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Internet-based CBT apps may benefit more people with depression

After performing a systematic review and meta-regression analysis, researchers found that the patient population sampled in the literature on self-guided internet-based cognitive behavioral therapies was similar to that of antidepressant or face-to-face psychotherapy studies.

These findings indicate that internet-based CBT has the potential to help a larger number of patients with depression than previously believed, according to researchers.

“Before this study, I thought past studies were probably focused on people with very mild depression, those who did not have other mental health problems, and were at low risk for suicide. To my surprise, that was not the case,” Lorenzo Lorenzo-Luaces, PhD, from the department of psychological and brain sciences at Indiana University Bloomington, said in a press release. “The science suggests that these apps and platforms can help a large number of people.”

The investigators hypothesized that self-guided internet-based CBT studies use stricter criteria that would bias the sample toward individuals with a less complex depression, and therefore overestimate treatment outcomes.

To determine the generalizability of the research on self-guided internet-based CBT, researchers updated a previously published meta-analysis by conducting a systematic literature search of clinical evidence and meta-regression analysis to test the effect of the different commonly used psychiatric entry criteria on the treatment-control differences. They also compared how often self-guided internet-based CBT studies vs. studies of face-to-face psychotherapy and antidepressant studies used exclusion criteria.

Lorenzo-Luaces and colleagues reviewed 21 studies including 4,781 participants. In their updated meta-analysis, the researchers found that at the study level, self-guided internet-based CBT was linked to more improvement in depression than the control conditions (g = 0.33; 95% CI, 0.2-0.46).

Analysis revealed that although only six of 21 self-guided internet-based CBT studies excluded patients with severe depressive symptoms, these studies were more likely than antidepressant studies to use this criterion (29% vs. 8.2%). Internet-based CBT studies did not use this criterion more often than face-to-face psychotherapy studies (38%), according to the results.

The analysis yielded no other evidence that self-guided internet-based CBTs used stricter entry criteria. On the contrary, strong evidence indicated that these studies were less likely to use most entry criteria — particularly exclusions on the basis of substance use or personality pathology, according to the researchers.

"Close to one in four people meet the criteria for major depressive disorder. If you include people with minor depression or who have been depressed for a week or a month with a few symptoms, the number grows, exceeding the number of psychologists who can serve them,” Lorenzo-Luaces said in the release. "This is not to say that you should stop taking your medication and go to the nearest app store. Internet CBT apps take the methods we have learned and make them available to the many people who could benefit from them. It's an exciting development." – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.