The DOI matches its Crossref record; 43 of the 49 references it cites were found in a registry or an index; 1 of the 22 sources its claims cite were checked for support.
Dismantling, optimising and personalising internet cognitive-behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data
Open accessAbstract
Background Internet cognitive behavioural therapy (iCBT) is a viable delivery format of CBT for depression. However, iCBT programmes include training in a wide array of cognitive and behavioural skills via different delivery methods, and it remains unclear which of these components are more efficacious and for whom.Methods We did a systematic review and individual participant data component network meta-analysis (cNMA) of iCBT trials for depression. We searched PubMed, PsycINFO, Embase, and the Cochrane Library for randomised controlled trials (RCTs) published from database inception to Jan 1, 2019, that compared any form of iCBT against another or a control condition in the acute treatment of adults (aged ≥18 years) with depression. Studies with inpatients or patients with bipolar depression were excluded. We sought individual participant data from the original authors. When these data were unavailable, we used aggregate data. Two independent researchers identified the included components. The primary outcome was depression severity, expressed as incremental mean difference (iMD) in the Patient Health Questionnaire-9 (PHQ-9) scores when a component is added to a treatment. We developed a web app that estimates relative efficacies between any two combinations of components, given baseline patient characteristics. This study is registered in PROSPERO, CRD42018104683.Findings We identified 76 RCTs, including 48 trials contributing individual participant data (11 704 participants) and 28 trials with aggregate data (6474 participants). The participants' weighted mean age was 42·0 years and 12 406 (71%) of 17 521 reported were women. There was suggestive evidence that behavioural activation might be beneficial (iMD -1·83 [95% credible interval (CrI) -2·90 to -0·80]) and that relaxation might be harmful (1·20 [95% CrI 0·17 to 2·27]). Baseline severity emerged as the strongest prognostic factor for endpoint depression. Combining human and automated encouragement reduced dropouts from treatment (incremental odds ratio, 0·32 [95% CrI 0·13 to 0·93]). The risk of bias was low for the randomisation process, missing outcome data, or selection of reported results in most of the included studies, uncertain for deviation from intended interventions, and high for measurement of outcomes. There was moderate to high heterogeneity among the studies and their components.Interpretation The individual patient data cNMA revealed potentially helpful, less helpful, or harmful components and delivery formats for iCBT packages. iCBT packages aiming to be effective and efficient might choose to include beneficial components and exclude ones that are potentially detrimental. Our web app can facilitate shared decision making by therapist and patient in choosing their preferred iCBT package.Funding Japan Society for the Promotion of Science.
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26 Own result · 21 Own method · 14 Own interpretation · 13 Not checked yet · 4 No basis given · 1 Partly supported · accuracy not yet measured
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was evidence that the non-specific treatment effects and behavioural activation components might have beneficial effects”
- Also stated in: § Discussion · plain
“the iMD of −1·83 (95% CrI −2·90 to −0·80) for behavioural activation in our cNMA corresponds to a standardised effect size of −0·31 (95% CrI −0·48 to −0·13)”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
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- The authors state this as an assumption: Component effects are additive: for any component c, the relative effect of c plus X versus X alone is the same for any combination X not containing c, and there are no interactions between components.
- Also stated in: § Discussion · plain
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In the paper
“We found that human encouragement in conjunction with automated encouragement decreases dropout from treatment (combined iOR 0·32 [95% CrI 0·13 to 0·93]; appendix p 73)”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“There was weaker evidence that behaviour therapy for insomnia was also helpful, showing large point estimates but with wider confidence intervals.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Results
hedgeddirect- Asserted: passes — The authors put it forward as true.
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- The authors state this as an assumption: Common heterogeneity was assumed across all treatment comparisons.
- The authors state this as an assumption: Component effects were assumed to be additive.
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In the paper
“The design-by-treatment test for global inconsistency showed strong evidence of global inconsistency (Q=37·8, 17 df, p=0·0026);”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Results
boosted- Asserted: passes — The authors put it forward as true.
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“which estimated the iMD for cognitive restructuring to be 0·30 (95% CrI −0·87 to 1·41), corresponding to a standardised effect size of 0·05 (95% CrI −0·15 to 0·24).”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
hedged- Asserted: passes — The authors put it forward as true.
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- The authors state this as an assumption: Component effects are additive: for any component c, the relative effect of c plus X versus X alone is the same for any combination X not containing c, and there are no interactions between components.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was stronger evidence that the behavioural activation and non-specific treatment effects components had beneficial effects”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Results
boosteddirect- Asserted: passes — The authors put it forward as true.
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- The authors state this as an assumption: Common heterogeneity was assumed across all treatment comparisons.
- The authors state this as an assumption: Component effects were assumed to be additive.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For dropouts from treatment, we did a cNMA of studies comparing active treatments from five trials providing aggregate data and ten providing individual participant data.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Results
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“All iCBT treatment packages were found to be superior to the waiting list control.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“There was moderate to high heterogeneity among the studies and their components.”
- Also stated in: § Results · plain
“Common heterogeneity τ was considered moderate to high.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Abstract > Findings
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Having automated encouragement via emails or text messaging and human encouragement by telephone or email without reference to the therapeutic contents might enhance adherence to the treatment.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
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- Probably not a substantial claim. 17
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In the paper
“López-López and colleagues’ decomposition of the CBT contents also raised some concerns because some arms had only homework as their content while many arms did not have psychoeducation”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
What the sources say
- Partly supportedcites [8] López-López, 2019, The process and delivery of CBT for depression in adults: a systematic review and network meta-analysis, Psychol Med sourceExperimental — accuracy not yet measured
The Results (Definition of interventions; page not provided) identify psychoeducation in 40 of 122 CBT arms, supporting that many arms did not report it. They also identify homework in 35 arms but do not say that any arm had homework as its only content; indeed, they say most interventions included multiple components. The Discussion (Limitations; page not provided) cautions that components may have been present but unreported. (LLM, conf=0.85)
hedged- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Partly supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We identified 76 RCTs, including 48 trials contributing individual participant data (11 704 participants) and 28 trials with aggregate data (6474 participants).”
- Also stated in: § Results · plain
“We finally included 76 trials and sought individual participant data from the original authors. Authors of 48 (63%) studies agreed to provide individual participant data representing 11 704 randomly assigned participants; the remaining 28 studies were included as aggregate data, representing 6474 randomly assigned participants (appendix p 17).”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Abstract > Findings
plainn = 76- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“weaker evidence that the behaviour therapy for insomnia component might be helpful”
- Also stated in: § Discussion · hedged
“There was suggestive evidence that behaviour therapy for insomnia could be beneficial. However, this therapy was included as a component in only four studies and the estimates for its efficacy were imprecise.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
- The authors state this as an assumption: Component effects are additive: for any component c, the relative effect of c plus X versus X alone is the same for any combination X not containing c, and there are no interactions between components.
- Also stated in: § Discussion · hedged
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Cognitive therapy, behavioural activation, third-wave cognitive behavioural therapy, CBT, psychoeducation, and problem-solving therapy were all shown to be more efficacious than waiting list.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Results
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
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In the paper
“These programmes often included relaxation as a component: 14 (48%) of 29 programmes used relaxation when neither human encouragement nor therapeutic guidance was used, 13 (45%) of 29 programmes used relaxation when only human encouragement was used, but only nine (20%) of 44 programmes used relaxation when human encouragement plus therapeutic guidance were used”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
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In the paper
“In our network, relaxation exercises were included in 36 arms but the reports generally did not specify what patients actually did in each programme.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These negative findings might be due to the fact that the authors included mostly face-to-face CBT interventions, which generally allowed broad discretion to therapists who might have reduced, modified, or even left out some contents and introduced new contents outside the therapy manual, unless the trials were rigorously monitored for fidelity.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“One comparison (cognitive therapy vs attention or psychological placebo) had much higher baseline severity than all other comparisons but otherwise these effect modifiers appeared to be evenly distributed across comparisons (appendix pp 64–65).”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Results
hedged- Asserted: passes — The authors put it forward as true.
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In the paper
“The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Methods > Role of the funding source
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
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In the paper
“This study is registered in PROSPERO (CRD42018104683)”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Methods > Statistical analyses
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“However, such studies have been typically underpowered and of poor methodological quality.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Introduction
What the sources say
- Not checked yetcites [4] Ahn, 2001, Where oh where are the specific ingredients? A meta-analysis of component studies in counseling and psychotherapy, J Couns Psychol source
- Not checked yetcites [5] Bell, 2013, Are the parts as good as the whole? A meta-analysis of component treatment studies, J Consult Clin Psychol source
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“Pairs of two independent reviewers (TAF, AS, EGO) independently assessed the validity of the included studies using the revised risk of bias tool by Cochrane.17”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Methods > Search strategy, selection criteria, and data extraction
What the sources say
- Not checked yetcites [17] Sterne, 2019, RoB 2: a revised tool for assessing risk of bias in randomised trials, BMJ
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
In the paper
“This protocol for this study has already been published.18”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Methods > Search strategy, selection criteria, and data extraction
What the sources say
- Not checked yetcites [18] Furukawa, 2019, Dismantling, personalising and optimising internet cognitive-behavioural therapy for depression: a study protocol for individual participant data component network meta-analysis, BMJ Open
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The inter-rater reliability of risk of bias assessment was satisfactory, with a mean percentage agreement of 93·9% (range 87·5–97·8%) and a mean weighted κ of 0·52 (range 0·17–0·84) for the five domains (appendix pp 58–59).”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Results
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Cognitive behavioural therapy (CBT) is the most widely studied type of psychotherapy for depression.1,2”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Introduction
What the sources say
- Not checked yetcites [1] Barth, 2013, Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis, PLoS Med source
- Not checked yetcites [2] Cuijpers, 2019, The effects of fifteen evidence-supported therapies for adult depression: a meta-analytic review, Psychother Res
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The risk of bias was low for the randomisation process, missing outcome data, or selection of reported results in most of the included studies, uncertain for deviation from intended interventions, and high for measurement of outcomes.”
- Also stated in: § Results · plain
“The risk of bias according to the Cochrane’s revised risk of bias tool17 was low in 66 studies (86%) for randomisation process, in six studies (8%) for the deviation from intended interventions, in 64 studies (83%) for missing outcome data, in two studies (3%) for measurement of the outcome, and 53 studies (69%) for selection of the reported results.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Abstract > Findings
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
- Also stated in: § Results · plain
None of the sources cited for this claim have been checked yet.
In the paper
“This report follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension statements for network meta-analysis19 and for individual participant data meta-analysis.20”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Methods > Search strategy, selection criteria, and data extraction
What the sources say
- Not checked yetcites [19] Hutton, 2015, The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations, Ann Intern Med source
- Not checked yetcites [20] Stewart, 2015, Preferred reporting items for systematic review and meta-analyses of individual participant data: the PRISMA-IPD statement, JAMA source
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“behavioural activation emerged as beneficial but cognitive restructuring did not in the current analyses, not because of these skills’ intrinsic efficacy but simply because of their ease of learning within iCBT.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We must be careful when extrapolating the combinations beyond those examined in the current dataset: as more and more components are combined to build packages not explored in the trials included in this study, the uncertainty around the estimates increases, and possible deviations from our assumptions (eg, additivity of component effects) might have a bigger impact on the validity of our results”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
hedgeddirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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It may state two separate claims as one.
- The authors state this as an assumption: Component effects are additive: for any component c, the relative effect of c plus X versus X alone is the same for any combination X not containing c, and there are no interactions between components.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Fourth, there was indication of intransitivity for a comparison between cognitive therapy and attention or psychological placebo and of global inconsistency in the network.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
hedged- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
In the paper
“the cNMA of CBT for panic disorder has identified muscle relaxation as detrimental.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
What the sources say
- Not checked yetcites [7] Pompoli, 2018, Dismantling cognitive-behaviour therapy for panic disorder: a systematic review and component network meta-analysis, Psychol Med source
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Although a post-hoc sensitivity analysis examining potential interactions among components provided similar results to the additive model, the study was possibly underpowered to detect interactions among components.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
hedged- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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It may state two separate claims as one.
- The authors state this as an assumption: Component effects are additive: for any component c, the relative effect of c plus X versus X alone is the same for any combination X not containing c, and there are no interactions between components.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the additive effect of guidance could then be due to human encouragement or due to the combination of human encouragement plus therapeutic guidance when the baseline severity was high at 25 points; the incremental effect decreased when the baseline severity was lower.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“with detailed definitions as described in the table and inquiries of the authors when necessary (see appendix pp 18–41 for results of our communications), we were able to achieve satisfactory to excellent inter-rater agreement.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The cNMA increased precision by including more studies than narrowly defined dismantling studies and by combining direct and indirect estimates.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“guided iCBT has been shown to be superior to unguided iCBT,10 especially among patients with higher baseline severity of depression.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
What the sources say
- Not checked yetcites [10] Cuijpers, 2019, Effectiveness and acceptability of cognitive behavior therapy delivery formats in adults with depression: a network meta-analysis, JAMA Psychiatry source
- Not checked yetcites [35] Karyotaki, 2021, Internet-based cognitive behavioral therapy for depression: a systematic review and individual patient data network meta-analysis, JAMA Psychiatry source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Any conclusions about specific efficacy of CBT skills therefore pertain to iCBT and will inform which components to include in the efficacious and efficient iCBT package, but such findings might not readily generalise to face-to-face CBT.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Such packages have the potential to be more efficacious, less burdensome for users, and less demanding on provider resources, with the net effect of rendering iCBT even more scalable.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- The authors state this as an assumption: Component effects are additive: for any component c, the relative effect of c plus X versus X alone is the same for any combination X not containing c, and there are no interactions between components.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Relaxation tended to be included in CBT arms that included a greater number of skills, which might have allowed less time to learn and practise those particular skills and have reduced their efficacy.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“the non-specific treatment effects component includes both the placebo effect and the common or non-specific psychotherapy factor”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
What the sources say
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In the current network, there was no evidence of data availability bias for individual participant data or of publication bias of active treatments over the waiting list, the most frequent control condition.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The authors state this as an assumption.
Skills not covered by the classification were assumed to have only non-specific treatment effects.
“When skills not covered in this classification (eg, expressive writing, dreamwork) were included, we assumed such interventions to have some non-specific treatment effects only.”
The authors state this as an assumption.
Common heterogeneity was assumed across all treatment comparisons.
“assuming common heterogeneity for all treatment comparisons.25”
The authors state this as an assumption.
Component effects were assumed to be additive.
“The models disentangled the effects of components assuming additivity,9”
The authors state this as an assumption.
Component-covariate interactions were assumed to be linear.
“The component-covariate interactions were modelled assuming linearity.”
The paper relies on this without support.
iCBT delivers each cognitive and behavioural skill uniformly and as intended by programme developers.
“iCBT provides a unique platform whereby each cognitive and behavioural skill is offered uniformly and as intended by the programme developers.”
The authors state this as an assumption.
Component effects are additive: for any component c, the relative effect of c plus X versus X alone is the same for any combination X not containing c, and there are no interactions between components.
“we assumed additivity of the component effects—ie, that for any given component (c), the relative effect of c plus X versus X only is the same for any X, where X represents any combination of”
“Thus, our results assumed no interactions between components.”
The authors state this as an assumption.
Most participants completed a majority of the included components.
“we can assume that most participants had actually completed a majority of the included components”
The paper relies on this without support.
Human encouragement that does not refer to therapeutic contents can be provided by trained lay people.
“Because human encouragement without reference to the therapeutic contents can be provided by trained lay people”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“For example, in the Strategic Use of New generation antidepressants study, switching or augmenting mediations as early as 3 weeks was associated with an NNT of 10 in achieving remission by 9 weeks in comparison with standard length acute phase treatment. 598”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [598]
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“depression demonstrated that BA was the most beneficial, followed by behavioral therapy for insomnia and problemsolving.(29) A meta-analysis focused on CBT for FCR found that contemporary approaches focused on the process of cognition showed greater efficacy than traditional CBT that focused on the contents of cogniti…”
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Self-citation
Metadata
- Authors
- Furukawa, T. A., Suganuma, A., Ostinelli, E. G., Andersson, G., Beevers, C. G., Shumake, J., Berger, T., Boele, F. W., Buntrock, C., Carlbring, P., Choi, I., Christensen, H., Mackinnon, A., Dahne, J., Huibers, M. J. H., Ebert, D. D., Farrer, L., Forand, N. R., Strunk, D. R., Ezawa, I. D., Forsell, E., Kaldo, V., Geraedts, A., Gilbody, S., Littlewood, E., Brabyn, S., Hadjistavropoulos, H. D., Schneider, L. H., Johansson, R., Kenter, R., Kivi, M., Björkelund, C., Kleiboer, A., Riper, H., Klein, J. P., Schröder, J., Meyer, B., Moritz, S., Bücker, L., Lintvedt, O., Johansson, P., Lundgren, J., Milgrom, J., Gemmill, A. W., Mohr, D. C., Montero-Marin, J., Garcia-Campayo, J., Nobis, S., Zarski, A.-C., O'Moore, K., Williams, A. D., Newby, J. M., Perini, S., Phillips, R., Schneider, J., Pots, W., Pugh, N. E., Richards, D., Rosso, I. M., Rauch, S. L., Sheeber, L. B., Smith, J., Spek, V., Pop, V. J., Ünlü, B., van Bastelaar, K. M. P., van Luenen, S., Garnefski, N., Kraaij, V., Vernmark, K., Warmerdam, L., van Straten, A., Zagorscak, P., Knaevelsrud, C., Heinrich, M., Miguel, C., Cipriani, A., Efthimiou, O., Karyotaki, E., & Cuijpers, P.
- Affiliations
- Kyoto University (JP)
- Warneford Hospital (GB)
- Linköping University (SE)
- The University of Texas at Austin (US)
- University of Bern (CH)
- University of Leeds (GB)
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- Stockholm University (SE)
- The University of Sydney (AU)
- Black Dog Institute (AU)
- Medical University of South Carolina (US)
- Vrije Universiteit Amsterdam (NL)
- Technical University of Munich (DE)
- Australian National University (AU)
- Donald & Barbara Zucker School of Medicine at Hofstra/Northwell (US)
- The Ohio State University (US)
- Region Stockholm (SE)
- Linnaeus University (SE)
- University of York (GB)
- University of Regina (CA)
- St. Joseph’s Healthcare Hamilton (CA)
- University of Bergen (NO)
- University of Gothenburg (SE)
- University of Lübeck (DE)
- University Medical Center Hamburg-Eppendorf (DE)
- GAIA (Germany) (DE)
- The University of Melbourne (AU)
- Northwestern University (US)
- Klinikum Osnabrück (DE)
- UNSW Sydney (AU)
- St Vincent's Hospital Sydney (AU)
- Imperial College London (GB)
- University of Nottingham (GB)
- University of Twente (NL)
- Trinity College Dublin (IE)
- McLean Hospital (US)
- Oregon Research Institute (US)
- Fontys University of Applied Sciences (NL)
- Tilburg University (NL)
- PsyQ (NL)
- Leiden University (NL)
- Zorginstituut Nederland (NL)
- Freie Universität Berlin (DE)
- Oxford Health NHS Foundation Trust (GB)
- Harvard University (US)
- Corresponding author
- Furukawa, Toshi A
- ORCID
- Furukawa, Toshi A
- Suganuma, Aya
- Ostinelli, Edoardo G
- Andersson, Gerhard
- Beevers, Christopher G
- Shumake, Jason
- Berger, Thomas
- Boele, Florien Willemijn
- Buntrock, Claudia
- Carlbring, Per
- Choi, Isabella
- Christensen, Helen
- Mackinnon, Andrew
- Dahne, Jennifer
- Huibers, Marcus J H
- Ebert, David D
- Farrer, Louise
- Forand, Nicholas R
- Strunk, Daniel R
- Ezawa, Iony D
- Forsell, Erik
- Kaldo, Viktor
- Gilbody, Simon
- Littlewood, Elizabeth
- Brabyn, Sally
- Hadjistavropoulos, Heather D
- Schneider, Luke H
- Johansson, Robert
- Kenter, Robin
- Kivi, Marie
- Björkelund, Cecilia
- Kleiboer, Annet
- Riper, Heleen
- Klein, Jan Philipp
- Schröder, Johanna
- Meyer, Björn
- Moritz, Steffen
- Lintvedt, Ove
- Johansson, Peter
- Lundgren, Johan
- Milgrom, Jeannette
- Gemmill, Alan W
- Mohr, David C
- Nobis, Stephanie
- Zarski, Anna-Carlotta
- Newby, Jill M
- Phillips, Rachel
- Schneider, Justine
- Pots, Wendy
- Richards, Derek
- Rosso, Isabelle M
- Rauch, Scott L
- Sheeber, Lisa B
- Smith, Jessica
- Spek, Viola
- Garnefski, Nadia
- Kraaij, Vivian
- Vernmark, Kristofer
- Warmerdam, Lisanne
- Zagorscak, Pavle
- Knaevelsrud, Christine
- Heinrich, Manuel
- Miguel, Clara
- Cipriani, Andrea
- Efthimiou, Orestis
- Karyotaki, Eirini
- Cuijpers, Pim
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2021-06
- Volume
- 8
- Issue
- 6
- Pages
- 500-511
- ISSN
- 2215-0366 (ISSN-L)
- PMC
- PMC8838916
- OpenAlex
- W3159498050
- Cited by
- 255
- References
- 49
- Citations by year
- 2026: 34 · 2025: 39 · 2024: 71 · 2023: 49 · 2022: 49 · 2021: 12
- FWCI
- 7.06
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- The Lancet Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, cc-by)
- VU Research Portal (publishedVersion, other-oa)
- PubMed Central (acceptedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- ANU Open Research (Australian National University) (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- BORIS (University Library Bern) (submittedVersion, cc-by-nc-nd)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- Minerva Access (University of Melbourne) (submittedVersion)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion, other-oa)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion)
- VU Research Portal (submittedVersion)
- Spiral (Imperial College London) (submittedVersion, cc-by-nc-nd)
- Trinity's Access to Research Output (TARA) (Trinity College Dublin) (submittedVersion, cc-by-nc-sa)
- Open Access CRIS of the University of Bern
- Funders
- Japan Society for the Promotion of Science
- 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 › Psychological Treatments and Assessments
- Keywords
- depression, treatment components, behavioral activation, relaxation, treatment discontinuation, baseline depression severity, prognostic factors, personalized treatment, individual patient data, treatment optimization, digital mental health interventions
- MeSH terms
- Network Meta-Analysis, Depressive Disorder, Humans, Systems Analysis, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Outcome Assessment, Health Care, Internet
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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