Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
GET.ON Institute GmbH, Hamburg, Germany.
J Med Internet Res. 2020 Aug 31;22(8):e18100. doi: 10.2196/18100.
Although there is evidence for the efficacy of internet-based cognitive behavioral therapy (iCBT), the generalizability of results to routine care is limited.
This study systematically reviews effectiveness studies of guided iCBT interventions for the treatment of depression or anxiety.
The acceptability (uptake, participants' characteristics, adherence, and satisfaction), effectiveness, and negative effects (deterioration) of nonrandomized pre-post designs conducted under routine care conditions were synthesized using systematic review and meta-analytic approaches.
A total of 19 studies including 30 groups were included in the analysis. Despite high heterogeneity, individual effect sizes of investigated studies indicate clinically relevant changes, with effect sizes ranging from Hedges' g=0.42-1.88, with a pooled effect of 1.78 for depression and 0.94 for anxiety studies. Uptake, participants' characteristics, adherence, and satisfaction indicate a moderate to high acceptability of the interventions. The average deterioration across studies was 2.9%.
This study provides evidence supporting the acceptability and effectiveness of guided iCBT for the treatment of depression and anxiety in routine care. Given the high heterogeneity between interventions and contexts, health care providers should select interventions that have been proven in randomized controlled clinical trials. The successful application of iCBT may be an effective way of increasing health care in multiple contexts.
虽然有证据表明基于互联网的认知行为疗法（iCBT）有效，但结果在常规护理中的推广有限。
本研究系统综述了针对抑郁或焦虑症的指导性 iCBT 干预措施的有效性研究。
使用系统评价和荟萃分析方法，综合了在常规护理条件下进行的非随机前后设计的可接受性（参与率、参与者特征、依从性和满意度）、有效性和负面效果（恶化）。
共纳入了 19 项研究，包括 30 个组进行分析。尽管存在高度异质性，但研究的个体效应大小表明存在临床相关的变化，抑郁研究的效应大小范围为 Hedges' g=0.42-1.88，而焦虑研究的效应大小为 0.94。参与率、参与者特征、依从性和满意度表明干预措施具有中等至高的可接受性。研究平均恶化程度为 2.9%。
本研究为在常规护理中使用指导性 iCBT 治疗抑郁和焦虑的可接受性和有效性提供了证据。鉴于干预措施和环境之间存在高度异质性，医疗保健提供者应选择已在随机对照临床试验中得到验证的干预措施。iCBT 的成功应用可能是在多种环境中增加医疗保健的有效途径。
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