Adherence to Internet-based and face-to-face cognitive behavioural therapy for depression: a meta-analysis

Wouter van Ballegooijen, Pim Cuijpers, Annemieke van Straten, Eirini Karyotaki, Gerhard Andersson, Jan H Smit, Heleen Riper, Wouter van Ballegooijen, Pim Cuijpers, Annemieke van Straten, Eirini Karyotaki, Gerhard Andersson, Jan H Smit, Heleen Riper

Abstract

Background: Internet-based cognitive behavioural therapy (iCBT) is an effective and acceptable treatment for depression, especially when it includes guidance, but its treatment adherence has not yet been systematically studied. We conducted a meta-analysis, comparing the adherence to guided iCBT with the adherence to individual face-to-face CBT.

Methods: Studies were selected from a database of trials that investigate treatment for adult depression (see www.evidencebasedpsychotherapies.org), updated to January 2013. We identified 24 studies describing 26 treatment conditions (14 face-to-face CBT, 12 guided iCBT), by means of these inclusion criteria: targeting depressed adults, no comorbid somatic disorder or substance abuse, community recruitment, published in the year 2000 or later. The main outcome measure was the percentage of completed sessions. We also coded the percentage of treatment completers (separately coding for 100% or at least 80% of treatment completed).

Results: We did not find studies that compared guided iCBT and face-to-face CBT in a single trial that met our inclusion criteria. Face-to-face CBT treatments ranged from 12 to 28 sessions, guided iCBT interventions consisted of 5 to 9 sessions. Participants in face-to-face CBT completed on average 83.9% of their treatment, which did not differ significantly from participants in guided iCBT (80.8%, P = .59). The percentage of completers (total intervention) was significantly higher in face-to-face CBT (84.7%) than in guided iCBT (65.1%, P < .001), as was the percentage of completers of 80% or more of the intervention (face-to-face CBT: 85.2%, guided iCBT: 67.5%, P = .003). Non-completers of face-to-face CBT completed on average 24.5% of their treatment, while non-completers of guided iCBT completed on average 42.1% of their treatment.

Conclusion: We did not find studies that compared guided iCBT and face-to-face CBT in a single trial. Adherence to guided iCBT appears to be adequate and could be equal to adherence to face-to-face CBT.

Conflict of interest statement

Competing Interests: Gerhard Andersson is a PLOS ONE Editorial Board member and that this does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1. Flow chart of included studies.
Figure 1. Flow chart of included studies.
Figure 2. Meta-analysis of percentage of completed…
Figure 2. Meta-analysis of percentage of completed sessions, where the completed sessions (mean and sd) are divided by the total number of sessions.
Figure 3. Meta-analysis of percentage of completers…
Figure 3. Meta-analysis of percentage of completers of the entire intervention, where N completers is divided by the total N.
Figure 4. Meta-analysis of the percentage of…
Figure 4. Meta-analysis of the percentage of participants who completed 80% of the sessions, where N completers (80%) is divided by the total N.

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