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
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“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
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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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“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
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“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
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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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“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
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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
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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.
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“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.
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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
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“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
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“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
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“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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“whereas the relaxation component might have negative effects”
- Also stated in: § Discussion · hedged
“By contrast, relaxation emerged as potentially harmful in our cNMA, with iMD of 1·20 (95% CrI 0·17 to 2·27).”
§ 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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- 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
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In the paper
“There was evidence that the non-specific treatment effects and behavioural activation components might have beneficial effects”
- Also stated in: § Discussion · boosted
“The non-specific treatment effects component had a robust additive effect of an iMD of −1·41 (95% CrI −2·52 to −0·30), corresponding to a standardised effect size of −0·24 (95% CrI −0·42 to −0·05).”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
boosteddirect- 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 · boosted
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“and might be able to promote therapy efficacy (combined iMD −0·55 [95% CrI −1·75 to 0·65]; figure 3).”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Discussion
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“Overall, there was no indication of systematic differences between individual participant data and aggregate data studies.”
§ 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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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
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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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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“For example, for a 45-year-old female patient, in a relationship, and with a baseline PHQ-9 score of 12, the relative effect of an efficient iCBT package consisting of psychoeducation, behavioural intervention, and problem solving using automated and human encouragement (ie, non-specific treatment effects plus psychoeducation plus behavioural activation plus problem solving plus automated Encourag”
§ 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.
- 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.
- 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.
- The authors state this as an assumption: Component-covariate interactions were assumed to be linear.
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 suggestive evidence that behavioural activation might be beneficial (iMD −1·83 [95% credible interval (CrI) −2·90 to −0·80])”
- Also stated in: § Results · boosted
“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 > Abstract > Findings
boostedconditional- 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.
- 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.
- Also stated in: § Results · boosted
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
“The obtained estimates for the components were imprecise but there was some suggestion that automated encouragement and human encouragement reduced dropout from treatment”
§ 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.
- 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.
- 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
“Baseline severity emerged as the strongest prognostic factor for endpoint depression.”
- Also stated in: § Results · plain
“Baseline severity was the strongest prognostic factor but the estimated effect modifications (ie, interactions with treatment components) were relatively small.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Abstract > Findings
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- The authors state this as an assumption: Component-covariate interactions were assumed to be linear.
- 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
“Baseline severity of depression emerged as the strongest prognostic factor”
§ 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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In the paper
“Combining human and automated encouragement reduced dropouts from treatment (incremental odds ratio, 0·32 [95% CrI 0·13 to 0·93]).”
- Also stated in: § Results · hedged
“there was some suggestion that automated encouragement and human encouragement reduced dropout from treatment (combined iOR 0·32 [95% CrI 0·13–0·93]; 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 > Abstract > Findings
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.
- 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.
- Also stated in: § Results · 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
“and that relaxation might be harmful (1·20 [95% CrI 0·17 to 2·27])”
- Also stated in: § Results · plain
“but the relaxation component was detrimental.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Abstract > Findings
plainconditional- 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.
- 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.
- 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
“Baseline severity was the strongest prognostic factor but the estimated effect modifications (ie, interactions with treatment components) were relatively small.”
§ 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.
- 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.
- The authors state this as an assumption: Component-covariate interactions were assumed to be linear.
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
“although the median completion rate of the programme lessons was 72%”
§ 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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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
“given the baseline severity, age, gender, and relationship status, our web app can estimate the relative effects of any combination treatment over another.”
§ 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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In the paper
“The results of the pre-specified and post-hoc sensitivity analyses for the primary outcome are shown in the appendix (pp 77–83); these results were concordant with the primary analyses.”
§ 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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In the paper
“The contour-enhanced funnel plot comparing all active treatments versus waiting list showed no evidence of publication bias (appendix p 66).”
§ 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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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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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 individual patient data cNMA revealed potentially helpful, less helpful, or harmful components and delivery formats for iCBT packages.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Abstract > Interpretation
hedgedconditional- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- 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.
- The authors state this as an assumption: Component-covariate interactions were assumed to be linear.
None of the sources cited for this claim have been checked yet.
In the paper
“It is now well established that guided iCBT can be as effective as face-to-face individual, group, or other delivery formats of CBT of similar length.10–12”
§ 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 [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 [11] Wagner, 2014, Internet-based versus face-to-face cognitive-behavioral intervention for depression: a randomized controlled non-inferiority trial, J Affect Disord source
- Not checked yetcites [12] Karyotaki, 2018, Do guided internet-based interventions result in clinically relevant changes for patients with depression? An individual participant data meta-analysis, Clin Psychol Rev source
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In the paper
“The inter-rater reliability of judgements for components was excellent, with a mean percentage agreement of 93·3% (range 84·0–98·6%) and a mean κ of 0·76 (range 0·38–0·96) for the 17 components (panel; appendix pp 42–51).”
§ 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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In the paper
“López-López and colleagues’8 cNMA of CBT for depression found no evidence of specific effects for any skills or delivery formats.”
§ 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 [8] López-López, 2019, The process and delivery of CBT for depression in adults: a systematic review and network meta-analysis, Psychol Med source
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“One fundamental limitation of all previous dismantling studies and cNMAs is that they dealt mainly with face-to-face CBT, in which it is difficult to be sure that the claimed components have actually been administered as intended and that no other elements were introduced, unless treatment fidelity was monitored.”
§ Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data > Introduction
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In the paper
“Similarly, our conclusions are applicable to the components and delivery modes as implemented in the included studies.”
§ 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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In the paper
“The included studies were generally of adequate quality except for the domains for which psychotherapy trials cannot escape possible biases due to unfeasibility of blinding.”
§ 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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In the paper
“We only assessed the transitivity assumption for a small number of possible effect modifiers, thus, our network might have been confounded by unobserved imbalances across comparisons, such as antidepressant use and treatment duration.”
§ 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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In the paper
“The same systematic review found no additive effect of cognitive restructuring; the SMD based on three dismantling studies was −0·06 (95% CI −0·68 to 0·55).”
§ 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 [6] Cuijpers, 2017, Component studies of psychological treatments of adult depression: a systematic review and meta-analysis, Psychother Res
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.
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 evidence supporting some of these recommendations, especially for cognitive restructuring, problem solving, or therapeutic guidance is still relatively imprecise”
§ 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: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a 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
“There might therefore be room for unguided iCBT itself to improve its efficacy by appropriately choosing the included components.”
§ 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.
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
“Lastly, by using individual participant data we were able to estimate relative efficacies of any combination of components based on patients’ baseline characteristics.”
§ 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.
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 present analyses, therefore, can only speak to the effects of the decision to include particular components as their principal ones in the iCBT programme at the start of the treatment, as per the intention-to-treat principle of interpreting RCTs.”
§ 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: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“which estimated a pooled standardised mean difference (SMD) of −0·46 (95% CI −0·91 to −0·01) for the additive effect of behavioural activation.”
§ 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 [6] Cuijpers, 2017, Component studies of psychological treatments of adult depression: a systematic review and meta-analysis, Psychother Res
hedgeddirect- 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.
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
“A sensitivity analysis excluding trials that used such miscellaneous components, however, corroborated the primary analysis results.”
§ 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.
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
“However, this intransitivity is unlikely to have affected the estimates for the components to a great extent, because the components included in the cognitive therapy and attention or psychological placebo comparison were also included in other comparisons.”
§ 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.
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
“Because human encouragement without reference to the therapeutic contents can be provided by trained lay people, these findings if replicated could increase scalability of iCBT.”
§ 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.
- Rests on an assumption: Human encouragement that does not refer to therapeutic contents can be provided by trained lay people.
None of the sources cited for this claim have been checked yet.
In the paper
“Important potential effect modifiers, such as childhood adversities37 or baseline cognitive or behavioural skills,38 were therefore not included in our model.”
§ 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 [37] Nemeroff, 2003, Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma, Proc Natl Acad Sci USA source
- Not checked yetcites [38] Cheavens, 2012, The compensation and capitalization models: a test of two approaches to individualizing the treatment of depression, Behav Res Ther source
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.
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
“Fifth, when the individual participant data were pooled, there were only four commonly reported patient characteristics that we could analyse as prognostic factors or effect modifiers.”
§ 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: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
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
“when we ran a sensitivity analysis limiting the included number of CBT skills per arm to four or fewer, the estimates were similar to those of the primary analysis.”
§ 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.
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
“no data were available as to exactly which components were completed and by whom.”
§ 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: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Probably not a substantial claim. 17
- It may state two separate claims as one. 21
The cited sources support only part of this claim — read each source’s verdict below.
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.
- 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.
- 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.
- 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.
- 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.
- 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: 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.
- 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 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
“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.
- 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 paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
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.
- 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
“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.
- 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
“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.
- 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.
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 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.
- 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
“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.
- 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.
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.
- 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.
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.
- 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.
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.
- 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 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.
- 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
“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.
- 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 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.
- 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.
- 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.
- 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
“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.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
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.
- 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.
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.
- 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.
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.
- 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
“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.
- 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
“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.
- 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.
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]
Citations
Cites
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910
RoB 2: a revised tool for assessing risk of bias in randomised trials
Sterne, J. A. C., Savović, J., Page, M. J., Elbers, R. G., Blencowe, N. S., Boutron, I., Cates, C. J., Cheng, H.-Y., Corbett, M. S., Eldridge, S. M., et al. (2019) · BMJ · doi:10.1136/bmj.l4898 · Cited by 34,787
Hutton, B., Salanti, G., Caldwell, D. M., Chaimani, A., Schmid, C. H., Cameron, C., Ioannidis, J. P. A., Straus, S., Thorlund, K., Jansen, J. P., et al. (2015) · Annals of Internal Medicine · doi:10.7326/m14-2385 · Cited by 8,269
Stewart, L. A., Clarke, M., Rovers, M., Riley, R. D., Simmonds, M., Stewart, G., & Tierney, J. F. (2015) · JAMA · doi:10.1001/jama.2015.3656 · Cited by 2,134
How important are the common factors in psychotherapy? An update
Wampold, B. E. (2015) · World Psychiatry · doi:10.1002/wps.20238 · Cited by 1,728
White, I. R., Barrett, J. K., Jackson, D., & Higgins, J. P. T. (2012) · Research Synthesis Methods · doi:10.1002/jrsm.1045 · Cited by 1,114
Karyotaki, E., Efthimiou, O., Miguel, C., Maas genannt Bermpohl, F., Furukawa, T. A., Cuijpers, P., Individual Patient Data Meta-Analyses for Depression (IPDMA-DE) Collaboration, Riper, H., Patel, V., Mira, A., et al. (2021) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2020.4364 · Cited by 866
Self-citationNemeroff, C. B., Heim, C. M., Thase, M. E., Klein, D. N., Rush, A. J., Schatzberg, A. F., Ninan, P. T., McCullough, J. P., Weiss, P. M., Dunner, D. L., et al. (2003) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2336126100 · Cited by 829
The Role of Common Factors in Psychotherapy Outcomes
Cuijpers, P., Reijnders, M., & Huibers, M. J. H. (2019) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-050718-095424 · Cited by 748
Self-citationEvaluation of inconsistency in networks of interventions
Veroniki, A. A., Vasiliadis, H. S., Higgins, J. P., & Salanti, G. (2013) · International Journal of Epidemiology · doi:10.1093/ije/dys222 · Cited by 576
Cited by
Sorted by citations
Time for united action on depression: a Lancet–World Psychiatric Association Commission
Herrman, H., Patel, V., Kieling, C., Berk, M., Buchweitz, C., Cuijpers, P., Furukawa, T. A., Kessler, R. C., Kohrt, B. A., Maj, M., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(21)02141-3 · Cited by 1,104
Self-citationMarx, W., Penninx, B. W. J. H., Solmi, M., Furukawa, T. A., Firth, J., Carvalho, A. F., & Berk, M. (2023) · Nature Reviews Disease Primers · doi:10.1038/s41572-023-00454-1 · Cited by 910
Self-citationDigital interventions for the treatment of depression: a meta-analytic review
Moshe, I., Terhorst, Y., Philippi, P., Domhardt, M., Cuijpers, P., Cristea, I., Pulkki-Råback, L., Baumeister, H., & Sander, L. B. (2021) · Psychological Bulletin · doi:10.1037/bul0000334 · Cited by 390
Self-citationStade, E. C., Stirman, S. W., Ungar, L. H., Boland, C. L., Schwartz, H. A., Yaden, D. B., Sedoc, J., DeRubeis, R. J., Willer, R., & Eichstaedt, J. C. (2024) · npj Mental Health Research · doi:10.1038/s44184-024-00056-z · Cited by 391
Components and Delivery Formats of Cognitive Behavioral Therapy for Chronic Insomnia in Adults
Furukawa, Y., Sakata, M., Yamamoto, R., Nakajima, S., Kikuchi, S., Inoue, M., Ito, M., Noma, H., Takashina, H. N., Funada, S., et al. (2024) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2023.5060 · Cited by 188
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
About these checks
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.
A language model drew the claims from the paper on 2026-10-06, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-06 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
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