Internet-Delivered Psychological Treatments for Mood and Anxiety Disorders: A Systematic Review of Their Efficacy, Safety, and Cost-Effectiveness
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{"title"=>"Internet-delivered psychological treatments for mood and anxiety disorders: A systematic review of their efficacy, safety, and cost-effectiveness", "type"=>"generic", "authors"=>[{"first_name"=>"Filip K.", "last_name"=>"Arnberg", "scopus_author_id"=>"26657887700"}, {"first_name"=>"Steven J.", "last_name"=>"Linton", "scopus_author_id"=>"35547951600"}, {"first_name"=>"Monica", "last_name"=>"Hultcrantz", "scopus_author_id"=>"56178291400"}, {"first_name"=>"Emelie", "last_name"=>"Heintz", "scopus_author_id"=>"25642783800"}, {"first_name"=>"Ulf", "last_name"=>"Jonsson", "scopus_author_id"=>"56667101200"}], "year"=>2014, "source"=>"PLoS ONE", "identifiers"=>{"issn"=>"19326203", "scopus"=>"2-s2.0-84901295625", "pui"=>"373160898", "doi"=>"10.1371/journal.pone.0098118", "isbn"=>"EN :1932-6203", "sgr"=>"84901295625", "pmid"=>"24844847"}, "id"=>"06af4342-d623-3bdf-8182-ce6d4f7e6ee1", "abstract"=>"BACKGROUND: Greater access to evidence-based psychological treatments is needed. This review aimed to evaluate whether internet-delivered psychological treatments for mood and anxiety disorders are efficacious, noninferior to established treatments, safe, and cost-effective for children, adolescents and adults., METHODS: We searched the literature for studies published until March 2013. Randomized controlled trials (RCTs) were considered for the assessment of short-term efficacy and safety and were pooled in meta-analyses. Other designs were also considered for long-term effect and cost-effectiveness. Comparisons against established treatments were evaluated for noninferiority. Two reviewers independently assessed the relevant studies for risk of bias. The quality of the evidence was graded using an international grading system., RESULTS: A total of 52 relevant RCTs were identified whereof 12 were excluded due to high risk of bias. Five cost-effectiveness studies were identified and three were excluded due to high risk of bias. The included trials mainly evaluated internet-delivered cognitive behavioral therapy (I-CBT) against a waiting list in adult volunteers and 88% were conducted in Sweden or Australia. One trial involved children. For adults, the quality of evidence was graded as moderate for the short-term efficacy of I-CBT vs. waiting list for mild/moderate depression (d = 0.83; 95% CI 0.59, 1.07) and social phobia (d = 0.85; 95% CI 0.66, 1.05), and moderate for no efficacy of internet-delivered attention bias modification vs. sham treatment for social phobia (d = -0.04; 95% CI -0.24, 0.35). The quality of evidence was graded as low/very low for other disorders, interventions, children/adolescents, noninferiority, adverse events, and cost-effectiveness., CONCLUSIONS: I-CBT is a viable treatment option for adults with depression and some anxiety disorders who request this treatment modality. Important questions remain before broad implementation can be supported. Future research would benefit from prioritizing adapting treatments to children/adolescents and using noninferiority designs with established forms of treatment.", "link"=>"http://www.mendeley.com/research/internetdelivered-psychological-treatments-mood-anxiety-disorders-systematic-review-efficacy-safety-9", "reader_count"=>199, "reader_count_by_academic_status"=>{"Unspecified"=>7, "Professor > Associate Professor"=>10, "Librarian"=>3, "Researcher"=>28, "Student > Doctoral Student"=>19, "Student > Ph. D. Student"=>39, "Student > Postgraduate"=>10, "Student > Master"=>37, "Other"=>8, "Student > Bachelor"=>30, "Lecturer"=>6, "Professor"=>2}, "reader_count_by_user_role"=>{"Unspecified"=>7, "Professor > Associate Professor"=>10, "Librarian"=>3, "Researcher"=>28, "Student > Doctoral Student"=>19, "Student > Ph. D. Student"=>39, "Student > Postgraduate"=>10, "Student > Master"=>37, "Other"=>8, "Student > Bachelor"=>30, "Lecturer"=>6, "Professor"=>2}, "reader_count_by_subject_area"=>{"Unspecified"=>15, "Agricultural and Biological Sciences"=>1, "Arts and Humanities"=>1, "Business, Management and Accounting"=>3, "Chemistry"=>1, "Computer Science"=>4, "Economics, Econometrics and Finance"=>1, "Nursing and Health Professions"=>6, "Mathematics"=>1, "Medicine and Dentistry"=>34, "Neuroscience"=>2, "Pharmacology, Toxicology and Pharmaceutical Science"=>1, "Psychology"=>118, "Social Sciences"=>11}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>34}, "Social Sciences"=>{"Social Sciences"=>11}, "Psychology"=>{"Psychology"=>118}, "Mathematics"=>{"Mathematics"=>1}, "Unspecified"=>{"Unspecified"=>15}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>1}, "Arts and Humanities"=>{"Arts and Humanities"=>1}, "Chemistry"=>{"Chemistry"=>1}, "Neuroscience"=>{"Neuroscience"=>2}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>1}, "Computer Science"=>{"Computer Science"=>4}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>3}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>6}}, "reader_count_by_country"=>{"Colombia"=>1, "Sweden"=>4, "Netherlands"=>1, "United Kingdom"=>3, "Malaysia"=>1, "Spain"=>2}, "group_count"=>14}

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  • {"files"=>["https://ndownloader.figshare.com/files/1504886"], "description"=>"<p>For the meta-analysis, the outcome chosen from each study was the Social Interaction Anxiety Scale.</p>", "links"=>[], "tags"=>["psychology", "Clinical psychology", "Mental health and psychiatry", "Anxiety disorders", "Obsessive-compulsive disorder", "Post-traumatic stress disorder", "Mental health therapies", "psychotherapy", "Mood disorders", "depression", "efficacy", "internet-based", "modification", "sham", "phobia"], "article_id"=>1032384, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Filip K. Arnberg", "Steven J. Linton", "Monica Hultcrantz", "Emelie Heintz", "Ulf Jonsson"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0098118.g004", "stats"=>{"downloads"=>1, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Short_term_efficacy_of_internet_based_attention_bias_modification_I_ABM_vs_sham_treatment_for_social_phobia_in_adults_/1032384", "title"=>"Short-term efficacy of internet-based attention bias modification (I-ABM) vs. sham treatment for social phobia in adults.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-05-20 03:34:35"}
  • {"files"=>["https://ndownloader.figshare.com/files/1504884"], "description"=>"<p>For the meta-analysis, the outcome chosen from each study was the Beck Depression Inventory I or II.</p>", "links"=>[], "tags"=>["psychology", "Clinical psychology", "Mental health and psychiatry", "Anxiety disorders", "Obsessive-compulsive disorder", "Post-traumatic stress disorder", "Mental health therapies", "psychotherapy", "Mood disorders", "depression", "efficacy", "therapist-guided", "internet-based", "waiting"], "article_id"=>1032382, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Filip K. Arnberg", "Steven J. Linton", "Monica Hultcrantz", "Emelie Heintz", "Ulf Jonsson"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0098118.g002", "stats"=>{"downloads"=>1, "page_views"=>19, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Short_term_efficacy_of_therapist_guided_internet_based_cognitive_behavioral_therapy_I_CBT_vs_waiting_list_for_depression_in_adults_/1032382", "title"=>"Short-term efficacy of therapist-guided internet-based cognitive behavioral therapy (I-CBT) vs. waiting list for depression in adults.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-05-20 03:34:35"}
  • {"files"=>["https://ndownloader.figshare.com/files/1504889"], "description"=>"<p>ABM =  Attention bias modification. CBT =  Cognitive behavior therapy. GAD =  Generalized anxiety disorder. OCD =  Obsessive-compulsive disorder. PD =  Panic disorder. PDT =  Psychodynamic therapy. PTSD =  Posttraumatic stress disorder.</p>a<p>Includes full- and part-time employed and students. For a few studies that only reported number of participants on sick leave, we report the proportion not on sick leave.</p>b<p>Psychotropic medication, although this was not stated explicitly in each report.</p>c<p>Includes major depressive episode acute/in partial remission, major depressive disorder, dysthymia; mainly mild/moderate severity, low suicidality.</p>d<p>Mainly GAD, social anxiety disorder, panic disorder; also major depressive disorder (<i>k</i> = 2).</p>", "links"=>[], "tags"=>["psychology", "Clinical psychology", "Mental health and psychiatry", "Anxiety disorders", "Obsessive-compulsive disorder", "Post-traumatic stress disorder", "Mental health therapies", "psychotherapy", "Mood disorders", "depression", "controlled", "trials", "having"], "article_id"=>1032387, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Filip K. Arnberg", "Steven J. Linton", "Monica Hultcrantz", "Emelie Heintz", "Ulf Jonsson"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0098118.t001", "stats"=>{"downloads"=>7, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Randomized_controlled_trials_assessed_as_having_low_or_moderate_risk_of_bias_/1032387", "title"=>"Randomized controlled trials assessed as having low or moderate risk of bias.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-05-20 03:34:35"}
  • {"files"=>["https://ndownloader.figshare.com/files/1504888"], "description"=>"<p>For the meta-analysis, the outcome chosen from each study was the Penn State Worry Questionnaire.</p>", "links"=>[], "tags"=>["psychology", "Clinical psychology", "Mental health and psychiatry", "Anxiety disorders", "Obsessive-compulsive disorder", "Post-traumatic stress disorder", "Mental health therapies", "psychotherapy", "Mood disorders", "depression", "efficacy", "internet-based", "waiting", "generalized"], "article_id"=>1032386, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Filip K. Arnberg", "Steven J. Linton", "Monica Hultcrantz", "Emelie Heintz", "Ulf Jonsson"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0098118.g005", "stats"=>{"downloads"=>3, "page_views"=>16, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Short_term_efficacy_of_internet_based_cognitive_behavioral_therapy_I_CBT_vs_waiting_list_for_generalized_anxiety_disorder_in_adults_/1032386", "title"=>"Short-term efficacy of internet-based cognitive behavioral therapy (I-CBT) vs. waiting list for generalized anxiety disorder in adults.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-05-20 03:34:35"}
  • {"files"=>["https://ndownloader.figshare.com/files/1504882"], "description"=>"<p>Flowchart of included efficacy trials and additional reports of long-term follow-up assessments.</p>", "links"=>[], "tags"=>["psychology", "Clinical psychology", "Mental health and psychiatry", "Anxiety disorders", "Obsessive-compulsive disorder", "Post-traumatic stress disorder", "Mental health therapies", "psychotherapy", "Mood disorders", "depression", "included", "efficacy", "trials", "reports", "follow-up"], "article_id"=>1032380, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Filip K. Arnberg", "Steven J. Linton", "Monica Hultcrantz", "Emelie Heintz", "Ulf Jonsson"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0098118.g001", "stats"=>{"downloads"=>0, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Flowchart_of_included_efficacy_trials_and_additional_reports_of_long_term_follow_up_assessments_/1032380", "title"=>"Flowchart of included efficacy trials and additional reports of long-term follow-up assessments.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-05-20 03:34:35"}
  • {"files"=>["https://ndownloader.figshare.com/files/1504891", "https://ndownloader.figshare.com/files/1504892", "https://ndownloader.figshare.com/files/1504893", "https://ndownloader.figshare.com/files/1504894"], "description"=>"<div><p>Background</p><p>Greater access to evidence-based psychological treatments is needed. This review aimed to evaluate whether internet-delivered psychological treatments for mood and anxiety disorders are efficacious, noninferior to established treatments, safe, and cost-effective for children, adolescents and adults.</p><p>Methods</p><p>We searched the literature for studies published until March 2013. Randomized controlled trials (RCTs) were considered for the assessment of short-term efficacy and safety and were pooled in meta-analyses. Other designs were also considered for long-term effect and cost-effectiveness. Comparisons against established treatments were evaluated for noninferiority. Two reviewers independently assessed the relevant studies for risk of bias. The quality of the evidence was graded using an international grading system.</p><p>Results</p><p>A total of 52 relevant RCTs were identified whereof 12 were excluded due to high risk of bias. Five cost-effectiveness studies were identified and three were excluded due to high risk of bias. The included trials mainly evaluated internet-delivered cognitive behavioral therapy (I-CBT) against a waiting list in adult volunteers and 88% were conducted in Sweden or Australia. One trial involved children. For adults, the quality of evidence was graded as moderate for the short-term efficacy of I-CBT vs. waiting list for mild/moderate depression (<i>d</i> = 0.83; 95% CI 0.59, 1.07) and social phobia (<i>d</i> = 0.85; 95% CI 0.66, 1.05), and moderate for no efficacy of internet-delivered attention bias modification vs. sham treatment for social phobia (<i>d</i> = −0.04; 95% CI −0.24, 0.35). The quality of evidence was graded as low/very low for other disorders, interventions, children/adolescents, noninferiority, adverse events, and cost-effectiveness.</p><p>Conclusions</p><p>I-CBT is a viable treatment option for adults with depression and some anxiety disorders who request this treatment modality. Important questions remain before broad implementation can be supported. Future research would benefit from prioritizing adapting treatments to children/adolescents and using noninferiority designs with established forms of treatment.</p></div>", "links"=>[], "tags"=>["psychology", "Clinical psychology", "Mental health and psychiatry", "Anxiety disorders", "Obsessive-compulsive disorder", "Post-traumatic stress disorder", "Mental health therapies", "psychotherapy", "Mood disorders", "depression", "treatments", "systematic"], "article_id"=>1032389, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Filip K. Arnberg", "Steven J. Linton", "Monica Hultcrantz", "Emelie Heintz", "Ulf Jonsson"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0098118.s001", "https://dx.doi.org/10.1371/journal.pone.0098118.s002", "https://dx.doi.org/10.1371/journal.pone.0098118.s003", "https://dx.doi.org/10.1371/journal.pone.0098118.s004"], "stats"=>{"downloads"=>14, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Internet_Delivered_Psychological_Treatments_for_Mood_and_Anxiety_Disorders_A_Systematic_Review_of_Their_Efficacy_Safety_and_Cost_Effectiveness_/1032389", "title"=>"Internet-Delivered Psychological Treatments for Mood and Anxiety Disorders: A Systematic Review of Their Efficacy, Safety, and Cost-Effectiveness", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2014-05-20 03:34:35"}
  • {"files"=>["https://ndownloader.figshare.com/files/1504890"], "description"=>"<p>ABM =  Attention bias modification. ADIS =  Anxiety Disorders Interview Schedule. BAT =  Behavioral approach test. BDI =  Beck Depression Inventory (I or II). BSQ =  Body Sensations Questionnaire. CBT =  Cognitive behavior therapy. FQ =  Fear Questionnaire. GAD =  Generalized anxiety disorder. GAI =  Generalized Anxiety Inventory. LSAS =  Liebowitz Social Anxiety Scale. OCD =  Obsessive-compulsive disorder. PCL-C =  PTSD Checklist–Civilian version. PDSS =  Panic Disorder Severity Scale, Self-Report. PDT =  Psychodynamic therapy. PSWQ =  Penn State Worry Questionnaire. SIAS =  Social Interaction Anxiety Scale. PTSD =  Posttraumatic stress disorder. SPS =  Social Phobia Scale. Y-BOCS =  Yale-Brown Obsessive-Compulsive Scale.</p>a<p>Study limitations (risk of bias);</p>b<p>Imprecision (e.g., small samples, heterogeneous effect sizes);</p>c<p>Indirectness (e.g., single trial).</p>", "links"=>[], "tags"=>["psychology", "Clinical psychology", "Mental health and psychiatry", "Anxiety disorders", "Obsessive-compulsive disorder", "Post-traumatic stress disorder", "Mental health therapies", "psychotherapy", "Mood disorders", "depression", "efficacy", "internet-delivered", "treatments"], "article_id"=>1032388, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Filip K. Arnberg", "Steven J. Linton", "Monica Hultcrantz", "Emelie Heintz", "Ulf Jonsson"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0098118.t002", "stats"=>{"downloads"=>6, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Evidence_of_Short_term_Efficacy_of_Internet_Delivered_Psychological_Treatments_for_Mood_and_Anxiety_Disorders_/1032388", "title"=>"Evidence of Short-term Efficacy of Internet-Delivered Psychological Treatments for Mood and Anxiety Disorders.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-05-20 03:34:35"}
  • {"files"=>["https://ndownloader.figshare.com/files/1504885"], "description"=>"<p>For the meta-analysis, the outcome chosen from each study was the Social Interaction Anxiety Scale.</p>", "links"=>[], "tags"=>["psychology", "Clinical psychology", "Mental health and psychiatry", "Anxiety disorders", "Obsessive-compulsive disorder", "Post-traumatic stress disorder", "Mental health therapies", "psychotherapy", "Mood disorders", "depression", "efficacy", "therapist-guided", "internet-based", "waiting", "phobia"], "article_id"=>1032383, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Filip K. Arnberg", "Steven J. Linton", "Monica Hultcrantz", "Emelie Heintz", "Ulf Jonsson"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0098118.g003", "stats"=>{"downloads"=>1, "page_views"=>12, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Short_term_efficacy_of_therapist_guided_internet_based_cognitive_behavioral_therapy_I_CBT_vs_waiting_list_for_social_phobia_in_adults_/1032383", "title"=>"Short-term efficacy of therapist-guided internet-based cognitive behavioral therapy (I-CBT) vs. waiting list for social phobia in adults.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-05-20 03:34:35"}

PMC Usage Stats | Further Information

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Relative Metric

{"start_date"=>"2014-01-01T00:00:00Z", "end_date"=>"2014-12-31T00:00:00Z", "subject_areas"=>[{"subject_area"=>"/Biology and life sciences", "average_usage"=>[291]}, {"subject_area"=>"/Medicine and health sciences/Mental health and psychiatry", "average_usage"=>[299, 481]}, {"subject_area"=>"/People and places/Geographical locations", "average_usage"=>[298]}, {"subject_area"=>"/People and places/Population groupings", "average_usage"=>[300]}, {"subject_area"=>"/Social sciences/Psychology", "average_usage"=>[314, 476]}]}
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