Harvard Medical School, Department of Health Care Policy, Boston, MA, USA; National University of Singapore, Department of Psychology, Kent Ridge Campus, Singapore.
National University of Singapore, Department of Psychology, Kent Ridge Campus, Singapore.
Clin Psychol Rev. 2024 Dec;114:102518. doi: 10.1016/j.cpr.2024.102518. Epub 2024 Nov 16.
Although the short-term efficacy of internet-delivered cognitive-behavioral therapy (i-CBT) is well-established, its long-term efficacy remains understudied. Robust variance estimation meta-analysis was thus conducted across guided and self-guided i-CBT, synthesizing data from 154 randomized controlled trials (N = 45,335) with ≥ 12-month follow-ups. For binary outcomes, guided (52.3% vs. 38.6%; log-risk ratio [LOG-RR] = 1.15 95% confidence interval [1.04, 1.26]) yielded higher remission, reliable improvement, and response rates, and lower suboptimal treatment outcome rates (9.3% vs. 10.8%; LOG-RR = 0.63 [0.45, 0.80]) than treatment-as-usual, active controls, and waitlists at ≥12 months. Insufficient studies precluded testing the efficacy between self-guided i-CBT and controls for binary outcomes. For baseline-to-12-month dimensional outcomes, guided i-CBT produced greater reductions in anxiety, depressive, post-traumatic stress disorder (PTSD) symptoms, and repetitive negative thinking (Hedge's g = -1.86 to -0.31), and self-guided i-CBT yielded stronger reductions in depressive symptoms (g = -0.51) than all controls. For outcome scores aggregated at ≥ 12-month follow-ups, guided i-CBT alleviated anxiety, depression, distress, insomnia, PTSD symptoms, role impairment, emotion regulation, and quality of life (g = -0.31 to 0.26), and self-guided i-CBT yielded lower anxiety and depressive symptoms (g = -0.16 to -0.09) than all controls. No significant differences in efficacy emerged between guided and self-guided i-CBT when sufficient studies existed for a meta-analysis. There was no evidence for publication bias. Long-term efficacy was similar to short-term efficacy for most outcomes. Implementing scalable i-CBTs should entail transparency about their long-term benefits and drawbacks.
虽然互联网提供的认知行为疗法（i-CBT）的短期疗效已经得到充分证实，但它的长期疗效仍有待研究。因此，对指导和自我指导的 i-CBT 进行了稳健的方差估计荟萃分析，综合了 154 项具有至少 12 个月随访的随机对照试验（N=45335）的数据。对于二分类结局，指导治疗（52.3% vs. 38.6%；对数风险比 [LOG-RR] = 1.15，95%置信区间 [1.04, 1.26]）在 12 个月后产生了更高的缓解率、可靠的改善率和反应率，以及更低的治疗效果不佳率（9.3% vs. 10.8%；LOG-RR = 0.63 [0.45, 0.80]），而不是治疗常规、积极对照和等待名单。由于研究不足，无法测试自我指导的 i-CBT 与对照组在二分类结局方面的疗效。对于从基线到 12 个月的维度结局，指导 i-CBT 能更显著地降低焦虑、抑郁、创伤后应激障碍（PTSD）症状和重复性消极思维（Hedge's g = -1.86 至 -0.31），而自我指导的 i-CBT 则能更显著地降低抑郁症状（g = -0.51），与所有对照组相比。对于在至少 12 个月随访后汇总的结局评分，指导 i-CBT 能减轻焦虑、抑郁、困扰、失眠、PTSD 症状、角色障碍、情绪调节和生活质量（g = -0.31 至 0.26），而自我指导的 i-CBT 能降低焦虑和抑郁症状（g = -0.16 至 -0.09），与所有对照组相比。当存在足够的荟萃分析研究时，指导和自我指导的 i-CBT 之间没有显示出疗效的显著差异。没有证据表明存在发表偏倚。对于大多数结局，长期疗效与短期疗效相似。实施可扩展的 i-CBT 应该透明地说明其长期的利弊。
