Introduction
Methods
Literature search strategy
Study selection
Study appraisal and data analysis
Results
Study selection and background
Study | Population/recruitment | Inclusion/exclusion | Conditions | Therapist guidance: therapist background | Dropout (%) |
---|---|---|---|---|---|
Abbott et al. (2009) Australia N = 27 | Population: Tinnitus | Inclusion: Adults 18–65 years, tinnitus for at least 3 months, diagnosed by physician, employed at organizations including BP Australia and BHP Billiton | Therapist-guided: Registered psychologist or trainees | 12 | |
Recruitment strategy: Work place | Exclusion: Currently receiving other psychological treatment for tinnitus | Information-only control: received weekly emails from therapist on non-CBT treatment content. Content consisted of basic psychoeducation related to tinnitus without the CBT component. Participants were provided weekly quizzes to assess memory of the weekly content. Minimal support regarding tinnitus status and coping was provided by therapist | 4 | ||
Andersson et al. (2002) Sweden N = 107 | Population: Tinnitus | Inclusion: Adults 16–70 years, tinnitus for at least 6 months, tinnitus diagnosed by physician, tinnitus a severe issue | ICBT: Composed of 10 components and 6 modules delivered over 6 weeks. Therapists responded to queries form participants as soon as possible. Participants also received weekly emails regarding next module | Therapist-guided: Not stated | 18 |
Recruitment strategy: Community through newspaper articles, and community websites | Waitlist control group: Completed questionnaires did not receive weekly support | ||||
Buhrman et al. 2004 Sweden N = 56 | Population: Chronic pain | Inclusion: Adults 18–65 years, chronic pain for longer than 3 months | ICBT: A 6 week CBT based program consisting of 6 modules was provided. Participants received a 10 min weekly telephone support by a trained therapist. Automated reminder emails were also sent each week | Therapist-guided: Graduate students trained in CBT and a clinical psychologist | 9 |
Recruitment strategy: Community through newspaper articles, and community websites | Exclusion: Bound to wheelchair, planned surgical treatment, other heart or vascular disease, other pain consequently to activity | Waiting-list control: No weekly support was provided | |||
Buhrman et al. (2011) Sweden N = 54 | Population: Chronic pain | Inclusion: Adults 18–65 years, chronic pain for longer than 3 months, currently employed or on short term sick leave, not a wheelchair user, no planned surgery, no history of cardiovascular disease | ICBT: An 8 module program was delivered over 12 weeks. Participants received guidance by a therapist each week along with automated reminder emails and weekly homework assignments | Therapist-guided: Graduate students trained in CBT and a clinical psychologist | 7 |
Recruitment strategy: Community through newspaper articles, and community websites | Waiting-list control: No weekly support was provided | ||||
Carpenter et al. (2012) United States N = 141 | Population: Chronic pain | Inclusion: Adults 21 years or older, chronic pain for longer than 6 months, average pain of 4 or above on 11 point scale | ICBT: Consisted of 6 modules over a 3 week period. Participants were asked to complete 2 chapters per week. Those that did not log in each week received a reminder email by a research assistant | Self-guided: N/A | 18 |
Recruitment strategy: Community online websites, newspapers, advertisements | Exclusion: Participating in multidisciplinary CBT from chronic pain program in the last 3 years | Waiting-list control: No weekly support was provided | |||
Chiauzzi et al. (2010) United States N = 199 | Population: Chronic pain | Inclusion: Adults 18 years or older, Pain present at least 10 days a month for at least 3 consecutive months, spinal origin of pain | ICBT: Participants received two weekly lessons related to CBT for chronic pain over 4 weeks for a total of 8 sessions | Self-guided: N/A | 15 |
Recruitment strategy: Community through newspaper articles, community websites, and community pain clinics | Exclusion: Other origins of pain including fibromyalgia, or rheumatoid disorders, cervical pain without low back pain, psychiatric hospitalization in the past year | Information-only control: received an email copy of a back pain guide developed by the National Institute of neurological Disorders and Stroke. Participants were asked to read the guide over a 4 week program | |||
Compen et al. (2018) The Netherlands N = 245 | Population: Cancer | Inclusion: diagnosis of cancer, score of 11 or greater on the HADS | ICBT: Participants were delivered an internet based mindfulness based cognitive therapy program over 8 weeks with therapist guidance over email. Each week guides provided written feedback on homework assignments | Therapist guided: Therapist meeting criteria for the UK mindfulness-based teacher therapist network good practice guidelines for teaching MBIs | 10% |
Recruitment strategy: Online and media, patient associations, and peer support groups | Exclusion: Severe psychiatric morbidity including suicide ideation, or current psychosis; change in psychotropic medications within the last 3 months; previous participation in mindfulness based intervention | Face-to-face group MBCT: an 8 week group based mindfulness based cognitive therapy program. After a 2.5 h weekly session, participants received daily homework assignments | |||
TAU: Participants received care consistent with usual care | |||||
Dear et al. (2013) Australia N = 64 | Population: Chronic pain | Inclusion: Adults 18 years or older, pain present for at least 3 months, pain assessed by specialist, stable dose of medication for at least 1 month for anxiety or depression | ICBT: Consisted of 5 modules over 8 weeks. Participants were asked to complete weekly lessons through automated email reminders. Weekly 10–15 min telephone or emails were provided by an experienced clinical psychologist | Therapist-guided: Clinical psychologist postgraduate | 7 |
Recruitment strategy: Community through newspaper articles, community websites, and community pain clinics | Exclusion: Currently experiencing psychotic illness or severe symptoms of depression | Waiting-list control: No weekly support was provided | |||
Dear et al. (2015) Australia N = 490 | Population: Chronic pain | Inclusion: Adults 18 years or older, pain present for at least 6 months, pain assessed by specialist | ICBT (regular contact): Participants received an 8 week program consisting of 5 modules. Weekly telephone or emails were provided by an experienced therapist. Received automated emails regularly | Therapist-guided: Postgraduate registered psychologist | 21 |
Recruitment strategy: Community through newspaper articles, community websites, and community pain clinics | Exclusion: Currently experiencing psychotic illness or severe symptoms of depression | ICBT (optional contact): Participants received an 8 week program consisting of 5 modules. Participants had the option to contact their therapist weekly. Received automated emails regularly | |||
ICBT (no contact): Participants received an 8 week program consisting of 5 modules. Contact was only provided if there was a significant deterioration in a participants mental health | |||||
Waiting-list control: No weekly support was provided | |||||
Ferwerda et al. (2017) Netherlands N = 133 | Population: RA | Inclusion: Adults, diagnosis of RA by a physician, elevated levels of distress based on the Impact of Rheumatic Diseases on General Health and Lifestyle | ICBT: Consisted of 4 modules and patients had flexibility to complete at their own pace (range 9–65 weeks; average 17 weeks). Each week therapist selected relevant assignments tailored to participants needs. Therapists contacted patients weekly or biweekly through email for encouragement and to provide feedback | Therapist-guided: Clinical psychologist at the Masters level with supervision from a senior clinical psychologist | 26 |
Recruitment strategy: Academic and nonacademic rheumatology clinics | Exclusion: Pregnant, inability to understand Dutch, severe physical or psychiatric comorbidity, currently engaged in CBT | Face-to-face care: This group involved standard rheumatoid care tailored to individuals with at least yearly checkups and monitor of disease activity. Patients also received standard care related to physiotherapy, occupational therapy and nursing | |||
Friesen et al. (2017) Canada N = 60 | Population: FM | Inclusion: Adults 18 years or older, diagnosis of FM by a physician, experienced pain for at least 3 months, pain assessed by specialist, clinical significant symptoms of FM based on the Fibromyalgia Impact Questionniare, at least mild symptoms of depression or anxiety | ICBT: Consisted of 5 modules over 8 weeks. Participants were asked to complete weekly lessons through automated email reminders. Weekly 5–10 min telephone or emails were provided by an experienced clinical psychologist | Therapist-guided: Clinical psychology doctoral student | 13 |
Recruitment strategy: Community through newspaper articles, community websites, and community pain clinics | Waiting-list control: No weekly support was provided | ||||
Glozier et al. (2013) Australia N = 562 | Population: CVD | Inclusion: Adults, self-reported history of CVD or related risk factors such as heart disease, hypertension etc., previous diagnosis of heart disease, stroke, or hypertension by a physician, psychological distress of a Kessler 10 score greater than or equal to 16, PHQ9 score of 8 or greater | ICBT: A 12 week CBT based program comprised of 12 modules delivered weekly called E-couch. Automated emails were sent if a participant did not complete the current module within 4 days. Phone calls were made 3–4 days after the initial reminder email if participants still hadn’t completed the module. No psychological support was provided through email or telephone | Self-guided: N/A | 34 |
Recruitment strategy: Community | Exclusion: Currently undergoing psychotherapy, expressed suicide ideation | Attention control: A 12 week online program provides information on health related topics in an interactive manner similar to the active treatment arm. Automated emails were sent if a participant did not complete the current module within 4 days. Phone calls were made three to four days after the initial reminder email if participants still hadn’t completed the module. No psychological support was provided through email or telephone | 3 | ||
Hesser et al. (2012) Sweden N = 99 | Population: Tinnitus | Inclusion: Adults 18 years or older, tinnitus for longer than 6 months, diagnosis confirmed by a physician, moderate to severe tinnitus distress based on the Tinnitus Handiicap Inventory | ICBT: 8 module delivered over an 8 week period. Participants were also asked to complete exercising and assignments. Participants received feedback from therapist within 24–36 h. Therapists sent reminder emails and phone calls if no response from participants | Therapist-guided: Not stated | 10 |
Recruitment strategy: Community through newspaper articles, and community websites | Exclusion: Severe medical or psychiatric conditions, presenting with suicide risk, ongoing treatment for tinnitus | IACT: Participants received internet delivered ACT treatment consisting of 8 modules. Participants received feedback from therapist within 24–36 h. Therapists sent reminder emails and phone calls if no response from participants | |||
DF: Discussion targeted tinnitus related problems | |||||
Jasper et al. (2014) Germany N = 85 | Population: Tinnitus | Inclusion: Adults 18 years or older, diagnosis of tinnitus for greater than 6 months, moderate to severe tinnitus distress based on Tinnitus Handicap Inventory or Mini-tinnitus Questionnaire | ICBT: 12 modules delivered over 10 week program targeted towards reducing tinnitus distress through CBT techniques. Participants were able to contact therapist once a week through email | Therapist-guided: CBT certified therapist or trainees | 10 |
Recruitment strategy: Community, clinical | Exclusion: Received CBT for tinnitus within the last 2 years, ongoing psychological treatment for tinnitus, major medical or psychiatric condition, suicidality | DF: Discussion targeted tinnitus related distress. Participants were encouraged to discuss their experiences | |||
Kaldo et al. (2008) Sweden N = 51 | Population: Tinnitus | Inclusion: Adults 18 years or older, diagnosed with tinnitus by a physician for at least 3 months, scoring above 10 on the Tinnitus Reaction Questionnaire, Scoring below 18 on HADS anxiety and depression | ICBT: Delivered over a 6 week period which included CBT content along with goal planning and homework assignments. Participants were asked to submit weekly assignments and diaries to therapist each week through email. Therapist responded to participants with feedback, support, and recommendations via email | Therapist-guided: Clinical psychology Masters students and licensed psychologist | 4 |
Recruitment strategy: Community through newspaper articles, community websites, and community tinnitus clinics | Exclusion: History of previous CBT for tinnitus treatment, severe depression or anxiety symptoms | Face-to face CBT: Included seven weekly sessions lasting 2 h each consisting of 6–7 participants in each group. Content was similar to the ICBT group | |||
Lundgren et al. (2016) Sweden N = 50 | Population: Heart failure | Inclusion: Age 18 years or older, mild depressive symptoms (greater than or equal to 5 on PHQ9), diagnosis of HF | ICBT: Program consisted of 7 modules delivered over 9 weeks. A guide provided written feedback on participant assignments. Participants also received weekly reminder emails for the program | Therapist guided: Mental health specialist nurse | 18 |
Recruitment strategy: Hospital outpatient | Exclusion: Admission to hospital during the last month due to HF, other treatment planned during intervention, severe level of depressive symptoms, high level of suicide risk or other psychiatric disorder | DF: Participants were presented discussion topics weekly for 9 weeks on a moderated discussion forum | |||
Migliorini et al. (2016) Australia N = 30 | Population: SCI | Inclusion: Adults 18–70 yrs, chronic SCI greater than 6 months, mild to severe depression and anxiety based on DASS21 | ICBT: 10 modules delivered over 10 week period. No formal support was provided by therapists | Self-guided: N/A | 19 |
Recruitment strategy: Specialized SCI rehabilitation units | Waiting-list control: No weekly support was provided | ||||
Newby et al. (2017) Australia N = 91 | Population: Diabetes | Inclusion: Adults aged 18 years or older, diagnosed with T1 or T2 diabetes, meet criteria for MDD | ICBT: Participants completed 6 lessons over 10 weeks. Participants also received practice assignments and extra resources after each lesson. Automated emails were set up to remind participants on lessons. Guidance was provided weekly to encourage participants to adhere to the program | Therapist guided: clinical psychologist at Masters or PhD level | 24 |
Recruitment strategy: Advertisements on diabetes websites, social media and flyers | Exclusion: Previous participation in CBT in the past month, changed antidepressant medications in the last 2 months, scoring below 5 or above 23 on the PHQ9, significant risk for suicide | Wait-list control: Participants received usual care from their health services | |||
Peters et al. (2017) Sweden N = 206 | Population: Heterogeneous pain population | Inclusion: Adults 18 yrs or older, having musculoskeletal pain for greater than 3 moths related to fibromyalgia or localized to back, neck or shoulders | ICBT: Included 8 module program based on the core principles of CBT delivered weekly. Weekly telephone and email support was provided | Therapist guided: graduate psychology students | 29 |
Recruitment strategy: National and local newspapers and magazines and Fibromyalgia websites | Exclusion: Inability to perform simple physical exercises, degenerative muscle diseases, heart or vascular disease, diagnosed with psychiatric disorders in the past 3 months, pregnancy, having psychological pain treatment in the past 3 months | PPI: Included 8 module program based on evidence based positive psychology targeting self-compassion, positive emotions, and optimism. The program was delivered weekly. Weekly telephone and email support was provided | Therapist guided: graduate psychology students | 25 | |
Waiting-list control: No weekly support was provided | 1 | ||||
Shigaki et al. (2013) United States N = 106 | Population: RA | Inclusion: Adults 18 years or older, RA diagnosed by rheumatologist, stable medication for 3 months | ICBT: Included 10 modules, each module was delivered over 10 weeks. Participants received weekly 10–30 min check ins from a therapist through telephone | Therapist-guided: Masters level counsellor | 18 |
Recruitment strategy: Community through community websites, and community RA clinics | Exclusion: Previous self management intervention, uncontrolled psychiatric diagnosis, uncontrolled medical comorbidities | Waiting-list control: No weekly support was provided | |||
Trudeau et al. (2015) United States N = 245 | Population: RA | Inclusion: Adults 18 years or older, diagnosis of arthritis by a physician, pain intensity greater than 4 on a 1–10 scale | ICBT: Participants were provided access to a CBT based web platform called painACTION.com. Participants received 2 sessions per week for 4 weeks (8 sessions total). All participants received automated weekly email reminders. Phone calls were made to those participants that did not log into the site | Self-guided: N/A | 11 |
Recruitment strategy: Community through community websites, and community RA clinics | Exclusion: Participating in another arthritis study in the past year, hospitalization for mental health reasons in the last year | Waiting-list control: No weekly support was provided | |||
Vallejo et al. (2015) Spain N = 60 | Population: RA | Inclusion: Adults 18 years or older, diagnosis of FM by a physician based on the American College of Rheumatology classification | ICBT: 10 week session which involved the 10 modules similar to the group CBT program. Participants were also asked questions at the end of each session to ensure they understood the topics. Participants also received feedback messages from the therapist and automatic emails if they did not log in for greater than 3 days | Therapist-guided: Doctoral level clinical psychologist | 0 |
Recruitment strategy: RA Rehabilitation Unit | Exclusion: Diagnoses of psychiatric disorder, presence of suicidal ideation, prior or present psychological treatment for FM, surgery in the next 3 months | Face-to-face group CBT: Participants received 10 weekly sessions, each session corresponded to the modules and involved assignments | |||
Waiting-list control: No weekly support was provided | |||||
Weise et al. (2016) Germany N = 124 | Population: Tinnitus | Inclusion: Adults 18 years or older, diagnosed with tinnitus by a physician for at least 6 months, at least a 38 or higher on the Tinnitus Handicap Inventory or 13 or higher on the Mini-Tinnitus Questionnaire | ICBT: Participants were provided a 10 week guided ICBT program consisting of 12 modules. Participants had the option to email therapist once a week. Therapist were limited to 10 min/week per patient | Therapist-guided: Licensed CBT therapist and masters level clinical psychologist | 5 |
Recruitment strategy: Community through newspaper articles, community websites, and community tinnitus clinics | Exclusion: Tinnitus psychological treatment in the last 2 years, severe medical or psychiatric condition, acute suicidality | DF: Participants were able to discuss tinnitus related topics | |||
Williams et al. (2010) United States N = 118 | Population: FM | Inclusion: Adults 18 years or older, diagnosed with FM using the American College of Rheumatology classification, stable medication use for at least 3 months prior to start | ICBT: An online program consisting of 13 modules based on traditional face to face CBT. Participants were provided access to the program for 6 months. No contact was provided to any participant | Self-guided: N/A | 9 |
Recruitment strategy: Clinical primary care or specialist physicians | Exclusion: Severe physical impairment, co-morbid medical illness, history of psychiatric disorder, suicide ideation or attempt within 2 years of study, substance abuse within 2 years, prior CBT for pain management, disability compensation for less than 2 year or pending status | TAU: Participants received usual care from their primary care physician | |||
Wilson et al. (2018) United States N = 47 | Population: Heterogeneous chronic disease population | Inclusion: Adults 18 years or older, score greater than 10 on the PHQ-9, diagnosis of a chronic disease (including chronic pain, diabetes, cardiac, respiratory disease), no changes in antidepressant or psychotropic medications in the next 8 weeks | ICBT: Self-directed online CBT program with weekly email or phone checks for 4 weeks to answer any questions about the program and track mood and self-management activities | Self-Directed: N/A Researcher including Psychiatric nurse practitioner and psychiatrist were available to ask technical questions | 68 |
Recruitment strategy: Online advertisements and outpatient clinical sites | Exclusion: Currently enrolled in psychotherapy for depression, confirmed pregnancy, acute psychotic disorder | Attention control: Received weekly emails or phone calls prompting participants to report on any progress towards their health goals |