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Are Trials of Computerized Therapy Generalizable? A Multidimensional Meta-analysis.
Chelsey R Wilks1, Garret G Zieve1, Hannah K Lessing1
1Behavioral Research and Therapy Clinics, Department of Clinical Psychology, University of Washington , Seattle, Washington.
Summary
Computerized cognitive behavioral therapy (cCBT) shows limited effectiveness for anxiety disorders in real-world settings. Future research should explore cCBT for patients with more complex conditions.
Area of Science:
- Mental Health
- Digital Therapeutics
- Clinical Psychology
Background:
- Computerized cognitive behavioral therapy (cCBT) is established as effective for anxiety and depression in research.
- Generalizability of cCBT effectiveness to non-research settings remains uninvestigated.
Purpose of the Study:
- To investigate the generalizability of cCBT effectiveness in real-world settings.
- To quantify the relationship between participant exclusion criteria and treatment outcomes in cCBT trials.
Main Methods:
- Multidimensional meta-analysis of 36 randomized controlled trials (RCTs) of cCBT for anxiety and/or depressive disorders.
- Examined number of exclusion criteria and exclusion rate as indices of participant exclusion.
- Analyzed between- and within-group effect sizes and rates of clinically significant improvement.
Main Results:
- A between-group effect size of 0.85 was found across all studies.
- Mean exclusion criteria: 12; mean exclusion rate: 0.49. Suicide risk was a common exclusion criterion.
- Significant correlation (r=0.70) between exclusion criteria and treatment change in anxiety studies, indicating limited effectiveness in non-research samples.
Conclusions:
- Evidence suggests limited effectiveness of cCBT for anxiety disorders in non-research settings.
- Future trials should assess cCBT for patients with more complex clinical presentations to improve dissemination.
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