For better or worse : An individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy

• Psychological treatments can relieve mental distress and improve well-being, and the dissemination of evidence-based methods can help patients gain access to the right type of aid. Meanwhile, Internet-based cognitive behavior therapy (ICBT) has shown promising results for many psychiatric disorders. However, research on the potential for negative effects of psychological treatments has been lacking. An individual patient data meta-analysis of 29 clinical trials of ICBT (N = 2866) was performed using the Reliable Change Index for each primary outcome measures to distinguish deterioration rates among patients in treatment and control conditions. Statistical analyses of predictors were conducted using generalized linear mixed models. Missing data was handled by multiple imputation.Deterioration rates were 122 (5.8%) in treatment and 130 (17.4%) in control conditions. Relative to receiving treatment, patients in a control condition had higher odds of deteriorating, Odds Ratios (OR) 3.10, 95% Confidence Interval (CI) [2.21-4.34]. Clinical severity at pre treatment was related to lower odds, OR 0.62, 95% CI [0.50-0.77], and 0.51, 95% CI [0.51-0.80], for treatment and control conditions. In terms of sociodemographic variables, being in a relationship, 0.58, 95% CI [0.35-0.95], having at least a university degree, 0.54, 95% CI [0.33-0.88], and being older, 0.78, 95% CI, [0.62-0.98], were also associated with lower odds of deterioration, but only for patients assigned to a treatment condition.Deterioration among patients receiving ICBT or being in a control condition can occur and should be monitored by researchers in order to reverse and prevent a negative treatment trend.Negative effects of psychological treatments is largely unknown for many researchers and clinicians. However, evidence suggest that 5-10% of all patients deteriorate during treatment and that some also experience other adverse and unwanted events. The results from the current study indicate that deterioration occurs among some patients receiving cognitive behaviour therapy via the Internet. Furthermore, certain sociodemographic variables seem to be associated with lower odds of deterioration; older age, higher educational level, being in a relationship, and having higher symptom severity at pre treatment assessment. In addition, proportionally more patients deteriorated while in wait- list control, suggesting that a better match between patient and treatment format may be required, and that there are ethical and methodological issues surrounding the use of waitings periods in randomised controlled trials.

Ämnesord

SAMHÄLLSVETENSKAP  -- Psykologi (hsv//swe)

SOCIAL SCIENCES  -- Psychology (hsv//eng)

Nyckelord

Internet-based cognitive behavior therapy

individual patient data meta-analysis

negative effects

deterioration

predictors

Psychology

psykologi

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