post-test was d=-0.02, in favour of guided self-help. At follow-up (up to 1 year) no significant difference was found either. No significant difference was found between the drop-out rates in the two treatments formats. Conclusions. It seems safe to conclude that guided self-help and face-to-face treatments can have comparable effects. It is time to start thinking about implementation in routine care.
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| 6. |
- Cuijpers, P, et al.
(författare)
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The effects of psychotherapy for adult depression are overestimated: a meta-analysis of study quality and effect size
- 2010
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Ingår i: PSYCHOLOGICAL MEDICINE. - 0033-2917 .- 1469-8978. ; 40:2, s. 211-223
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Tidskriftsartikel (refereegranskat)abstract
- Background. No meta-analytical study has examined whether the quality of the Studies examining psychotherapy for adult depression is associated with the effect sizes found. This study assesses this association. Method. We used a database of 115 randomized controlled trials in which 178 psychotherapies for adult depression were compared to a control condition. Eight quality criteria were assessed by two independent coders: participants met diagnostic criteria for a depressive disorder, a treatment manual was used, the therapists were trained, treatment integrity was checked, intention-to-treat analyses were used, N andgt;= 50, randomization was Conducted by an independent party, and assessors of outcome were blinded. Results. Only 11 studies (16 comparisons) met the eight quality criteria. The standardized mean effect size found for the high-quality studies (d=0.22) was significantly smaller than in the other Studies (d=0.74, pandlt;0.001), even after restricting the sample to the Subset of other studies that used the kind of care-as-usual or non-specific controls that tended to be used in the high-quality studies. Heterogeneity was zero in the group of high-quality studies. The numbers needed to be treated in the high-quality studies was 8, while it was 2 in the lower-quality Studies. Conclusions. We found strong evidence that the effects of psychotherapy for adult depression have been overestimated in meta-analytical studies. Although the effects of psychotherapy are significant, the), are Much smaller than was assumed until now, even after controlling for the type of control condition used.
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| 7. |
- Cuijpers, Pim, et al.
(författare)
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The effects of psychotherapy for adult depression on suicidality and hopelessness : a systematic review and meta-analysis
- 2013
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Ingår i: Journal of Affective Disorders. - : Elsevier. - 0165-0327 .- 1573-2517. ; 144:3, s. 183-190
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Although treatment guidelines suggest that suicidal patients with depression should be treated for depression with psychotherapy, it is not clear whether these psychological treatments actually reduce suicidal ideation or suicide risk.METHODS: We conducted a systematic review and meta-analysis of studies on psychotherapy for depression in which outcomes on suicidality were reported. We also focused on outcomes on hopelessness because this is strongly associated with suicidal behavior in depression.RESULTS: Thirteen studies (with 616 patients) were included, three of which examined the effects of psychotherapy for depression on suicidal ideation and suicide risk, and eleven on hopelessness. No studies were found with suicide attempts or completed suicides as the outcome variables. The effects on suicidal ideation and suicide risk were small (g=0.12; 95% CI: -0.20-0.44) and not statistically significant. A power calculation showed that these studies only had sufficient power to find an effect size of g=0.47. The effects on hopelessness were large (g=1.10; 95% CI: 0.72-1.48) and significant, although heterogeneity was very high. Furthermore, significant publication bias was found. After adjustment of publication bias the effect size was reduced to g=0.60.DISCUSSION: At this point, there is insufficient evidence for the assumption that suicidality in depressed patients can be reduced with psychotherapy for depression. Although psychotherapy of depression may have small positive effects on suicidality, available data suggest that psychotherapy for depression cannot be considered to be a sufficient treatment. The effects on hopelessness are probably higher.
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| 8. |
- Rozental, Alexander, et al.
(författare)
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Consensus statement on defining and measuring negative effects of Internet interventions
- 2014
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Internet interventions have a great potential for alleviating emotional distress and promoting mental health. A number of clinical trials have demonstrated their efficacy for several psychiatric conditions, and Internet interventions will likely become a common alternative to face-to-face treatments. Meanwhile, research has paid little attention to the potential negative effects associated with treatment, warranting further investigation of the possibility that some patients might deteriorate or experience adverse events. Evidence from face-to-face treatments suggests that negative effects afflict 5-10% of all patients undergoing treatment in terms of deterioration alone. However, there is currently a lack of consensus on how to define and measure negative effects in psychotherapy research in general, leaving researchers without practical guidelines for monitoring and reporting negative effects in clinical trials.Method: The current paper seeks to provide recommendations that could promote the study of negative effects in Internet interventions with the aim of increasing the knowledge of its occurrence and characteristics. Ten leading experts in the field of Internet interventions were invited to participate and share their perspective on how to explore negative effects, using the Delphi technique to facilitate a dialogue and reach an agreement.Results: The importance of conducting further research on negative effects is emphasized, and suggestions on how to classify and measure negative effects in Internet interventions are provided, involving methods from both quantitative and qualitative research. Potential mechanisms underlying negative effects are also presented, differentiating common factors shared with face-to-face treatments from those unique to treatments delivered via the Internet.Conclusion: Negative effects are to be expected and need to be acknowledged to a greater extent, advising researchers to systematically probe for negative effects whenever conducting clinical trials involving Internet interventions, as well as to share their findings in scientific journals.
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| 9. |
- van Straten, A., et al.
(författare)
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Guided Internet-delivered cognitive behavioural treatment for insomnia: a randomized trial
- 2014
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Ingår i: Psychological Medicine. - : Cambridge University Press. - 0033-2917 .- 1469-8978. ; 44:7, s. 1521-1532
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Insomnia is a prevalent problem with a high burden of disease (e.g. reduced quality of life, reduced work capacity) and a high co-morbidity with other mental and somatic disorders. Cognitive behavioural therapy (CBT) is effective in the treatment of insomnia but is seldom offered. CBT delivered through the Internet might be a more accessible alternative. In this study we examined the effectiveness of a guided Internet-delivered CBT for adults with insomnia using a randomized controlled trial (RCT).METHOD:A total of 118 patients, recruited from the general population, were randomized to the 6-week guided Internet intervention (n = 59) or to a wait-list control group (n = 59). Patients filled out an online questionnaire and a 7-day sleep diary before (T0) and after (T1) the 6-week period. The intervention group received a follow-up questionnaire 3 months after baseline (T2).RESULTS:Almost three-quarters (72.9%) of the patients completed the whole intervention. Intention-to-treat (ITT) analysis showed that the treatment had statistically significant medium to large effects (p < 0.05; Cohen's d between 0.40 and 1.06), and resulted more often in clinically relevant changes, on all sleep and secondary outcomes with the exception of sleep onset latency (SOL) and number of awakenings (NA). There was a non-significant difference in the reduction in sleep medication between the intervention (a decrease of 6.8%) and control (an increase of 1.8%) groups (p = 0.20). Data on longer-term effects were inconclusive.CONCLUSIONS:This study adds to the growing body of literature that indicates that guided CBT for insomnia can be delivered through the Internet. Patients accept the format and their sleep improves.
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