The Effectiveness of Online CBT in Routine Clinical Practice (2012)

Ruwaard, J., Lange, A., Schrieken, B., Dolan, C.V., & Emmelkamp, P. (2012). The effectiveness of online cognitive behavioral treatment in routine clinical practice. PLoS One, doi: 10.1002/cpp.1767

ABSTRACT CONTEXT: Randomized controlled trails have identified online cognitive behavioral therapy as an efficacious intervention in the management of common mental health disorders. OBJECTIVE: To assess the effectiveness of online CBT for different mental disorders in routine clinical practice. DESIGN: An uncontrolled before-after study, with measurements at baseline, posttest, 6-week follow-up, and 1-year follow-up. PARTICIPANTS & SETTING: 1500 adult patients (female: 67%; mean age: 40 years) with a GP referral for psychotherapy were treated at a Dutch online mental health clinic for symptoms of depression (n = 413), panic disorder (n = 139), posttraumatic stress (n = 478), or burnout (n = 470). INTERVENTIONS: Manualized, web-based, therapist-assisted CBT, of which the efficacy was previously demonstrated in a series of controlled trials. Standardized duration of treatment varied from 5 weeks (online CBT for Posttraumatic stress) to 16 weeks (online CBT for Depression). MAIN OUTCOME MEASURES: Validated self-report questionnaires of specific and general psychopathology, including the Beck Depression Inventory, the Impact of Event Scale, the Panic Disorder Severity Scale-Self Report, the Oldenburg Burnout Inventory, and the Depression Anxiety Stress Scales. RESULTS: Treatment adherence was 71% (n =1071). Study attrition was 21% at posttest, 33% at 6-week FU and 65% at 1-year FU. Mixed-model repeated measures regression identified large short-term reductions in all measures of primary symptoms (d = 1.9 ± 0.2 to d = 1.2 ± 0.2; P < .001), which sustained up to one year after treatment. At posttest, rates of reliable improvement and recovery were 71% and 52% in the completer sample (full sample: 55%/40%). Patient satisfaction was high. CONCLUSIONS: Results suggest that online therapist-assisted CBT may be as effective in routine practice as it is in clinical trials. Although pre-treatment withdrawal and long-term outcomes require further study, results warrant continued implementation of online CBT.

Keywords Cognitive Behavior Therapy/*methods; Internet; Computer assisted protocol directed therapy; Effectiveness Studies; Follow-Up Studies; Internet Intervention; Treatment Outcome;