Table 1:
Characteristics of Included Systematic Reviews
| Author, Year | Objective | Study Design and Methods | Comparators | Outcomes of interest |
|---|---|---|---|---|
| Andrews et al, 201821 | Replication and extension of 2010 meta-analysis to examine whether computerised therapy for the anxiety and depressive disorders is effective, acceptable, and practical health care. |
Inclusion criteria Adutls ≥18 yrs with a primary diagnosis of either major depression, GAD, PD with or without agoraphobia, or SAD Diagnosis could be determined by a clinician, through telephone interview or by meeting a recognised cut-off on a validated self-report questionnaire. Exclusion criteria Studies of treatments aimed at a range of diagnoses (transdiagnostic studies), and studies of depressive or anxiety symptoms in which no data on the probability of satisfying diagnostic criteria were supplied. |
Waitlist control, information control, care as usual, or placebo. | Subgroup analyses examining the effects of iCBT on change in symptom severity for depression and anxiety disorders. |
| Arnberg et al, 201420 | (1) Is internet-delivered psychological treatment efficacious, safe, and cost-effective for mood and anxiety disorders in children, adolescents and adults? (2) Is internet-delivered treatment noninferior to established psychological treatments? |
Inclusion Criteria Participants: children, adolescents, and adults with anxiety or mood disorders, including major depression, dysthymia, bipolar disorder, social phobia, PD, GAD, PTSD, OCD, specific phobia, and separation anxiety (in children and adolescents). Intervention: internet-delivered psychological treatments that are based on an explicit psychological theory and not conducted at a clinic. Any support had to be remotely delivered (e.g. email-like messages or telephone). The degree of support was categorized into pure self-help (no support), technician-assisted (e.g., nonclinical), or therapist-guided (i.e., clinical support). Study design: for short-term effects and risk of adverse events, only RCTs were included. For long-term follow-up assessments (i.e., ≥6 mo post-assessment), RCTs and observational studies were included because of the ethical and practical dilemmas of conducting long-term RCTs. For cost-effectiveness data, economic evaluations based on individual-level data and decision models were used. Exclusion Criteria Studies where the participants were selected primarily because of a specific physical illness. |
Any established psychological treatments, waiting list, usual care, or attention control. | Change in symptoms of the primary disorder, adverse events, and cost per effect and per quality-adjusted life year. |
| Kampmann et al, 201625 | Evaluate the efficacy of technology-assisted interventions for individuals with a diagnosis of SAD. |
Inclusion Criteria Participants: lts ≥18 yrs who meet the criteria for a diagnosis of SAD and who had their SAD symptoms assessed during or after the initial assessment. Interventions: treatments targeting SAD symptoms. Study design: RCTs with at least 10 participants per treatment condition, no language restrictions. Exclusion Criteria Dissertation abstracts, reviews, and study protocols. |
Passive control, active control. | Symptoms of depression at post-assessment, efficacy and changes in quality of life. |
| Adelman et al, 20147 | Examine cCBT efficacy for non-PTSD, non-OCD anxiety disorders along multiple dimensions, including treatment efficacy by comparison condition, diagnostic target, level of therapist involvement, study quality, and participant age group. |
Inclusion Criteria RCTs assessing efficacy of cCBT for anxiety disorders, subjects who meet criteria for GAD, PD, SAD, or a specific phobia based on DSM-IV criteria, trials recorded to compare cCBT to waiting list or in-person CBT control condition. Exclusion Criteria OCD and PTSD trials, due to the underlying neuropathology of these conditions, the CBT techniques used to treat these conditions were considered to be sufficiently different from the other anxiety disorders, OCD, and PTSD within diagnostic categories that are distinct from the anxiety disorders. Trials with <10 participants. |
Waiting list or in-person CBT. | Endpoint score on a rating scale used to measure anxiety. Results were stratified by comparator. |
| Kaltenthaler et al, 200822 | Systematically review RCTs of computerized CBT (cCBT) software packages for the treatment of mild to moderate depression. |
Inclusion Criteria Adults with mild to moderate depression, with or without anxiety, as defined by individual studies. Exclusion Criteria Studies on postnatal depression, bipolar disorder, depression with psychotic symptoms or current major depression, or serious suicidal thoughts. |
Current standard treatments including therapist-led CBT, non-directive counselling, primary care counselling, routine management (including drug treatment), and alternative methods of CBT delivery such as bibliotherapy and group CBT. | Improvement in psychological symptoms, quality of life, patient satisfaction. |
| Dedert et al, 201323 | (1) For adults with depressive disorder, PTSD, PD, or GAD, what are the effects of cCBT interventions compared with inactive controls? (2) For cCBT interventions, what level, type, and modality of user support is provided (e.g., daily telephone calls, weekly email correspondence), who provides this support (e.g., therapist, graduate student, peer), what is the clinical context (primary intervention, adjunct), and how is this support related to patient outcomes? Examine the influence of support-related factors on treatment outcomes, including satisfaction, response, and completion. (3) For adults with major depression, PTSD, PD, or GAD, what are the effects of cCBT interventions compared with face-toface therapy? Compare the effectiveness of cCBT with face-to-face CBT. |
Inclusion Criteria Participants: Adults ≥18 yrs with one or more of the following conditions:
Interventions: CBT delivered primarily by a computerized (i.e., electronic) mechanism. Interventions may be self-guided or with clinician support, but the computerized mechanism must be the key intervention that differs from the control group. Study design: RCTs with N > 20. Exclusion Criteria Participants: people with test anxiety, phobias, or SAD. Interventions: interpersonal therapy designed to prevent the onset or relapse of mental illness; interventions that are primarily telemedicine-based (e.g., therapy via video chat or phone interactions, including those by interactive voice response); interventions that use virtual reality as the primary therapeutic mode, do not use the key components of CBT, disease management interventions where CBT is only one component of a more comprehensive intervention, are delivered primarily in face-to-face encounters but supplemented by text messages, or use online materials that do not meet the definition of CBT or CBT-related intervention. |
Usual care not involving psychotherapy; waitlist control; attention/information control, cCBT with a different level of therapist support, face-to-face CBT. | Patient satisfaction, safety, symptom measure, health related quality of life. |
| Richards et al, 201524 | Systematically review and conduct a meta-analysis of internet-delivered psychological therapy for GAD compared to waiting list control groups. |
Inclusion Criteria Adults ≥18yr who have a clinical diagnosis of GAD and may have comorbidity with depression and/or impairment in functioning. Study design: RCTs. |
Waiting list | Clinical efficacy |
Abbreviations: cCBT, computerized CBT; GAD, generalized anxiety disorder; iCBT, internet-delivered cognitive behavioural therapy; OCD, obsessive compulsive disorder; PD, panic disorder; PTSD, posttraumatic stress disorder; RCT, randomized controlled trial; SAD, social anxiety disorder; SD, standard deviation.