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Investigating trajectories of change in psychological distress amongst patients with depression and generalised anxiety disorder treated with internet cognitive behavioural therapy

Open access
Sunderland, Matthew, Wong, Nora, Hilvert-Bruce, Zita, Andrews, Gavin·2012·Behaviour Research and Therapy
DOI 10.1016/j.brat.2012.03.005
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Abstract

Internet based cognitive behavioural therapy (CBT) is efficacious for the treatment of anxiety and depression. The current study aimed to examine the effectiveness of internet based CBT prescribed by primary care clinicians for the treatment of depression and generalised anxiety disorder. Psychological distress data from 302 patients who completed an online CBT course for depression and 361 patients who completed an online CBT course for generalised anxiety disorder were subjected to growth mixture analysis. For both disorders psychological distress decreased across each lesson in a quadratic trend. Two classes of individuals were identified with different trajectories of change: a large group of individuals who responded well to the courses and a smaller group of individuals with a lower response. Both groups were similar with respect to socio-demographic characteristics however the Low Responders tended to have higher levels of symptom severity and psychological distress at baseline in comparison to the responders. For the majority of patients (75-80%) the internet CBT courses for depression and generalised anxiety disorder were effective. Further research is required to identify and effectively treat the smaller proportion of patients who did not improve during internet CBT.

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Crossref · 10.1016/j.brat.2012.03.005

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30 of 30 references verified0 citation errors · 0 not checkable

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  • Only half of those who complete iCBT achieve full recovery, leaving 30% with residual symptoms that place them at high risk of relapse, and 20% who do not improve.

    “Despite these promising results, there remains room for improvement, as only half of those who complete iCBT achieve full recovery, leaving 30% with residual symptoms that place them at high risk of relapse, and 20% who do not improve (Sunderland et al., 2012; Newby et al., 2013).”

    From Online mindfulness-enhanced cognitive behavioural therapy for anxiety and depression: Outcomes of a pilot trial (2018) · cites this paper as Sunderland et al., 2012

    The Discussion (p. 19) reports that about 20–25% of patients who completed iCBT were low responders, supporting the claim’s approximate 20% figure. It does not report that half achieved full recovery or that 30% had residual symptoms placing them at high risk of relapse; its 75–80% responder group reflects improvement, not necessarily full recovery. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Three papers, regarding two trials, reported clinical efficacy data disaggregated by location.

    “Three papers, regarding two trials, reported clinical efficacy data disaggregated by location [40,41,44].”

    From Computerized cognitive behavior therapy for anxiety and depression in rural areas:a systematic review (2015) · cites this paper as [44]

    The Statistical Analysis (p. 10) includes rurality in comparisons between responder classes, and Predictors of change (pp. 13–14) reports those comparisons for the depression and GAD courses. But the paper does not present clinical efficacy outcomes separately by location; its Introduction (p. 5) describes this as a quality-assurance study of two programs, not a trial. This source alone cannot establish the sentence’s count of three papers and two trials. (LLM, conf=0.83)

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  • Eight papers regarding six different trials measured rural location as a predictor of outcomes, adherence, or acceptability.

    “Eight papers regarding six different trials measured rural location as a predictor of outcomes, adherence, or acceptability [38-45].”

    From Computerized cognitive behavior therapy for anxiety and depression in rural areas:a systematic review (2015) · cites this paper as [44]

  • Older, compared with younger, individuals are more likely to adhere to iCBT programs when completed under the care of their primary care physician.

    “Consistent with the current results, previous research has also indicated that older, compared with younger, individuals are more likely to adhere to these programs when completed under the care of their primary care physician [7], [10].”

    From A Naturalistic Study of the Acceptability and Effectiveness of Internet-Delivered Cognitive Behavioural Therapy for Psychiatric Disorders in Older Australians (2013) · cites this paper as [10]

    The Introduction (p. 5) says the study examined trajectories among patients who completed the programs, and Intervention/Procedure (p. 6) describes clinician-prescribed iCBT. The passages found for age concern differences between treatment-response groups, not whether older patients were more likely than younger patients to adhere or complete treatment. Searches for age, adherence, completion, and dropout did not establish the attributed comparison. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • Of the quasi-experimental studies, the risk in one study was unclear due to insufficient information on several variables and moderate in another, due to low numbers of participants completing the outcome measurements.

    “Of the quasi-experimental studies, the risk in one study was unclear due to insufficient information on several variables [44] and moderate in another [45], due to low numbers of participants completing the outcome measurements.”

    From Computerized cognitive behavior therapy for anxiety and depression in rural areas:a systematic review (2015) · cites this paper as [44]

    The Introduction (p. 5) says the study examined patients who completed the internet CBT courses, and the Discussion (p. 18) identifies limitations including the absence of a control sample. Neither passage establishes that few participants completed outcome measurements or assigns a moderate risk rating. Searches for completion numbers and risk-of-bias language did not find support for the part of the sentence associated with this source. (LLM, conf=0.70)

    Experimental — accuracy not yet measured

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Cites

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1 of the 31 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Muthén. L. K., & Muthén, B. O. (2010) Mplus User's Guide. Sixth Edition. Los Angeles, CA: Muthén & Muthén.
  2. Ustun, T. B., Kostanjsek, N., Chatterji, S., & Rehm, J. (2010) Measuring Health and Disability: Manual for the WHO Disability Assessment Schedule. Geneva, Switzerland: WHO Press.

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Authors
Sunderland, M., Wong, N., Hilvert-Bruce, Z., & Andrews, G.
Affiliations
  • UNSW Sydney (AU)
  • St Vincent's Hospital Sydney (AU)
Corresponding author
Sunderland, Matthew
ORCID
Venue
Behaviour Research and Therapy
Publisher
Elsevier BV
Published
2012-06
Volume
50
Issue
6
Pages
374-380
ISSN
0005-7967 (ISSN-L)
DOI
10.1016/j.brat.2012.03.005
OpenAlex
W1974383935
Cited by
84
References
31
Citations by year
2026: 2 · 2025: 2 · 2024: 3 · 2023: 9 · 2022: 6 · 2021: 12 · 2020: 5 · 2019: 9 · 2018: 6 · 2017: 2 · 2016: 6 · 2015: 7 · 2014: 6 · 2013: 7 · 2012: 2
FWCI
9.86
Type
journal article
Language
en
Open access
Licence
Locations
  • Behaviour Research and Therapy (publishedVersion)
  • PubMed (publishedVersion)
  • UNSWorks (UNSW Sydney) (submittedVersion, cc-by-nc-nd)
  • UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
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 › Social Psychology › Mental Health Treatment and Access
Keywords
internet-based cognitive behavioral therapy, depression, generalized anxiety disorder, psychological distress, treatment response trajectories, low responders, primary care, symptom severity
MeSH terms
Adult, Anxiety Disorders, Depressive Disorder, Female, Humans, Male, Stress, Psychological, Time Factors, Cognitive Behavioral Therapy, Treatment Outcome, Remote Consultation, Internet

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