Is computerised CBT really helpful for adult depression?-A meta-analytic re-evaluation of CCBT for adult depression in terms of clinical implementation and methodological validity
Open accessAbstract
BACKGROUND: Depression is a major cause of disability worldwide, and computerised cognitive behavioural therapy (CCBT) is expected to be a more augmentative and efficient treatment. According to previous meta-analyses of CCBT, there is a need for a meta-analytic revaluation of the short-term effectiveness of this therapy and for an evaluation of its long-term effects, functional improvement and dropout. METHODS: Five databases were used (MEDLINE, PsycINFO, EMBASE, CENTRAL and CiNii). We included all RCTs with proper concealment and blinding of outcome assessment for the clinical effectiveness of CCBT in adults (aged 18 and over) with depression. Using Cohen's method, the standard mean difference (SMD) for the overall pooled effects across the included studies was estimated with a random effect model. The main outcome measure and the relative risk of dropout were included in the meta-analysis. RESULTS: Fourteen trials met the inclusion criteria, and sixteen comparisons from these were used for the largest meta-analysis ever. All research used appropriate random sequence generation and Intention-to-Treat analyses (ITT), and employed self-reported measures as the primary outcome. For the sixteen comparisons (2807 participants) comparing CCBT and control conditions, the pooled SMD was -0.48 [95% IC -0.63 to -0.33], suggesting similar effect to the past reviews. Also, there was no significant clinical effect at long follow-up and no improvement of function found. Furthermore, a significantly higher drop-out rate was found for CCBT than for controls. When including studies without BDI as a rating scale and with only modern imputation as sensitivity analysis, the pooled SMD remained significant despite the reduction from a moderate to a small effect. Significant publication bias was found in a funnel plot and on two tests (Begg's p = 0.09; Egger's p = 0.01). Using a trim and fill analysis, the SMD was -0.32 [95% CI -0.49 to -0.16]. CONCLUSION: Despite a short-term reduction in depression at post-treatment, the effect at long follow-up and the function improvement were not significant, with significantly high drop-out. Considering the risk of bias, our meta-analysis implied that the clinical usefulness of current CCBT for adult depression may need to be re-considered downwards in terms of practical implementation and methodological validity.
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The effects of iCBT were observed to be transient and participants' drop-out rate was high.
“the effects were observed to be transient and the participants’ drop-out rate was high [5].”
A number of studies in the broader CCBT literature have found evidence of a publication bias; studies reporting negative findings are less likely to be published.
“A number of studies in the broader CCBT literature have found evidence of a publication bias. Studies reporting negative findings are less likely to be published [26,49,50].”
From Computerized cognitive behavior therapy for anxiety and depression in rural areas:a systematic review (2015) · cites this paper as [50]
Effect sizes have been estimated at d=0.44-1.90 for clinician-supported, and d=0.21-0.70 for self-guided, interventions.
“Effect sizes have been estimated at d=0.44-1.90 for clinician-supported, and d=0.21-0.70 for self-guided, interventions [42-45,47,48].”
From MoodHacker Mobile Web App With Email for Adults to Self-Manage Mild-to-Moderate Depression: Randomized Controlled Trial (2016) · cites this paper as [45]
There is ample evidence for short and long term benefits for eHealth delivered CBT for treating anxiety and depressive conditions in both general population and clinical settings, with greater improvement for guided interventions.
“Thus there is currently ample evidence for the short and long term benefits for eHealth delivered Cognitive Behavioural Therapy (CBT) for treating anxiety and depressive conditions in both general population and clinical settings [21–23], with greater improvement shown for those interventions that include guidance throughout the intervention period [21,24].”
From Effectiveness of eHealth interventions for reducing mental health conditions in employees: A systematic review and meta-analysis (2017) · cites this paper as [22]
Internet-delivered CBT-based programs for depression symptom management have been shown to be effective both for adults with major depressive disorder and those with elevated, but subthreshold, depression symptoms, although one recent review identified concerns with dropout and lack of long-term effects.
“Internet-delivered CBT-based programs for depression symptom management have been shown to be effective both for adults with major depressive disorder and those with elevated, but subthreshold, depression symptoms, although one recent review identified concerns with dropout and lack of long-term effects [42-45].”
From MoodHacker Mobile Web App With Email for Adults to Self-Manage Mild-to-Moderate Depression: Randomized Controlled Trial (2016) · cites this paper as [45]
Our results are consistent with a recent meta-analysis of computerized CBT programs showing that results of computer-based CBT programs typically attenuate over time.
“Although our results are consistent with a recent meta-analysis of computerized CBT programs showing that results of computer-based CBT programs typically attenuate over time [45]”
From MoodHacker Mobile Web App With Email for Adults to Self-Manage Mild-to-Moderate Depression: Randomized Controlled Trial (2016) · cites this paper as [45]
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BackgroundCombined treatment of depression.
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“Furthermore, the I-squared (I [2]) statistic for heterogeneity was also used for confirmation of Cochrane’s Q statistic.”
BackgroundMethodComputerised CBT self‐help for depression in Higher Education: Reflections on a pilot
Mitchell, N. (2009) · Counselling and Psychotherapy Research · doi:10.1080/14733140902993343 · Cited by 6 · cited 1× · see citing works
“Also, further development of CCBT in terms of sophistication and attractiveness accompanying the rapid progress of information technology [65] might enhance the effectiveness of and adherence to CCBT, such as in the format of a therapeutic computer game [66].”
BackgroundCombined Pharmacotherapy and Psychological Treatment for Depression: A Systematic Review
Pampallona, S., Bollini, P., Tibaldi, G., Kupelnick, B., & Munizza, C. (2004) · Archives of General Psychiatry · doi:10.1001/archpsyc.61.7.714 · Cited by 5 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- Moran PW Lambert JM Lambert MJ, Christensen ER, De Julio SS A review of current assessment tools for monitoring changes in depression The Measurement of Psychotherapy Outcome in Research and Evaluation 1983 New York: Wiley 263 303
- Moran PW A Review of Current Assessment Tools for Monitoring Changes in Depression 1982 Brigham Young University: Department of Psychology
Cited by
Sorted by citations
Philippe, T. J., Sikder, N., Jackson, A., Koblanski, M. E., Liow, E., Pilarinos, A., & Vasarhelyi, K. (2022) · JMIR Mental Health · doi:10.2196/35159 · Cited by 436 · see citing works
Gilbody, S., Littlewood, E., Hewitt, C., Brierley, G., Tharmanathan, P., Araya, R., Barkham, M., Bower, P., Cooper, C., Gask, L., et al. (2015) · BMJ · doi:10.1136/bmj.h5627 · Cited by 409 · see citing works
“33”
Insights from user reviews to improve mental health apps
Alqahtani, F., & Orji, R. (2020) · Health Informatics Journal · doi:10.1177/1460458219896492 · Cited by 286 · see citing works
Stratton, E., Lampit, A., Choi, I., Calvo, R. A., Harvey, S. B., & Glozier, N. (2017) · PLOS ONE · doi:10.1371/journal.pone.0189904 · Cited by 252 · see citing works
Kuester, A., Niemeyer, H., & Knaevelsrud, C. (2016) · Clinical Psychology Review · doi:10.1016/j.cpr.2015.11.004 · Cited by 261 · see citing works
Deady, M., Choi, I., Calvo, R. A., Glozier, N., Christensen, H., & Harvey, S. B. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1473-1 · Cited by 222 · see citing works
Stawarz, K., Preist, C., Tallon, D., Wiles, N., & Coyle, D. (2018) · Journal of Medical Internet Research · doi:10.2196/10120 · Cited by 198 · see citing works
“Much of this work has focused on the development and evaluation of computerized cognitive behavioral therapy (CBT) [5,8-13].”
Carroll, K. M., Kiluk, B. D., Nich, C., Gordon, M. A., Portnoy, G. A., Marino, D. R., & Ball, S. A. (2014) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2013.13070987 · Cited by 177 · see citing works
“The strengths of this protocol include methodological features of importance for rigorous clinical trials of computer-assisted therapies (20, 21) and therapist-delivered behavioral therapies more broadly (38).”
BackgroundMethodBirney, A. J., Gunn, R., Russell, J. K., & Ary, D. V. (2016) · JMIR mHealth and uHealth · doi:10.2196/mhealth.4231 · Cited by 159 · see citing works
“70 for self-guided, interventions [42-45,47,48].”
Telemental health: A status update
Aboujaoude, E., Salame, W., & Naim, L. (2015) · World Psychiatry · doi:10.1002/wps.20218 · Cited by 154 · see citing works
“…(RCTs) and 2,976 subjects compared both assisted and unassisted cCBT to either waitlist or traditional CBT in the treatment of adult depression (13). cCBT showed a moderate post-treatment effect size on depressive symptoms when compared to the waitlist group, with equivalent outcomes compared…”
ResultAn evaluation of a peer support intervention for student mental health
Byrom, N. (2018) · Journal of Mental Health · doi:10.1080/09638237.2018.1437605 · Cited by 146 · see citing works
“The mid-point retention is comparable to computerised CBT, a NICE recommend psycho-social intervention for mild to moderate depression, which has a 50% attrition (So et al., 2013).”
MethodWu, A. C., Donnelly-McLay, D., Weisskopf, M. G., McNeely, E., Betancourt, T. S., & Allen, J. G. (2016) · Environmental Health · doi:10.1186/s12940-016-0200-6 · Cited by 143 · see citing works
“Concerns toward ICBT include a meta-analysis published in 2013 of effectiveness of computerized CBT on adult depression showing the lack of significant effect of long-term treatment outcomes compared to short-term treatment duration and significantly high participant drop-out [48].”
BackgroundAref-Adib, G., McCloud, T., Ross, J., O'Hanlon, P., Appleton, V., Rowe, S., Murray, E., Johnson, S., & Lobban, F. (2019) · The Lancet Psychiatry · doi:10.1016/s2215-0366(18)30302-x · Cited by 118 · see citing works
Sztein, D. M., Koransky, C. E., Fegan, L., & Himelhoch, S. (2018) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x17717402 · Cited by 135 · see citing works
“Of note, there was one meta-analysis investigation in which follow-up rates of depressive symptoms were found to be not significantly different from the control group.(25) The present meta-analysis also examined whether clinician assistance was a necessary prerequisite for the success of an iCBT program.”
ResultImproving the Efficiency of Psychotherapy for Depression: Computer-Assisted Versus Standard CBT
Thase, M. E., Wright, J. H., Eells, T. D., Barrett, M. S., Wisniewski, S. R., Balasubramani, G. K., McCrone, P., & Brown, G. K. (2018) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2017.17010089 · Cited by 131 · see citing works
Self-citationFish, J., Brimson, J., & Lynch, S. (2016) · Mindfulness · doi:10.1007/s12671-016-0548-2 · Cited by 126 · see citing works
“Additional therapist support appears to be more effective than those without (ES=1 vs .2; Spek et al. 2007) and reduce attrition rates (So et al. 2013), so there is some loss of effectiveness when direct contact with a therapist is lost.”
BackgroundResultInfluentialJuegos serios para el tratamiento o la prevención de la depresión: una revisión sistemática
Fleming, T. M., Cheek, C., Merry, S. N., Thabrew, H., Bridgman, H., Stasiak, K., Shepherd, M., Perry, Y., & Hetrick, S. (2015) · Revista de Psicopatología y Psicología Clínica · doi:10.5944/rppc.vol.19.num.3.2014.13904 · Cited by 120 · see citing works
“Attrition (non-completion) rates have been shown to range from 2 to 83% (Melville, Casey, & Kavanagh, 2010;Richards et al., 2012;So et al., 2013).”
BackgroundWeb-Based Bereavement Care: A Systematic Review and Meta-Analysis
Wagner, B., Rosenberg, N., Hofmann, L., & Maaß, U. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00525 · Cited by 117 · see citing works
Vallury, K. D., Jones, M., & Oosterbroek, C. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.4145 · Cited by 105 · see citing works
“Studies reporting negative findings are less likely to be published [26,49,50].”
Stawarz, K., Preist, C., & Coyle, D. (2019) · JMIR Mental Health · doi:10.2196/12546 · Cited by 107 · see citing works
“For example, they tend to have short-term effects [13] and only when supported by a therapist, rather than as stand-alone interventions [14,15].”
BackgroundZwerenz, R., Becker, J., Knickenberg, R. J., Siepmann, M., Hagen, K., & Beutel, M. E. (2017) · Psychotherapy and Psychosomatics · doi:10.1159/000481177 · Cited by 108 · see citing works
“Findings on the applicability of online self-help for primary care patients have been mixed, especially when offered in usual care settings [13] .”
BackgroundPatient experience of computerised therapy for depression in primary care
Knowles, S. E., Lovell, K., Bower, P., Gilbody, S., Littlewood, E., & Lester, H. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-008581 · Cited by 89 · see citing works
Computer-Assisted Cognitive-Behavior Therapy and Mobile Apps for Depression and Anxiety
Wright, J. H., Mishkind, M., Eells, T. D., & Chan, S. R. (2019) · Current Psychiatry Reports · doi:10.1007/s11920-019-1031-2 · Cited by 93 · see citing works
Lattie, E. G., Nicholas, J., Knapp, A. A., Skerl, J. J., Kaiser, S. M., & Mohr, D. C. (2019) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-019-00979-2 · Cited by 81 · see citing works
Systematic review of universal and targeted workplace interventions for depression
Yunus, W. M. A. W. M., Musiat, P., & Brown, J. S. L. (2017) · Occupational and Environmental Medicine · doi:10.1136/oemed-2017-104532 · Cited by 73 · see citing works
Duffecy, J., Grekin, R., Hinkel, H., Gallivan, N., Nelson, G., & O'Hara, M. W. (2019) · JMIR Mental Health · doi:10.2196/10778 · Cited by 60 · see citing works
“Internet interventions for the treatment of depression are widely accepted as efficacious [14-18].”
Backgroundvan Beugen, S., Ferwerda, M., Koulil, S. S., Smit, J. V., Zeeuwen-Franssen, M. E. J., Kroft, E. B. M., de Jong, E. M. G. J., Otero, M. E., Donders, A. R. T., van de Kerkhof, P. C. M., et al. (2016) · Psychotherapy and Psychosomatics · doi:10.1159/000447267 · Cited by 68 · see citing works
Thase, M. E., McCrone, P., Barrett, M. S., Eells, T. D., Wisniewski, S. R., Balasubramani, G. K., Brown, G. K., & Wright, J. H. (2020) · Psychotherapy and Psychosomatics · doi:10.1159/000508143 · Cited by 60 · see citing works
Self-citationBaker, F., Baker, K., & Burrell, J. (2021) · Journal of Occupational and Organizational Psychology · doi:10.1111/joop.12340 · Cited by 65 · see citing works
Nishi, D., Susukida, R., Usuda, K., Mojtabai, R., & Yamanouchi, Y. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.07.016 · Cited by 67 · see citing works
Depression in primary care: part 2—management
Ramanuj, P., Ferenchick, E. K., & Pincus, H. A. (2019) · BMJ · doi:10.1136/bmj.l835 · Cited by 62 · see citing works
Yang, H., Gao, S., Li, J., Yu, H., Xu, J., Lin, C., Yang, H., Teng, C., Ma, H., & Zhang, N. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.915689 · Cited by 65 · see citing works
The Implementation of Internet Interventions for Depression: A Scoping Review
Drozd, F., Vaskinn, L., Bergsund, H. B., Haga, S. M., Slinning, K., & Bjørkli, C. A. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.5670 · Cited by 60 · see citing works
“In the last few years there has been increasing evidence for the efficacy of internet interventions for treating depression (Andersson & Cuijpers, 2009; Foroushani, Schneider, & Assareh, 2011; So et al., 2013; Spek et al., 2007).”
A Psychodynamic Perspective on a Systematic Review of Online Psychotherapy for Adults
Machado, D. D. B., Laskoski, P. B., Severo, C. T., Bassols, A. M. S., Sfoggia, A., Kowacs, C., Krieger, D. V., Torres, M. B., Gastaud, M. B., Wellausen, R. S., et al. (2016) · British Journal of Psychotherapy · doi:10.1111/bjp.12204 · Cited by 59 · see citing works
Fordham, B., Sugavanam, T., Edwards, K., Hemming, K., Howick, J., Copsey, B. J., Lee, H., Kaidesoja, M., Kirtley, S., Hopewell, S., et al. (2021) · Health Technology Assessment · doi:10.3310/hta25090 · Cited by 59 · see citing works
Stratton, E., Lampit, A., Choi, I., Gavelin, H. M., Aji, M., Taylor, J., Calvo, R. A., Harvey, S. B., & Glozier, N. (2022) · Journal of Medical Internet Research · doi:10.2196/37776 · Cited by 57 · see citing works
Huffman, J. C., Adams, C. N., & Celano, C. M. (2017) · Psychosomatics · doi:10.1016/j.psym.2017.09.003 · Cited by 48 · see citing works
“some question about the impact of this approach alone (79).”
Nakao, S., Nakagawa, A., Oguchi, Y., Mitsuda, D., Kato, N., Nakagawa, Y., Tamura, N., Kudo, Y., Abe, T., Hiyama, M., et al. (2018) · Journal of Medical Internet Research · doi:10.2196/10743 · Cited by 45 · see citing works
Internet‐Based Psychotherapy for Adult Depression: What About the Mechanisms of Change?
Mogoaşe, C., Cobeanu, O., David, D., Giosan, C., & Szentágotai, A. (2016) · Journal of Clinical Psychology · doi:10.1002/jclp.22326 · Cited by 45 · see citing works
Six, S. G., Byrne, K., Aly, H., & Harris, M. W. (2022) · JMIR Mental Health · doi:10.2196/39516 · Cited by 31 · see citing works
“One caveat of this type of therapy is its low adherence rate [32,33].”
BackgroundWright, J. H., Owen, J. J., Eells, T. D., Antle, B. F., Bishop, L. B., Girdler, R. V., Harris, L. M., Wright, R. B., Wells, M. J., Gopalraj, R. K., et al. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.46716 · Cited by 38 · see citing works
Chan, C., West, S., & Glozier, N. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.5639 · Cited by 32 · see citing works
“In their study, So et al [5] reported limited long-term gains from CCBT, along with an increased rate of participant withdrawal.”
InfluentialMontero‐Marín, J., Prado-Abril, J., Botella, C., Mayoral, F., Baños, R., Herrera‐Mercadal, P., Romero‐Sanchiz, P., Gili, M., Castro, A., Nogueira‐Arjona, R., et al. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.3985 · Cited by 33 · see citing works
“Several studies show that Web-based psychological treatments are effective for the treatment of depression, in both unguided and guided interventions, although the effects are more favorable in the latter case [33,36-38].”
Rasing, S. P. A., Stikkelbroek, Y. A. J., & Bodden, D. H. M. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17010153 · Cited by 33 · see citing works
“, outside controlled research settings, has smaller effects and a higher attrition rate when compared to computerized CBT in adults who are recruited for participation in research [22].”
BackgroundMehrotra, S., Sudhir, P. M., Rao, G. N., Thirthalli, J., & Srikanth, T. K. (2018) · Behavioral Sciences · doi:10.3390/bs8040036 · Cited by 33 · see citing works
“Moderate effect sizes in terms of reductions in depressive symptoms have been noted in CBT based online interventions, but a meta-analysis indicated low impact on functioning [10,54].”
BackgroundDuffy, D. J., Richards, D., Hisler, G. C., & Timulák, L. (2024) · Journal of Medical Internet Research · doi:10.2196/47927 · Cited by 34 · see citing works
“First, a plethora of articles stated a lack of research that details the process of implementing iCBT in naturalistic settings; therefore, more research is needed to understand and improve iCBT uptake [38,44,52,56-58, 60, 64, 65 ].”
Srivastava, P., Mehta, M., Sagar, R., & Ambekar, A. (2020) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2020.101970 · Cited by 32 · see citing works
Abrahamsson, N., Ahlund, L., Ahrin, E., & Alfonsson, S. (2018) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2018.06.010 · Cited by 30 · see citing works
Klein, N. S., Bockting, C., Wijnen, B. F. M., Kok, G. D., van Valen, E., Riper, H. M., Cuijpers, P. J., Dekker, J., van der Heiden, C., Burger, H., et al. (2018) · Journal of Medical Internet Research · doi:10.2196/10437 · Cited by 29 · see citing works
“al [48] that found short-term effects of internet-based treatments for MDD but no effects beyond 6 months posttreatment.”
Telepsychiatry in an Era of Digital Mental Health Startups
Achtyes, E. D., Glenn, T., Monteith, S., Geddes, J. R., Whybrow, P. C., Martini, J., & Bauer, M. (2023) · Current Psychiatry Reports · doi:10.1007/s11920-023-01425-9 · Cited by 28 · see citing works
Watanabe, N., Horikoshi, M., Yamada, M., Shimodera, S., Akechi, T., Miki, K., Inagaki, M., Yonemoto, N., Imai, H., Tajika, A., et al. (2015) · Trials · doi:10.1186/s13063-015-0805-z · Cited by 28 · see citing works
“63) in the shortterm follow up than those in control conditions, whilst to neither superiority nor inferiority in the long term [8].”
BackgroundMethodInfluentialSelf-citationJonassaint, C. R., Gibbs, P., Belnap, B. H., Karp, J. F., Abebe, K. Z., & Rollman, B. L. (2017) · BJPsych Open · doi:10.1192/bjpo.bp.116.003657 · Cited by 28 · see citing works
Noguchi, R., Sekizawa, Y., So, M., Yamaguchi, S., & Shimizu, E. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1248-8 · Cited by 25 · see citing works
“Although the potential effects of iCBT in reducing depressive symptoms have been shown in meta-analyses [3, 4], the effects were observed to be transient and the participants’ drop-out rate was high [5].”
BackgroundSelf-citationAkechi, T., Yamaguchi, T., Uchida, M., Imai, F., Momino, K., Katsuki, F., Sakurai, N., Miyaji, T., Horikoshi, M., Furukawa, T. A., et al. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-024794 · Cited by 26 · see citing works
Self-citationAutomatic Identification of Depression Using Facial Images with Deep Convolutional Neural Network
Kong, X., Yao, Y., Wang, C., Wang, Y., Teng, J., & Qi, X. (2022) · Medical Science Monitor · doi:10.12659/msm.936409 · Cited by 27 · see citing works
Computer-Assisted CBT and Mobile Apps for Depression: Assessment and Integration Into Clinical Care
Wright, J. H., & Mishkind, M. C. (2020) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.20190044 · Cited by 25 · see citing works
He, R., Wei, J., Huang, K., Yang, H., Chen, Y., Liu, Z., Ma, L., Jia, Y., & Chen, L. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114897 · Cited by 27 · see citing works
Purkayastha, S., Addepally, S. A., & Bucher, S. (2019) · JMIR Human Factors · doi:10.2196/14146 · Cited by 28 · see citing works
“Thus, current literature suggests supplementing pharmacological interventions with cognitive behavioral therapy (CBT) as the most effective combination treatment for the management of major depression in most patients [11,12].”
BackgroundGunn, J., Cameron, J., Densley, K., Davidson, S., Fletcher, S., Palmer, V., Chondros, P., Dowrick, C., & Pirkis, J. (2018) · Patient Education and Counseling · doi:10.1016/j.pec.2017.07.008 · Cited by 25 · see citing works
Testing a stepped care model for binge-eating disorder: a two-step randomized controlled trial
Tasca, G. A., Koszycki, D., Brugnera, A., Chyurlia, L., Hammond, N. G., Francis, K., Ritchie, K., Ivanova, I. V., Proulx, G., Wilson, B., et al. (2018) · Psychological Medicine · doi:10.1017/s0033291718001277 · Cited by 24 · see citing works
“However, longterm remission rates from depression or anxiety symptoms after low-intensity treatment appear to be low (Ali et al., 2017) and dropout rates are high (So et al., 2013), which may result in further demoralization and reduced treatment seeking.”
BackgroundResultInfluentialGiosan, C., Cobeanu, O., Mogoaşe, C., Szentagotai, A., Mureşan, V., & Boian, R. (2017) · Trials · doi:10.1186/s13063-017-1960-1 · Cited by 23 · see citing works
“Moreover, the benefits of treatment have been reported to be rather short lived, the impact on functioning was found to be minimal, and high attrition rates seriously limited the potential clinical benefits [17].”
BackgroundYu, S., Liu, Y., Cao, M., Tian, Q., Xu, M., Yu, L., Yang, S., & Zhang, W. (2025) · Cancer Nursing · doi:10.1097/ncc.0000000000001274 · Cited by 22 · see citing works
Taylor, A., Tallon, D., Kessler, D. S., Peters, T. J., Shafran, R., Williams, C., & Wiles, N. (2019) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2019.1641146 · Cited by 22 · see citing works
“Whilst some investigators have found that computerised CBT is acceptable to both patients and therapists, trial outcomes have been mixed (Gilbody et al., 2015; So et al., 2013).”
BackgroundBrief Online Self-help Exercises for Postnatal Women to Improve Mood: A Pilot Study
Ayers, S., Fitzgerald, G., & Thompson, S. (2015) · Maternal and Child Health Journal · doi:10.1007/s10995-015-1755-5 · Cited by 22 · see citing works
Integrating the Digital and the Traditional to Deliver Therapy for Depression
Stawarz, K., Preist, C., Tallon, D., Thomas, L., Turner, K. M., Wiles, N., Kessler, D. S., Shafran, R., & Coyle, D. (2020) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3313831.3376510 · Cited by 24 · see citing works
“They can be an effective first-step approach in treating symptoms of depression [1, 29, 57], but cCBT has been predominantly used for low-intensity treatment [53] and improvements in depression tend to be short-term and drop-out rates high [34, 66].”
BackgroundPihlaja, S., Lahti, J. M. T., Lipsanen, J. O., Ritola, V., Gummerus, E.-M., Stenberg, J., & Joffe, G. (2020) · Journal of Medical Internet Research · doi:10.2196/15732 · Cited by 21 · see citing works
Are Trials of Computerized Therapy Generalizable? A Multidimensional Meta-analysis
Wilks, C. R., Zieve, G. G., & Lessing, H. K. (2016) · Telemedicine and e-Health · doi:10.1089/tmj.2015.0129 · Cited by 18 · see citing works
Rodriguez-Pulido, F., Castillo-Sánchez, G., Hamrioui, S., Martin, L. D., Vazquez-Beltrán, P., Díez, I. D. L. T., & Franco, M. (2020) · Journal of Medical Systems · doi:10.1007/s10916-020-1543-7 · Cited by 21 · see citing works
Klein, N. S., Kok, G. D., Burger, H., van Valen, E., Riper, H. M., Cuijpers, P. J., Dekker, J., Smit, F., van der Heiden, C., & Bockting, C. (2018) · Psychotherapy and Psychosomatics · doi:10.1159/000485039 · Cited by 20 · see citing works
Krejtz, I., Holas, P., Rusanowska, M., & Nezlek, J. B. (2018) · Journal of Clinical Psychology · doi:10.1002/jclp.22617 · Cited by 20 · see citing works
Yokomitsu, K., Irie, T., Sekiguchi, M., Shimizu, A., Matsuoka, H., Merry, S., & Stasiak, K. (2020) · JMIR Research Protocols · doi:10.2196/15164 · Cited by 32 · see citing works
“Considering these findings, we assumed a similar effect size (0.60) to that of internet-based and other computerized psychological treatments or game-based digital interventions against wait-list [22,35,36] for the reduction of primary outcomes assessed using Patient Health Questionnaire-9 (PHQ-9).”
InfluentialRodríguez-Fernández, J. M., Danies, E., Hoertel, N., Galanter, W., Saner, H. E., & Franco, O. H. (2021) · Journal of Applied Gerontology · doi:10.1177/07334648211056231 · Cited by 17 · see citing works
“Telemedicine alternatives in mental health care can facilitate therapy delivery, information resources, counseling, and networking (Cooper, 2013; Dölemeyer et al., 2013; So et al., 2013).”
BackgroundLobban, F. A., Appelbe, D. E., Appleton, V., Billsborough, J., Fisher, N. R., Foster, S., Gill, B., Glentworth, D., Harrop, C. E., Johnson, S., et al. (2020) · BMC Health Services Research · doi:10.1186/s12913-020-5002-4 · Cited by 16 · see citing works
“Despite substantial investment, many DHIs are either not adopted by their intended users, are abandoned, fail to scale up locally or spread to other settings, or are not sustained over time [9, 10].”
BackgroundMoving towards the benign: automatic interpretation bias modification in dysphoria
Cowden Hindash, A. H., & Rottenberg, J. A. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.09.005 · Cited by 15 · see citing works
Yoshizaki, A., Murata, E., Yamamoto, T., Fujisawa, T. X., Hanaie, R., Hirata, I., Matsumoto, S., Mohri, I., & Taniike, M. (2023) · JMIR mhealth and uhealth · doi:10.2196/40836 · Cited by 15 · see citing works
“One of the goals of remote interventions such as mHealth or computerized cognitive behavioral therapy is to minimize dropouts and maintain intervention adherence—high dropout rates, which can reach up to 80%, have been one of the main issues plaguing remote cognitive behavioral therapy [44-47].”
Kanapathy, J., & Bogle, V. (2019) · Journal of Health Psychology · doi:10.1177/1359105317713360 · Cited by 14 · see citing works
Patient experience of supported computerized CBT in an inner-city IAPT service: a qualitative study
Perera-Delcourt, R. P., & Sharkey, G. (2019) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x18000284 · Cited by 14 · see citing works
“…be less impressive and have shorter-term effect, and also be compromised by higher drop-out, than previously considered (de Graaf et al. , 2009); particularly when publication bias and detail of study findings are taken into account, according to the largest meta-analysis to date (So et al. , 2013).”
BackgroundGiosan, C., Cobeanu, O., Mogoaşe, C., Szentágotai Tătar, A., Mureşan, V., & Boian, R. (2016) · Trials · doi:10.1186/s13063-016-1740-3 · Cited by 13 · see citing works
Internetbasierte Therapie in der Versorgung von Patienten mit depressiven Störungen: Ein Überblick
Backenstrass, M., & Wolf, M. (2018) · Zeitschrift für Psychiatrie Psychologie und Psychotherapie · doi:10.1024/1661-4747/a000339 · Cited by 8 · see citing works
Psychology in the Age of Austerity
Ferraro, D. J. (2016) · Psychotherapy and Politics International · doi:10.1002/ppi.1369 · Cited by 12 · see citing works
Rajeshkumar, L., Mishkind, M., Coleman, J. J., Pahwa, M., LaPreze, D., Solenske, S., & Wright, J. H. (2024) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000815 · Cited by 7 · see citing works
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In-Depth Co-Design of Mental Health Monitoring Technologies by People with Lived Experience
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Dissemination of computer-assisted cognitive-behavior therapy for depression in primary care
Antle, B. F., Owen, J. J., Eells, T. D., Wells, M. J., Harris, L. M., Cappiccie, A., Wright, B., Williams, S. M., & Wright, J. H. (2018) · Contemporary Clinical Trials · doi:10.1016/j.cct.2018.11.001 · Cited by 10 · see citing works
Fulford, H., McSwiggan, L. C., Kroll, T., & MacGillivray, S. A. (2016) · JMIR Mental Health · doi:10.2196/mental.5966 · Cited by 9 · see citing works
“However, in a recent meta-analysis of computerized cognitive behavioral therapy (cCBT) by So et al [9] only short-term reductions in symptoms were noted, long-term follow-up and functional improvement were not significant and there was a recommendation that the clinical usefulness of cCBT should be reconsidered downwa…”
Psychological Wellbeing and Work
Stolk, C. V., Hofman, J., Hafner, M., & Janta, B. (2014) · Cited by 8 · see citing works
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Mental Health and the Self-Tracking Student
Weinberg, L. (2021) · Catalyst Feminism Theory Technoscience · doi:10.28968/cftt.v7i1.34039 · Cited by 7 · see citing works
“…online measures involving selfadministration and mindfulness techniques have been shown to have “high dropout rates” and “no long-term benefits” (So et al. 2013), and yet is increasingly advocated for in a range of institutional contexts, including schools, workplaces, | Catalyst: Feminism,…”
BackgroundΠαπαδάτου-Παστού, Μ., Goozée, R., Barley, E. A., Haddad, M., & Tzotzoli, P. (2015) · Pilot and Feasibility Studies · doi:10.1186/s40814-015-0029-8 · Cited by 8 · see citing works
Computerised self help for depression in primary care
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Exploring the use of mobile information and communication technologies by people with mood disorders
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“Furthermore, the use and uptake of CCBT to date is still low, which remains a challenge and a cause for concern (Clarke et al., 2015; Gilbody et al., 2015; Richards and Richardson, 2012; So et al., 2013; Wright et al., 2019).”
Internet-Delivered Psychotherapy for Anxiety Disorders and Depression
Titov, N., Dear, B. F., & Andersson, G. (2014) · Focus · doi:10.1176/appi.focus.12.3.299 · Cited by 5 · see citing works
Practical Development of a Robot to Assist Cognitive Reconstruction in Psychiatric Day Care
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“Although such support is necessary, the number of psychiatrists, nurses, and counselors who specialize in CBT is still limited [26].”
BackgroundMethodCan Cognitive Therapy Be Conducted by Computers?
Eells, T. D., Barrett, M. S., Wright, J. H., & Thase, M. E. (2015) · Current Behavioral Neuroscience Reports · doi:10.1007/s40473-015-0051-4 · Cited by 5 · see citing works
“A meta-analysis by So and colleagues [22] explicitly focused on two issues of concern raised in the Richards and”
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Barriers to Implementation of a Technology-Based Mental Health Intervention in a Rural Setting
Antle, B. F., Harris, L. M., Wright, J. H., Eells, T. D., Cappiccie, A., Williams, S. M., Katz, R., Logsdon, A. R., & Owen, J. J. (2021) · Contemporary Rural Social Work Journal · doi:10.61611/2165-4611.1220 · Cited by 3 · see citing works
“…compared to waitlist controls, information control, treatment as usual, or placebo (Andrews et al., 2018; Thase et al., 2018; Wright et al., 2018; So et al., 2013; Wilks et al., 2016; Richards & Richardson, 2012; Andrews et al., 2010), with changes sustained six weeks to six months post…”
Background
- Authors
- So, M., Yamaguchi, S., Hashimoto, S., Sado, M., Furukawa, T. A., & McCrone, P.
- Affiliations
- King's College London (GB)
- National Center of Neurology and Psychiatry (JP)
- Edogawa University (JP)
- Keio University (JP)
- Kyoto University (JP)
- Corresponding author
- So, Mirai
- Venue
- BMC Psychiatry
- Published
- 2013-04-15
- Volume
- 13
- Issue
- 1
- Pages
- 113-113
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC3638010
- OpenAlex
- W1998160684
- Cited by
- 129
- References
- 66
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 6 · 2023: 8 · 2022: 8 · 2021: 9 · 2020: 11 · 2019: 9 · 2018: 18 · 2017: 15 · 2016: 14 · 2015: 16 · 2014: 8 · 2013: 1
- FWCI
- 19.87
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Funders
- Japan Society for the Promotion of Science (25293150)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- computerized cognitive behavioral therapy, adult depression, treatment effectiveness, long-term follow-up, functional improvement, dropout, publication bias, risk of bias, methodological validity, clinical implementation
- MeSH terms
- Adult, Depressive Disorder, Humans, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Treatment Outcome
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