Factors associated with differential response to online cognitive behavioural therapy

Button, Katherine S.; Wiles, Nicola J.; Lewis, Glyn; Peters, Tim J.; Kessler, David

doi:10.1007/s00127-011-0389-1

Cited by 69Digital Mental Health InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

Factors associated with differential response to online cognitive behavioural therapy

Button, Katherine S., Wiles, Nicola J., Lewis, Glyn, Peters, Tim J., Kessler, David·2012·Social Psychiatry and Psychiatric Epidemiology

DOI 10.1007/s00127-011-0389-1

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Abstract

Purpose Patients differ in their response to treatments. There is obvious clinical utility in establishing patient characteristics that are associated with differential treatment responses (i.e., are effect modifiers or moderators of treatment response). Factors that moderate response to cognitive behavioural therapy (CBT) remain unclear. This study investigates whether factors prognostic of general depression outcome generally are also moderators of response to online CBT in a sample of depressed patients recruited through U.K. general practices.Methods Secondary analysis of a randomised controlled trial, internet-based psychotherapy for depression. A total of 297 patients referred from 55 U.K. general practices and suffering from depression were randomly allocated to receive either online CBT or waiting list control. Treatment effect was measured by comparing depression score at 4 months between randomization groups. Treatment effect modification was assessed using regression analyses focusing on interactions between treatment effect and putative moderator variables.Results Pretreatment severity and marital status moderated treatment response. More severe patients, and patients who were separated, widowed, or divorced, benefited most from the intervention. Weak evidence suggested that treatment effectiveness diminished with increasing recent adverse life events. No evidence was found to suggest that educational attainment, age, and history of depression-moderated treatment response.Conclusions Secondary analyses of trials comparing two or more treatments allow factors that may moderate treatment response to be distinguished from more general prognostic indicators, although caution is needed in interpreting such exploratory analyses.

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Three studies found that greater pre-treatment depression symptom severity was associated with greater response to online CBT.
“Three studies found that greater pre-treatment depression symptom severity was associated with greater response to online CBT (Button et al., 2012;de Graaf et al., 2010;Spek et al., 2008).”
From Predictors of adherence and outcome in internet-based cognitive behavior therapy delivered in a telephone counseling setting (2014) · cites this paper as Button et al., 2012
The finding that relationship status was unrelated to outcome is inconsistent with studies that have examined relationship status and outcome in online CBT.
“This finding is inconsistent with studies that have examined relationship status and outcome in online CBT (Button et al., 2012;Spek et al., 2008).”
From Predictors of adherence and outcome in internet-based cognitive behavior therapy delivered in a telephone counseling setting (2014) · cites this paper as Button et al., 2012

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Self-citation
Demographic and clinical predictors of response to internet-enabled cognitive-behavioural therapy for depression and anxiety.
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Predicting outcome of Internet-based treatment for depressive symptoms
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Authors: Button, K. S., Wiles, N. J., Lewis, G., Peters, T. J., & Kessler, D.
Affiliations: University of Bristol (GB)
Southmead Hospital (GB)
Corresponding author: Button, Katherine S.
ORCID: Button, Katherine S.
Wiles, Nicola J.
Lewis, Glyn
Kessler, David
Venue: Social Psychiatry and Psychiatric Epidemiology
Publisher: Springer Science and Business Media LLC
Published: 2011-05-04
Volume: 47
Issue: 5
Pages: 827-833
ISSN: 0933-7954 (ISSN-L)
1433-9285
DOI: 10.1007/s00127-011-0389-1
OpenAlex: W2029203702
Cited by: 69
References: 21
Citations by year: 2026: 1 · 2025: 6 · 2024: 5 · 2023: 1 · 2022: 7 · 2021: 6 · 2020: 4 · 2019: 3 · 2018: 11 · 2017: 4 · 2016: 6 · 2015: 2 · 2014: 6 · 2013: 6 · 2012: 1
FWCI: 5.69
Type: journal article
Language: en
Open access: closed
Licence: www.springer.com/tdm (tdm)
Locations: Social Psychiatry and Psychiatric Epidemiology (publishedVersion)
PubMed (publishedVersion)
UCL Discovery (University College London) (submittedVersion)
Explore Bristol Research (submittedVersion)
Funders: Bupa Foundation
Topics: Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords: internet-based cognitive behavioral therapy, internet-based psychotherapy, depression, treatment moderators, effect modification, marital status, life events, prognostic factors, general practice patients
MeSH terms: Adult, Depressive Disorder, United Kingdom, Humans, Life Change Events, Middle Aged, Online Systems, Patient Acceptance of Health Care, Psychiatric Status Rating Scales, Psychotherapy, Surveys and Questionnaires, Socioeconomic Factors, Time Factors, Waiting Lists, Cognitive Behavioral Therapy, Effect Modifier, Epidemiologic, Linear Models, Treatment Outcome, Marital Status, Internet

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Factors associated with differential response to online cognitive behavioural therapy

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