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Response and Remission Rates in Internet-Based Cognitive Behavior Therapy: An Individual Patient Data Meta-Analysis.

Gerhard Andersson1,2, Per Carlbring3,4, Alexander Rozental2,5

  • 1Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.

Frontiers in Psychiatry
|November 12, 2019
PubMed
Summary

Internet-delivered cognitive behavior therapy (ICBT) shows significant recovery rates, with about half of patients improving. Higher symptom severity and being female predict better outcomes, while anxiety disorders may slightly decrease response.

Keywords:
individual patient data meta-analysisinternet-based cognitive behavior therapypredictorsrecoveryresponse rates

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Area of Science:

  • Mental Health
  • Psychiatry
  • Digital Health

Background:

  • Internet-delivered cognitive behavior therapy (ICBT) has been established for over two decades.
  • Despite numerous trials, systematic investigation of response rates remains crucial.
  • This study aims to determine reliable change and recovery rates across various conditions using a large dataset of Swedish ICBT trials.

Approach:

  • An individual patient meta-analysis (IPDMA) was conducted on data from 2,866 patients across 29 Swedish clinical trials.
  • Data included pre- and post-treatment scores for anxiety disorders, depression, and other conditions.
  • Reliable Change Index (RCI) and remission rates were calculated, with predictors explored via logistic regression.

Key Points:

  • Approximately 65.6% of patients achieved recovery (RCI z=1.96), and 35.0% reached remission.
  • Higher baseline symptom severity (OR=1.36) and female gender (OR=2.22) were associated with increased odds of response.
  • Anxiety disorders were linked to decreased treatment response (OR=0.51).

Conclusions:

  • ICBT efficacy aligns with traditional CBT, with roughly half of clients responding and a third achieving remission.
  • Higher symptom severity and female gender may enhance treatment improvement.
  • Lower remission rates compared to traditional CBT warrant further investigation; anxiety disorders may have a slightly reduced response.