Introduction
Evidence of effectiveness of iCBT
iCBT for military and veteran populations
Aims and scope of review
Methods
Search terms
Inclusion and exclusion criteria
Study selection
Data extraction
Data Analysis
Results
Study characteristics
Study | Study Condition | Specific Control Condition | Outcome Measured | Target Outcome |
N
|
g
|
SE
| Pre- | Post | ||
---|---|---|---|---|---|---|---|---|---|---|---|
M
|
SD
|
M
|
SD
| ||||||||
Acosta et al. (2017) | Control (TAU) | VA Care Services | Substance Use | Primary | 69 | 0.43 | 0.08 | 27.60 | 24.90 | 17.50 | 20.30 |
Control (TAU) | VA Care Services | PTSD | Primary | 69 | 0.49 | 0.09 | 46.90 | 10.60 | 40.90 | 12.80 | |
Control (TAU) | VA Care Services | QoL | Secondary | 69 | 0.40 | 0.08 | 46.90 | 22.50 | 56.20 | 23.00 | |
iCBT | -- | Substance Use | Primary | 55 | 0.12 | 0.09 | 20.10 | 25.20 | 17.30 | 21.90 | |
iCBT | -- | PTSD | Primary | 55 | 0.46 | 0.10 | 47.40 | 13.30 | 41.20 | 13.10 | |
iCBT | -- | QoL | Secondary | 55 | 0.26 | 0.09 | 52.70 | 22.80 | 59.10 | 25.40 | |
Belsher et al. (2015 | iCBT | -- | PTSD | Primary | 12 | 0.42 | 0.19 | 54.30 | 13.58 | 47.90 | 14.72 |
Cooper et al. (2017) | Control (Active) | Psychoeducation | Health & Functioning | Primary | 34 | 0.63 | 0.12 | 115.68 | 32.94 | 136.32 | 30.65 |
iCBT | -- | Health & Functioning | Primary | 32 | 0.68 | 0.13 | 105.56 | 38.36 | 130.69 | 27.65 | |
Dobkin et al. (2020) | Control (TAU) | VA Care Services | Anxiety | Secondary | 39 | 0.05 | 0.11 | 23.49 | 4.57 | 23.77 | 5.25 |
Control (TAU) | VA Care Services | Behavior | Secondary | 39 | -0.16 | 0.11 | 25.31 | 6.98 | 26.69 | 9.04 | |
Control (TAU) | VA Care Services | Health & Functioning | Secondary | 39 | -0.14 | 0.11 | 32.01 | 8.98 | 30.65 | 9.40 | |
Control (TAU) | VA Care Services | QoL | Secondary | 39 | 0.12 | 0.11 | 50.84 | 26.17 | 47.39 | 28.12 | |
Control (TAU) | VA Care Services | Depression | Primary | 39 | 0.05 | 0.11 | 21.60 | 4.30 | 21.37 | 5.27 | |
iCBT | -- | Depression | Primary | 39 | 1.21 | 0.14 | 22.49 | 3.85 | 16.46 | 5.18 | |
iCBT | -- | Anxiety | Secondary | 39 | 0.76 | 0.12 | 24.15 | 4.14 | 20.10 | 5.55 | |
iCBT | -- | Behavior | Secondary | 39 | 0.80 | 0.12 | 25.16 | 6.02 | 31.39 | 8.15 | |
iCBT | -- | Health & Functioning | Secondary | 39 | 0.29 | 0.11 | 33.23 | 8.02 | 35.72 | 8.49 | |
iCBT | -- | QoL | Secondary | 39 | 0.55 | 0.11 | 47.50 | 20.75 | 59.19 | 20.71 | |
Engel et al. (2015) | Control (TAU) | PTSD Care | PTSD | Primary | 29 | 0.44 | 0.13 | 54.48 | 11.23 | 48.52 | 13.87 |
Control (TAU) | PTSD Care | Depression | Secondary | 29 | 0.28 | 0.13 | 11.67 | 4.65 | 10.24 | 5.12 | |
iCBT | -- | PTSD | Primary | 29 | 0.38 | 0.13 | 58.00 | 9.95 | 50.72 | 18.76 | |
iCBT | -- | Depression | Secondary | 29 | 0.39 | 0.13 | 13.53 | 5.43 | 11.00 | 6.65 | |
Engel et al. (2021) | Control (Waitlist) | -- | PTSD | Primary | 13 | 0.19 | 0.18 | 33.59 | 15.34 | 30.46 | 15.51 |
iCBT | -- | PTSD | Primary | 8 | 0.09 | 0.21 | 33.50 | 14.88 | 31.75 | 17.53 | |
Herbst et al. (2018) | iCBT | -- | Substance Use | Primary | 20 | 1.19 | 0.19 | 4.40 | 2.20 | 1.80 | 1.90 |
iCBT | -- | Health & Functioning | Secondary | 20 | 0.32 | 0.15 | 37.00 | 23.70 | 29.40 | 22.30 | |
Hobfoll et al. (2016) | Control (Waitlist) | -- | PTSD | Primary | 94 | -0.15 | 0.07 | 37.46 | 11.48 | 39.21 | 11.18 |
Control (Waitlist) | -- | Depression | Secondary | 94 | 0.04 | 0.07 | 12.40 | 5.36 | 12.17 | 5.08 | |
iCBT | -- | PTSD | Primary | 209 | 0.37 | 0.05 | 40.03 | 11.19 | 35.95 | 10.93 | |
iCBT | -- | Depression | Secondary | 209 | 0.25 | 0.05 | 12.45 | 5.36 | 11.11 | 5.52 | |
Litz et al. (2007) | Control (Active) | Supportive Counselling | Anxiety | Secondary | 17 | 0.55 | 0.17 | 20.92 | 15.00 | 12.59 | 13.45 |
Control (Active) | Supportive Counselling | Depression | Secondary | 17 | 0.57 | 0.17 | 24.43 | 12.08 | 17.47 | 11.19 | |
Control (Active) | Supportive Counselling | PTSD | Primary | 17 | 0.80 | 0.18 | 29.16 | 9.93 | 20.00 | 11.50 | |
iCBT | -- | Anxiety | Secondary | 14 | 0.92 | 0.21 | 18.70 | 10.60 | 8.43 | 5.93 | |
iCBT | -- | Depression | Secondary | 14 | 0.66 | 0.19 | 18.87 | 9.52 | 12.14 | 9.56 | |
iCBT | -- | PTSD | Primary | 14 | 0.88 | 0.20 | 26.71 | 9.02 | 14.86 | 13.35 | |
Mackintosh et al. (2017) | Control (Active) | Anger Management Treatment | PTSD | Primary | 30 | 2.39 | 0.24 | 50.30 | 19.70 | 43.40 | 12.30 |
Control (Active) | Anger Management Treatment | Depression | Secondary | 30 | 0.46 | 0.13 | 14.00 | 7.34 | 8.30 | 12.30 | |
Control (Active) | Anger Management Treatment | Health & Functioning | Secondary | 30 | 0.15 | 0.12 | 3.30 | 1.69 | 2.60 | 4.27 | |
Control (Active) | Anger Management Treatment | Anxiety | Primary | 30 | 0.74 | 0.14 | 48.90 | 8.05 | 38.30 | 14.20 | |
Control (Active) | Anger Management Treatment | Health & Functioning | Secondary | 30 | 0.50 | 0.13 | 17.20 | 4.11 | 12.60 | 8.65 | |
iCBT | -- | Anxiety | Primary | 28 | 0.81 | 0.14 | 46.40 | 9.05 | 37.90 | 10.80 | |
iCBT | -- | Health & Functioning | Secondary | 28 | 0.40 | 0.13 | 15.50 | 3.70 | 10.70 | 10.30 | |
iCBT | -- | PTSD | Primary | 28 | -0.19 | 0.13 | 43.30 | 17.90 | 32.30 | 49.40 | |
iCBT | -- | Depression | Secondary | 28 | 0.13 | 0.13 | 12.30 | 5.40 | 8.90 | 21.50 | |
iCBT | -- | Health & Functioning | Secondary | 28 | -0.07 | 0.12 | 2.80 | 1.80 | 2.30 | 5.70 | |
Mohr et al. (2011) | Control (TAU) | Outpatient Clinic | Depression | Primary | 29 | 0.38 | 0.13 | 19.23 | 3.72 | 17.27 | 5.29 |
iCBT | -- | Depression | Primary | 20 | 0.64 | 0.16 | 20.83 | 3.96 | 16.71 | 6.42 | |
Nelson et al. (2014) | iCBT | -- | Depression | Primary | 19 | 0.28 | 0.15 | 21.86 | 11.11 | 18.21 | 13.20 |
iCBT | -- | Anxiety | Secondary | 19 | 0.39 | 0.16 | 16.36 | 12.42 | 11.57 | 10.15 | |
iCBT | -- | Health & Functioning | Secondary | 19 | 0.33 | 0.15 | 25.93 | 11.68 | 29.86 | 10.75 | |
Pfeiffer et al. (2020) | Control (TAU) | Primary or Integrated Care | Depression | Primary | 128 | 0.43 | 0.06 | 13.40 | 3.60 | 11.70 | 4.10 |
Control (TAU) | Primary or Integrated Care | Health & Functioning | Secondary | 128 | 0.40 | 0.06 | 32.10 | 9.90 | 36.20 | 10.30 | |
Control (TAU) | Primary or Integrated Care | QoL | Secondary | 128 | 0.18 | 0.06 | 38.80 | 8.70 | 40.50 | 9.90 | |
iCBT | -- | Depression | Primary | 108 | 0.65 | 0.07 | 14.00 | 3.90 | 11.10 | 4.70 | |
iCBT | -- | Health & Functioning | Secondary | 108 | 0.54 | 0.07 | 31.40 | 9.70 | 37.30 | 11.50 | |
iCBT | -- | QoL | Secondary | 108 | 0.41 | 0.07 | 37.70 | 8.30 | 41.60 | 9.90 | |
Possemato et al. (2016) | Control (Active) | Self-Managed PTSD Coach | PTSD | Primary | 10 | 0.33 | 0.20 | 56.00 | 15.30 | 49.80 | 18.10 |
Control (Active) | Self-Managed PTSD Coach | Depression | Secondary | 10 | 0.26 | 0.20 | 11.30 | 9.70 | 8.70 | 8.30 | |
Control (Active) | Self-Managed PTSD Coach | QoL | Secondary | 10 | -0.35 | 0.20 | 63.30 | 29.20 | 52.60 | 25.50 | |
iCBT | -- | PTSD | Primary | 10 | 0.98 | 0.25 | 51.00 | 7.70 | 40.00 | 10.90 | |
iCBT | -- | Depression | Secondary | 10 | 0.32 | 0.20 | 11.60 | 6.70 | 9.40 | 5.50 | |
iCBT | -- | QoL | Secondary | 10 | 0.50 | 0.21 | 37.50 | 19.70 | 47.70 | 16.10 | |
Possemato et al. (2019)a | iCBT | -- | PTSD | Primary | 9 | 0.41 | 0.21 | 48.20 | 11.61 | 41.78 | 14.90 |
iCBT | -- | Substance Use | Secondary | 9 | 0.16 | 0.21 | 12.60 | 8.10 | 11.17 | 7.58 | |
iCBT | -- | QoL | Secondary | 9 | 0.54 | 0.22 | 47.76 | 19.39 | 63.45 | 27.62 | |
iCBT | -- | Health & Functioning | Secondary | 9 | 0.79 | 0.24 | 1.08 | 0.40 | 1.63 | 0.65 | |
iCBT | -- | Depression | Primary | 9 | 0.17 | 0.21 | 59.31 | 13.03 | 62.23 | 15.99 | |
Possemato et al. (2019)b | iCBT | -- | PTSD | Primary | 11 | 0.63 | 0.21 | 51.87 | 9.01 | 43.16 | 13.42 |
iCBT | -- | Substance Use | Secondary | 11 | 0.27 | 0.19 | 13.30 | 8.70 | 10.77 | 8.52 | |
iCBT | -- | QoL | Secondary | 11 | 0.47 | 0.20 | 43.78 | 16.42 | 53.42 | 20.10 | |
iCBT | -- | Health & Functioning | Secondary | 11 | 0.47 | 0.20 | 1.44 | 0.49 | 1.76 | 0.67 | |
iCBT | -- | Depression | Primary | 11 | 0.24 | 0.19 | 57.47 | 12.45 | 60.99 | 14.34 | |
Pulantara et al. (2018) | iCBT | -- | Behavior | Primary | 27 | 2.13 | 0.23 | 15.59 | 4.13 | 5.63 | 4.76 |
iCBT | -- | PTSD | Secondary | 27 | 0.81 | 0.15 | 38.41 | 14.10 | 27.22 | 11.87 | |
iCBT | -- | Depression | Secondary | 27 | 0.88 | 0.15 | 8.41 | 5.22 | 3.63 | 5.34 | |
iCBT | -- | Anxiety | Secondary | 27 | 0.60 | 0.14 | 6.17 | 5.32 | 2.91 | 2.94 | |
Stecker et al. (2014) | Control (TAU) | Access to Usual Services | PTSD | Primary | 151 | 0.37 | 0.06 | 59.70 | 11.70 | 55.00 | 13.10 |
Control (TAU) | Access to Usual Services | Depression | Secondary | 151 | 0.54 | 0.06 | 16.40 | 4.80 | 13.80 | 4.80 | |
iCBT | -- | PTSD | Primary | 123 | 0.61 | 0.07 | 59.20 | 11.80 | 51.30 | 13.60 | |
iCBT | -- | Depression | Secondary | 123 | 0.66 | 0.07 | 16.30 | 4.70 | 12.80 | 5.60 | |
Taylor et al. (2017) | Control (Active) | In-Person CBT | Behavior | Primary | 34 | 2.95 | 0.27 | 72.50 | 2.10 | 79.40 | 2.40 |
Control (TAU) | Phone Call Assessments | Behavior | Primary | 33 | 0.09 | 0.12 | 72.90 | 2.20 | 73.10 | 2.30 | |
iCBT | -- | Behavior | Primary | 33 | 5.02 | 0.43 | 73.20 | 2.20 | 84.50 | 2.20 | |
Timmons (1997) | Control (Active) | Stress Inoculation Training | Anxiety | Primary | 16 | 0.65 | 0.18 | 62.25 | 10.09 | 55.56 | 6.40 |
Control (Waitlist) | -- | Anxiety | Primary | 16 | -0.20 | 0.16 | 60.75 | 9.84 | 63.00 | 11.54 | |
iCBT | -- | Anxiety | Primary | 16 | 0.40 | 0.17 | 60.25 | 10.90 | 55.94 | 8.42 | |
Voorhees et al. (2012) | iCBT | -- | Depression | Secondary | 50 | 0.37 | 0.10 | 8.90 | 4.00 | 7.30 | 4.40 |
iCBT | -- | PTSD | Primary | 50 | 0.27 | 0.10 | 35.00 | 10.80 | 32.00 | 11.40 | |
iCBT | -- | QoL | Secondary | 50 | 0.01 | 0.09 | 44.60 | 10.80 | 44.50 | 11.40 |
Overall analyses
Effects of iCBT on primary outcomes across outcomes measured
Effects of iCBT on secondary outcomes across outcomes measured
Meta-regression
Model |
B
|
SE
| 95% CI |
Z
|
Q
|
df
| |
---|---|---|---|---|---|---|---|
Lower | Upper | ||||||
Continuous Predictors
| -- | -- | -- | -- | -- | 8.64* | 3 |
Age | 0.01 | 0.00 | -0.00 | 0.01 | 1.33 | -- | -- |
Dropout Rate | -0.00 | 0.00 | -0.01 | 0.01 | -0.32 | -- | -- |
Length of Intervention | -0.04 | 0.01 | -0.07 | -0.02 | -2.87** | -- | -- |
Effects of iCBT on Study Outcomes across categorical predictors
Overall
Intervention Outcome |
k
|
g
|
SE
| 95% CI |
Z
|
Q
| |
---|---|---|---|---|---|---|---|
Lower | Upper | ||||||
Concurrent Treatment
| 7.84** | ||||||
Yes | 37 | 0.62a | 0.06 | 0.50 | 0.74 | 10.04*** | |
No | 19 | 0.40 | 0.05 | 0.30 | 0.50 | 7.89*** | |
Delivery
| 0.42 | ||||||
Facilitated | 33 | 0.52a | 0.04 | 0.44 | 0.61 | 12.11*** | |
Self-Guided | 23 | 0.58a | 0.08 | 0.42 | 0.74 | 7.23*** | |
Format
| 5.33 | ||||||
Web | 26 | 0.46a | 0.07 | 0.33 | 0.58 | 6.99*** | |
Mobile App | 14 | 0.64a | 0.12 | 0.41 | 0.88 | 5.31*** | |
Computer | 13 | 0.56a | 0.06 | 0.44 | 0.68 | 9.16*** | |
Phone^ | 3 | -- | -- | -- | -- | -- | |
Gender
| 3.21 | ||||||
Males | 33 | 0.47a | 0.05 | 0.37 | 0.57 | 8.93*** | |
Mixed | 23 | 0.63a | 0.07 | 0.49 | 0.77 | 8.86*** | |
Females^ | 0 | -- | -- | -- | -- | -- | |
Outcomes Measured
| 11.64 | ||||||
Depression | 14 | 0.49a | 0.08 | 0.34 | 0.65 | 6.33*** | |
PTSD | 13 | 0.47a | 0.06 | 0.36 | 0.59 | 8.01*** | |
Health & Functioning | 9 | 0.42a | 0.07 | 0.28 | 0.55 | 6.10*** | |
Quality of Life | 7 | 0.36 | 0.09 | 0.19 | 0.53 | 4.19*** | |
Anxiety | 6 | 0.64a | 0.08 | 0.48 | 0.80 | 7.77*** | |
Substance Use^ | 4 | -- | -- | -- | -- | -- | |
Behavior^ | 3 | -- | -- | -- | -- | -- |
Primary outcomes
Intervention Outcome & Moderators |
k
|
g
|
SE
| 95% CI |
Z
|
Q
| |
---|---|---|---|---|---|---|---|
Lower | Upper | ||||||
Concurrent Treatment
| 6.12* | ||||||
Yes | 15 | 0.88a | 0.14 | 0.61 | 1.15 | 6.39*** | |
No | 10 | 0.48a | 0.09 | 0.30 | 0.65 | 5.35*** | |
Delivery
| 2.30 | ||||||
Facilitated | 14 | 0.61a | 0.08 | 0.46 | 0.76 | 7.91*** | |
Self-Guided | 11 | 0.89a | 0.17 | 0.56 | 1.21 | 5.29*** | |
Format
| 2.24 | ||||||
Web | 13 | 0.59a | 0.13 | 0.35 | 0.84 | 4.69*** | |
Mobile App | 5 | 1.09a | 0.32 | 0.46 | 1.72 | 3.38** | |
Computer | 5 | 0.67a | 0.14 | 0.39 | 0.94 | 4.79*** | |
Phone^ | 2 | -- | -- | -- | -- | -- | |
Gender
| 4.61* | ||||||
Males | 16 | 0.56a | 0.10 | 0.38 | 0.75 | 5.93*** | |
Mixed | 9 | 0.97a | 0.17 | 0.65 | 1.30 | 5.90*** | |
Females^ | 0 | -- | -- | -- | -- | -- |
Secondary outcomes
Intervention Outcome & Moderators |
k
|
g
|
SE
| 95% CI |
Z
|
Q
| |
---|---|---|---|---|---|---|---|
Lower | Upper | ||||||
Concurrent Treatment
| 4.25* | ||||||
Yes | 22 | 0.52a | 0.06 | 0.40 | 0.64 | 8.57*** | |
No | 9 | 0.35 | 0.06 | 0.24 | 0.46 | 6.21*** | |
Delivery
| 0.76 | ||||||
Facilitated | 19 | 0.50a | 0.05 | 0.39 | 0.60 | 9.44*** | |
Self-Guided | 12 | 0.42a | 0.07 | 0.28 | 0.56 | 5.77*** | |
Format
| 8.34* | ||||||
Web | 13 | 0.39 | 0.07 | 0.26 | 0.52 | 5.89*** | |
Mobile App | 9 | 0.46a | 0.10 | 0.26 | 0.66 | 4.47*** | |
Computer | 8 | 0.52a | 0.06 | 0.40 | 0.64 | 8.56*** | |
Phone^ | 1 | -- | -- | -- | -- | -- | |
Gender
| 0.67 | ||||||
Males | 17 | 0.43a | 0.06 | 0.31 | 0.55 | 6.97*** | |
Mixed | 14 | 0.50a | 0.07 | 0.37 | 0.63 | 7.52*** | |
Females^ | 0 | -- | -- | -- | -- | -- |