Response and Remission Rates in Internet-Based Cognitive Behavior Therapy: An Individual Patient Data Meta-Analysis

Gerhard Andersson, Per Carlbring, Alexander Rozental, Gerhard Andersson, Per Carlbring, Alexander Rozental

Abstract

Background: Internet-delivered cognitive behavior therapy (ICBT) was developed over 20 years ago and has since undergone a number of controlled trials, as well as several systematic reviews and meta-analyses. However, the crucial question of response rates remains to be systematically investigated. The aim of this individual patient meta-analysis (IPDMA) was to use a large dataset of trials conducted in Sweden to determine reliable change and recovery rates across trials for a range of conditions. Methods: We used previously collected and aggregated data from 2,866 patients in 29 Swedish clinical trials of ICBT for three categories of conditions: anxiety disorders, depression, and others. Raw scores at pre-treatment and post-treatment were used in an IPDMA to determine the rate of reliable change and recovery. Jacobson and Truax's, (1991) reliable change index (RCI) was calculated for each primary outcome measure in the trials as well as the recovery rates for each patient, with the additional requirement of having improved substantially. We subsequently explored potential predictors using binomial logistic regression. Results: In applying an RCI of z = 1.96, 1,162 (65.6%) of the patients receiving treatment were classified as achieving recovery, and 620 (35.0%) were classified as reaching remission. In terms of predictors, patients with higher symptom severity on the primary outcome measure at baseline [odds ratio (OR) = 1.36] and being female (OR = 2.22) increased the odds of responding to treatment. Having an anxiety disorder was found to decrease the response to treatment (OR = 0.51). Remission was predicted by diagnosis in the same direction (OR = 0.28), whereas symptom severity was inversely predictive of worse outcome (OR = 0.81). Conclusions: Response seems to occur among approximately half of all clients administered ICBT, whereas about a third reach remission. This indicates that the efficacy of ICBT is in line with that of CBT based in prior trials, with a possible caveat being the lower remission rates. Having more symptoms and being female might increase the chances of improvement, and a small negative effect of having anxiety disorder versus depression and other conditions may also exist. A limitation of the IPDMA was that only studies conducted in Sweden were included.

Keywords: individual patient data meta-analysis; internet-based cognitive behavior therapy; predictors; recovery; response rates.

Copyright © 2019 Andersson, Carlbring and Rozental.

References

    1. Andersson G. Internet interventions: past, present and future. Internet Interv (2018) 12:181–8. 10.1016/j.invent.2018.03.008
    1. Vlaescu G, Alasjö A, Miloff A, Carlbring P, Andersson G. Features and functionality of the Iterapi platform for internet-based psychological treatment. Internet Interv (2016) 6:107–14. 10.1016/j.invent.2016.09.006
    1. Andersson G. The internet and CBT: a clinical guide. Boca Raton: CRC Press; (2015). 10.1201/b13645
    1. Baumeister H, Reichler L, Munzinger M, Lin J. The impact of guidance on Internet-based mental health interventions—a systematic review. Internet Interv (2014) 1:205–15. 10.1016/j.invent.2014.08.003
    1. Carlbring P, Andersson G, Cuijpers P, Riper H, Hedman-Lagerlöf E. Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis. Cogn Behav Ther (2018) 47:1–18. 10.1080/16506073.2017.1401115
    1. Andersson G, Rozental A, Shafran R, Carlbring P. Long-term effects of internet-supported cognitive behavior therapy. Expert Rev Neurother (2018) 18:21–8. 10.1080/14737175.2018.1400381
    1. Andersson G, Hedman E. Effectiveness of guided Internet-delivered cognitive behaviour therapy in regular clinical settings. Verhaltenstherapie (2013) 23:140–8. 10.1159/000354779
    1. Vigerland S, Lenhard F, Bonnert M, Lalouni M, Hedman E, Ahlen J, et al. Internet-delivered cognitive behavior therapy for children and adolescents: a systematic review and meta-analysis. Clin Psychol Rev (2016) 50:1–10. 10.1016/j.cpr.2016.09.005
    1. Andersson G, Carlbring P, Titov N, Lindefors N. (2019). Internet interventions for adults with anxiety and mood disorders: A narrative umbrella review of recent meta-analyses. Can J Psychiatry 64: 465–470. 10.1177/0706743719839381
    1. Dear BF, Zou JB, Ali S, Lorian CN, Johnston L, Sheehan J, et al. Clinical and cost-effectiveness of therapist-guided internet-delivered cognitive behavior therapy for older adults with symptoms of anxiety: a randomized controlled trial. Behav Ther (2015. b) 46:206–17. 10.1016/j.beth.2014.09.007
    1. Nygren T, Brohede D, Koshnawa K, Osmana SS, Johansson R, Andersson G. Internet-based treatment of depressive symptoms in a Kurdish population: a randomized controlled trial. J Clin Psychol (2019) 75:985–98. 10.1002/jclp.22753
    1. Rozental A, Forsell E, Svensson A, Andersson G, Carlbring P. Internet-based cognitive behavior therapy for procrastination: a randomized controlled trial. J Consult Clin Psychol (2015) 83:808–24. 10.1037/ccp0000023
    1. Sijbrandij M, Kunovski I, Cuijpers P. Effectiveness of internet-delivered cognitive behavioral therapy for posttraumatic stress disorder: a systematic review and meta-analysis. Depress Anxiety (2016) 33:783–91. 10.1002/da.22533
    1. Păsărelu C, Andersson G, Bergman Nordgren L, Dobrean A. Internet-delivered transdiagnostic and tailored cognitive behavioral therapy for anxiety and depression: a systematic review and meta-analysis. Cogn Behav Ther (2017) 46:1–28. 10.1080/16506073.2016.1231219
    1. Dear BF, Staples LG, Terides MD, Karin E, Zou J, Johnston L, et al. Transdiagnostic versus disorder-specific and clinician-guided versus self-guided internet-delivered treatment for generalized anxiety disorder and comorbid disorders: a randomized controlled trial. J Anxiety Disord (2015. a) 36:63–77. 10.1016/j.janxdis.2015.09.003
    1. Johansson R, Hesslow T, Ljotsson B, Jansson A, Jonsson L, Färdig S, et al. Internet-based affect-focused psychodynamic therapy for social anxiety disorder: a randomized controlled trial with 2-year follow-up. Psychotherapy (2017) 54:351–60. 10.1037/pst0000147
    1. Donker T, Bennett K, Bennett A, Mackinnon A, van Straten A, Cuijpers P, et al. Internet-delivered interpersonal psychotherapy versus internet-delivered cognitive behavioral therapy for adults with depressive symptoms: randomized controlled noninferiority trial. J Med Internet Res (2013) 15:e82. 10.2196/jmir.2307
    1. Dahlin M, Andersson G, Magnusson K, Johansson T, Sjögren J, Håkansson A, et al. Internet-delivered acceptance-based behaviour therapy for generalized anxiety disorder: a randomized controlled trial. Behav Res Ther (2016) 77:86–95. 10.1016/j.brat.2015.12.007
    1. Boettcher J, Berger T, Renneberg B. Internet-based attention training for social anxiety: a randomized controlled trial. Cogn Ther Res (2012) 36:552–36. 10.1007/s10608-011-9374-y
    1. *Ström M, Uckelstam C-J, Andersson G, Hassmén P, Umefjord G, Carlbring P. Internet-delivered therapist-guided physical activity for mild to moderate depression: a randomized controlled trial. PeerJ (2013) 1:e178. 10.7717/peerj.178
    1. *Boettcher J, Åstrom V, Pahlsson D, Schenstrom O, Andersson G, Carlbring P. Internet-based mindfulness treatment for anxiety disorders: a randomized controlled trial. Behav Ther (2014) 45:241–53. 10.1016/j.beth.2013.11.003
    1. Carlbring P, Ekselius L, Andersson G. Treatment of panic disorder via the Internet: a randomized trial of CBT vs. applied relaxation. J Behav Ther Exp Psychiatry (2003) 34:129–40. 10.1016/S0005-7916(03)00026-0
    1. *Paxling B, Almlöv J, Dahlin M, Carlbring P, Breitholtz E, Eriksson T, et al. Guided internet-delivered cognitive behavior therapy for generalized anxiety disorder: a randomized controlled trial. Cogn Behav Ther (2011) 40:159–73. 10.1080/16506073.2011.576699
    1. Hedman E, Andersson E, Andersson G, Lindefors N, Lekander M, Rück C, et al. Mediators in Internet-based cognitive behavior therapy for severe health anxiety. PLoS One (2013) 8:e77752. 10.1371/journal.pone.0077752
    1. Bendelin N, Hesser H, Dahl J, Carlbring P, Zetterqvist Nelson K, Andersson G. Experiences of guided Internet-based cognitive-behavioural treatment for depression: a qualitative study. BMC Psychiatry (2011) 11:107. 10.1186/1471-244X-11-107
    1. Rozental A, Magnusson K, Boettcher J, Andersson G, Carlbring P. For better or worse: an individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy. J Consult Clin Psychol (2017) 85:160–77. 10.1037/ccp0000158
    1. Rozental A, Andersson G, Carlbring P. In the absence of effects: an individual patient data meta-analysis of non-response and its predictors in internet-based cognitive behavior therapy. Front Psychol (2019) 10:589. 10.3389/fpsyg.2019.00589
    1. Loerinc AG, Meuret AE, Twohig MP, Rosenfield D, Bluett EJ, Craske MG. Response rates for CBT for anxiety disorders: need for standardized criteria. Clin Psychol Rev (2015) 42:72–82. 10.1016/j.cpr.2015.08.004
    1. Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol (1991) 59:12–9. 10.1037/0022-006X.59.1.12
    1. Karyotaki E, Ebert DD, Donkin L, Riper H, Twisk J, Burger S, et al. Do guided Internet-based interventions result in clinically relevant changes for patients with depression? An individual participant data meta-analysis. Clin Psychol Rev (2018) 63:80–92. 10.1016/j.cpr.2018.06.007
    1. Stewart L, Tierney JF. To IPD or not to IPD? Advantages and disadvantages of systematic reviews using individual patient data. Eval Health Prof (2002) 25(1):76–97. 10.1177/0163278702025001006
    1. Simmonds MC, Higgins JPT, Stewart LA, Tierney JF, Clarke MJ, Thompson SG. Meta-analysis of individual patient data from randomized trials: a review of methods used in practice. Clin Trials (2005) 2(3):209–17. 10.1191/1740774505cn087oa
    1. Bower P, Kontopantelis E, Sutton AP, Kendrick T, Richards D, Gilbody S, et al. Influence of initial severity of depression on effectiveness of low intensity interventions: meta-analysis of individual patient data. Br Med J (2013) 346:f540. 10.1136/bmj.f540
    1. Riper H, Hoogendoorn A, Cuijpers P, Karyotaki E, Boumparis N, Pastor AM, et al. Effectiveness and treatment moderators of internet interventions for adult problem drinking: an individual patient data meta-analysis of 19 randomised controlled trials. Plos Med (2018) 15:e1002714. 10.1371/journal.pmed.1002714
    1. Mukaka M, White SA, Terlouw DJ, Mwapasa V, Kalilani-Phiri L, Faragher EB. Is using multiple imputation better than complete case analysis for estimating a prevalence (risk) difference in randomized controlled trials when binary outcome observations are missing? Trials (2016) 17:341. 10.1186/s13063-016-1473-3
    1. Akl EA, Kahale LA, Agoritsas T, Brignardello-Petersen R, Busse JW, Carrasco-Labra A, et al. Handling trial participants with missing outcome data when conducting a meta-analysis: a systematic survey of proposed approaches. Syst Rev (2015) 4:98–8. 10.1186/s13643-015-0083-6
    1. Jacobson NS, Roberts LJ, Berns SB, McGlinchey JB. Methods for defining and determining the clinical significance of treatment effects: description, application, and alternatives. J Consult Clin Psychol (1999) 67:300–7. 10.1037/0022-006X.67.3.300
    1. Evans C, Margison F, Barkham M. The contribution of reliable and clinically significant change methods to evidence-based mental health. Evid-Based Ment Health (1998) 1(3):70–2. 10.1136/ebmh.1.3.70
    1. Saemundsson BR, Borsdottir F, Kristjansdottir H, Olason DB, Smari J, Sigurdsson JF. Psychometric properties of the Icelandic version of the Beck Anxiety Inventory in a clinical and a student population. Eur J Psychol Assess (2011) 27:133–41. 10.1027/1015-5759/a000059
    1. Heeren A, Maurange P, Rossignol M, Vanhaelen M, Peschard V, Eeckhout C, et al. Self-report version of the Liebowitz Social Anxiety Scale: psychometric properties of the French version. Can J Behav Sci (2012) 44:99–107. 10.1037/a0026249
    1. Lee EH, Kim JH, Yu BH. Reliability and validity of the self-report version of the Panic Disorder Severity Scale in Korea. Depress Anxiety (2009) 26:E120–3. 10.1002/da.20461
    1. Zuithoff NPA, Vergouwe Y, Kling M, Nazareth I, van Wezep MJ, Moons KGM, et al. The Patient Health Questionnaire-9 for detection of major depressive disorder in primary care: consequences of current thresholds in a crossectional study. BMC Fam Pract (2010) 11:98. 10.1186/1471-2296-11-98
    1. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology (1997) 49:822–30. 10.1016/S0090-4295(97)00238-0
    1. Beck AT, Steer RA. Beck depression inventory. Manual, Svensk version (Swedish version). Fagernes: Psykologiförlaget AB; (1996). 10.1037/t00742-000
    1. Sundin EC, Horowitz MJ. Impact of Event Scale: psychometric properties. Br J Psychiatry (2002) 180:205–9. 10.1192/bjp.180.3.205
    1. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med (2006) 166:1092–7. 10.1001/archinte.166.10.1092
    1. Pallesen S, Nordhus IH, Carlstedt B, Thayer JF, Johnsen TB. A norwegian adaption of the penn state worry questionnaire: factor structure, reliability, validity and norms. Scand J Psychol (2006) 47:281–91. 10.1111/j.1467-9450.2006.00518.x
    1. Arrindell WA. The fear of fear concept: stability, retest artifact and predictive power. Behav Res Ther (1993) 31:139–48. 10.1016/0005-7967(93)90065-3
    1. Carey MP, Spector IP, Lantinga LJ, Krauss DJ. Reliability of the Dyadic Adjustment Scale. Psychol Assess (1993) 5:238–40. 10.1037/1040-3590.5.2.238
    1. Klorman R, Weerts TC, Hastings JE, Melamed BG, Lang PJ. Psychometric properties of some specific-fear questionnaires. Behav Ther (1974) 5:401–9. 10.1016/S0005-7894(74)80008-0
    1. Fantino B, Moore N. The self-reported Montgomery-Åsberg Depression rating scale is a useful evaluative tool in major depressive disorder. BMC Psychiatry (2009) 9:26. 10.1186/1471-244X-9-26
    1. Muris P, Merckelbach H. A comparison of two spider fear questionnaires. J Behav Ther Exp Psychiatry (1996) 27:241–4. 10.1016/S0005-7916(96)00022-5
    1. Gerstein DR, Volberg RA, Toce MT, Harwood H, Johnson RA, Buie T, et al. Gambling Impact and Behavior Study: Report to the National Gambling Impact Study Commission. Chicago, IL: NORC, at the University of Chicago; (1999).
    1. Hedman E, Andersson E, Ljótsson B, Andersson G, Andersson EM, Schalling M, et al. Clinical and genetic outcome determinants of Internet- and group-based cognitive behavior therapy for social anxiety disorder. Acta Psychiatr Scand (2012) 126:126–36. 10.1111/j.1600-0447.2012.01834.x
    1. jamovi project. jamovi (Version 0.9) [Computer Software] (2018). Retrieved from .
    1. First MB, Gibbon M, Spitzer RL, Williams JB. Structured clinical interview for DSM-IV Axis I Disorders (SCID-I). Washington, D.C: American Psychiatric Press; (1997).
    1. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry (1998) 59:22–33. 10.1037/t18597-000
    1. Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Gusman FD, Charney DS, et al. The development of a clinician-administered PTSD scale. J Trauma Stress (1995) 8(1):75–90.
    1. *Ivanova E, Lindner P, Ly KH, Dahlin M, Vernmark K, Andersson G, et al. Guided and unguided Acceptance and Commitment Therapy for social anxiety disorder and/or panic disorder provided via the Internet and a smartphone application: a randomized controlled trial. J Anxiety Disord (2016) 44:27–35. 10.1016/j.janxdis.2016.09.012
    1. Nyström MBT, Stenling A, Sjöström E, Neely G, Lindner P, Hassmén P, et al. Behavioral activation versus physical activity via the Internet: a randomized controlled trial. J Affect Disord (2017) 215:85–93. 10.1016/j.jad.2017.03.018
    1. *Andersson E, Walen C, Hallberg J, Paxling B, Dahlin M, Almlov J, et al. A randomized controlled trial of guided Internet-delivered cognitive behavioral therapy for erectile dysfunction. J Sex Med (2011) 8:2800–9. 10.1111/j.1743-6109.2011.02391.x
    1. *Boettcher J, Magnusson K, Marklund A, Berglund E, Blomdahl R, Braun U, et al. Adding a smartphone app to Internet-based self-help for social anxiety: a randomized controlled trial. Comput Hum Behav (2018) 87:98–108. 10.1016/j.chb.2018.04.052
    1. Andersson G, Hesser H, Veilord A, Svedling L, Andersson F, Sleman O, et al. Randomised controlled non-inferiority trial with 3-year follow-up of internet-delivered versus face-to-face group cognitive behavioural therapy for depression. J Affect Disord (2013. a) 151:986–94. 10.1016/j.jad.2013.08.022
    1. *Carlbring P, Hägglund M, Luthström A, Dahlin M, Kadowaki Å, Vernmark K, et al. Internet-based behavioral activation and acceptance-based treatment for depression: a randomized controlled trial. J Affect Disord (2013) 148:331–7. 10.1016/j.jad.2012.12.020
    1. *Ivarsson D, Blom M, Hesser H, Carlbring P, Enderby P, Nordberg R, et al. Guided Internet-delivered cognitive behaviour therapy for post-traumatic stress disorder: a randomized controlled trial. Internet Interv (2014) 1:33–40. 10.1016/j.invent.2014.03.002
    1. *Vernmark K, Lenndin J, Bjärehed J, Carlsson M, Karlsson J, Öberg J, et al. Internet administered guided self-help versus individualized e-mail therapy: a randomized trial of two versions of CBT for major depression. Behav Res Ther (2010) 48(5):368–76. 10.1016/j.brat.2010.01.005
    1. *Carlbring P, Maurin L, Törngren C, Linna E, Eriksson T, Sparthan E, et al. Individually-tailored, Internet-based treatment for anxiety disorders: a randomized controlled trial. Behav Res Ther (2011) 49(1):18–24. 10.1016/j.brat.2010.10.002
    1. *Nordgren LB, Hedman E, Etienne J, Bodin J, Kadowaki A, Eriksson S, et al. Effectiveness and cost-effectiveness of individually tailored Internet-delivered cognitive behavior therapy for anxiety disorders in a primary care population: a randomized controlled trial. Behav Res Ther (2014) 59:1–11. 10.1016/j.brat.2014.05.007
    1. *Andersson G, Paxling B, Roch-Norlund P, Östman G, Norgren A, Almlöv J, et al. Internet-based psychodynamic versus cognitive behavioral guided self-help for generalized anxiety disorder: a randomized controlled trial. Psychother Psychosom (2012) 81:344–55. 10.1159/000339371
    1. *Carlbring P, Nilsson-Ihrfelt E, Waara J, Kollenstam C, Buhrman M, Kaldo V, et al. Treatment of panic disorder: live therapy vs. self-help via the Internet. Behav Res Ther (2005) 43(10):1321–33. 10.1016/j.brat.2004.10.002
    1. Andersson G, Waara J, Jonsson U, Malmaeus F, Carlbring P, Öst L-G. Internet-Based exposure treatment versus one-session exposure treatment of snake phobia: A randomized controlled trial. Cogn Behav Ther (2013. b) 42:284–91. 10.1080/16506073.2013.844202
    1. *Boettcher J, Hasselrot J, Sund E, Andersson G, Carlbring P. Combining attention training with Internet-based cognitive-behavioural self-help for social anxiety: a randomised controlled trial. Cogn Behav Ther (2013) 43:34–48. 10.1080/16506073.2013.809141
    1. *Kuckertz JM, Gildebrant E, Liliequist B, Karlstrom P, Vappling C, Bodlund O, et al. Moderation and mediation of the effect of attention training in social anxiety disorder. Behav Res Ther (2014) 53:30–40. 10.1016/j.brat.2013.12.003
    1. *Dagöö J, Asplund RP, Bsenko HA, Hjerling S, Holmberg A, Westh S, et al. Cognitive behavior therapy versus interpersonal psychotherapy for social anxiety disorder delivered via smartphone and computer: a randomized controlled trial. J Anxiety Disord (2014) 28:410–7. 10.1016/j.janxdis.2014.02.003
    1. *Andersson G, Carlbring P, Holmstrom A, Sparthan E, Furmark T, Nilsson-Ihrfelt E, et al. Internet-based self-help with therapist feedback and in vivo group exposure for social phobia: a randomized controlled trial. J Consult Clin Psychol (2006) 74(4):677–86. 10.1037/0022-006X.74.4.677
    1. *Carlbring P, Gunnarsdóttir M, Hedensjö L, Andersson G, Ekselius L, Furmark T. Treatment of social phobia from a distance: a randomized trial of internet delivered cognitive behavior therapy (CBT) and telephone support. Br J Psychiatry (2007) 190:123–8. 10.1192/bjp.bp.105.020107
    1. *Tillfors M, Carlbring P, Furmark T, Lewenhaupt S, Spak M, Eriksson A, et al. Treating university students with social phobia and public speaking fears: Internet delivered self-help with or without live group exposure sessions. Depress Anxiety (2008) 25:708–17. 10.1002/da.20416
    1. *Furmark T, Carlbring P, Hedman E, Sonnenstein A, Clevberger P, Bohman B, et al. Bibliotherapy and Internet delivered cognitive behaviour therapy with additional guidance for social anxiety disorder: randomised controlled trial. Br J Psychiatry (2009) 195:440–7. 10.1192/bjp.bp.108.060996
    1. *Silfvernagel K, Westlinder A, Andersson S, Bergman K, Hernandez RD, Fallhagen L, et al. Individually tailored internet-based cognitive behaviour therapy for older adults with anxiety and depression: a randomised controlled trial. Cogn Behav Ther (2018) 47:286–300. 10.1080/16506073.2017.1388276
    1. *Andersson G, Waara J, Jonsson U, Malmaeus F, Carlbring P, Öst LG. Internet-based self-help versus one-session exposure in the treatment of spider phobia: a randomized controlled trial. Cogn Behav Ther (2009) 38:114–20. 10.1080/16506070902931326
    1. *Carlbring P, Degerman N, Jonsson J, Andersson G. Internet-based treatment of pathological gambling with a three-year follow-up. Cogn Behav Ther (2012) 41:321–34. 10.1080/16506073.2012.689323
    1. Gyani A, Shafran R, Layard R, Clark DM. Enhancing recovery rates: lessons from year one of IAPT. Behav Res Ther (2013) 51:597–606. 10.1016/j.brat.2013.06.004
    1. Springer KS, Levy HC, Tolin DF. Remission in CBT for adult anxiety disorders: a meta-analysis. Clin Psychol Rev (2018) 61:1–8. 10.1016/j.cpr.2018.03.002
    1. Titov N, Dear BF, Staples L, Bennett-Levy J, Klein B, Rapee RM, et al. The first 30 months of the MindSpot Clinic: Evaluation of a national e-mental health service against project objectives. Aust N Z J Psychiatry (2017) 51:1227–39. 10.1177/0004867416671598
    1. Karyotaki E, Kleiboer A, Smit F, Turner DT, Mira Pastor A, Andersson G, et al. Predictors of treatment dropout in self-guided web-based interventions for depression: an ‘‘individual patient data’’ meta-analysis. Psychol Med (2015) 45:2717–26. 10.1017/S0033291715000665
    1. Oxman AD, Clarke MJ, Stewart LA. From science to practice: meta-analyses using individual patient data are needed. JAMA (1995) 274(10):845–6. 10.1001/jama.1995.03530100085040
    1. Andersson G, Bergström J, Buhrman M, Carlbring P, Holländare F, Kaldo V, et al. Development of a new approach to guided self-help via the Internet. Swedish Exp J Technol Hum Serv (2008) 26:161–81. 10.1080/15228830802094627
    1. Frisch MB, Cornell J, Villanueva M, Retzlaff PJ. Clinical validation of the quality of life inventory: a measure of life satisfaction for use in treatment planning and outcome assessment. Psychol Assess (1992) 4:92–101. 10.1037/1040-3590.4.1.92
    1. Hofmann SG, Wu JQ, Boettcher H. Effect of cognitive-behavioral therapy for anxiety disorders on quality of life: a meta-analysis. J Consult Clin Psychol (2014) 82:375–91. 10.1037/a0035491

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