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Guided internet CBT versus "gold standard" depression treatments: An individual patient analysis. | LitMetric

AI Article Synopsis

  • Guided internet-based cognitive behavioral therapy (iCBT) shows promise for treating depression but needs more comparison with standard treatments like psychotherapy and medications.
  • A study compared results from a trial of iCBT with two other depression treatment trials, adjusting for sample differences, and analyzed outcomes like remission and dropout rates.
  • The findings suggest that while iCBT has higher dropout rates, its effectiveness is comparable to traditional treatments and it is superior to placebo, although limitations in study design were noted.

Article Abstract

Objective: Guided, computerized cognitive behavioral therapy delivered over the internet (iCBT) is a promising treatment for depression. However, comparisons to "gold standard" treatments and comparators, such as structured psychotherapy, medications, or pill placebo are rare. We compare the results of an 8-week trial of guided iCBT to outcomes from two trials of depression treatment, Penn-Vandy and U. Washington, using individual patient data.

Method: We adjusted for sample differences by restricting the iCBT sample to randomised controlled trial (RCT) inclusion criteria and using propensity scores. Three separate samples were included in analyses: iCBT trial (N = 89), Penn-Vandy (N = 240), and U. Washington (N = 241). Continuous outcomes were analyzed with linear-mixed models and noninferiority analyses were conducted for iCBT versus the psychotherapy conditions. The primary outcomes were attrition, remission, and the Hamilton Rating Scale for Depression.

Results: Dropout was greater in iCBT than in CT, medications, placebo (Penn-Vandy), and CT and BA (U. Washington), but the rates of remission were similar. In continuous analyses, iCBT was superior to placebo in both RCTs and most analyses indicated no difference between iCBT and the active treatments.

Conclusions: Guided iCBT appears not inferior to "gold standard" treatments for depression and is superior to placebo. Weaknesses include a lack of randomization, unblinded assessments, and a shorter "frame of treatment" in the iCBT sample.

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Source
http://dx.doi.org/10.1002/jclp.22733DOI Listing

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