Does Web-Based CBT Work?

Summary of Research Support for Web-Based CBT


Overview

Controlled studies consistently reveal that Web-Based Cognitive Behavioral Training (WCBT) is an effective solution for several anxiety disorders, depression, and a number of other mental health and adjustment problems. In these studies, users provided with WCBT have had much better outcomes than those in control groups. In fact, WCBT has performed as well as the current therapy of choice, face to face Cognitive Behavioral Therapy (FCBT), in severa0 l (e.g., Furmark et al 2009, Bergstrom et al, 2010).1

WCBT Effectiveness for Anxiety and Depression - General

Numerous studies have supported the effectiveness of WCBT for depression and anxiety. A meta-analysis of 22 randomized controlled trials demonstrated WCBT’s effectiveness for anxiety disorders and depression (Andrews et al, 2010). WCBT has been exceedingly well-received by participants in the studies. Users report that WCBT is as credible as FCBT and they like it much or more than FCBT (Newman et al 1997).

Reviewers of the research report WCBT provides better

  • cost-effectiveness,
  • standardization/consistency of services,
  • accessibility, and
  • privacy (eg, Khanna et al 2007)

The National Institute for Health and Clinical Excellence (NICE) in Great Britain has already approved two WCBT packages as effective treatments for anxiety and depression (NICE, 2006). Such an endorsement requires a broad range of (a) effectiveness and (b) cost-benefit data. (Note that much of the recent WCBT research has been conducted in the UK, Scandinavia, and Australia.)

Highlights of WCBT Research for Social Anxiety Disorder

WCBT has effectively reduced problems with Social Anxiety Disorders in numerous studies. Two recent, compelling studies, one in Switzerland and the other in Australia are noted below, due their excellent design and relevance. They suggest the following:

  1. WCBT is effective for Social Anxiety Disorder.
  2. WCBT is effective even if offered without any therapist support.

2011

Derived from Swedish (Text-based)

Randomized Controlled Trial

Berger, Caspar, et al

Behavior Research & Therapy

WCBT: Post > Pre
WCBT with therapist support = WCBT without therapist support

2010

Australian-Anxiety Online

Naturalistic Participant Choice

Klein, Meyer, et al

Jou of Medical Internet Research

WCBT: Post > Pre
Large Effect Size

Highlights of WCBT Research for Panic

Numerous trials of WCBT have been conducted for addressing Panic Disorder. These studies have, with few exceptions, yielded compelling results. Some have been modestscale trials while others have been randomized controlled trials (RCTs). As the table below displays, WCBT has outperformed control groups. Several studies have found it as effective as FCBT, which is often viewed as the treatment of choice for Panic Disorder, due to its effectiveness that matches or surpasses medications and produces more durable benefits.2

The consistent conclusion of these investigations has been that WCBT is a very promising solution for Panic Disorder, particularly well-suited as the first step in a stepped-care model. See these recent examples of studies from the U.K., Australia, and Sweden, where research activity has been notable:

2010

Australian-Anxiety Online

Klein, Meyer, et al

Jou of Medical Internet Research

WCBT: Post > Pre
Large Effect Size

2005

Internet Text-based (Swedish I)

Carlbring et al

Beh Res Ther

WCBT = Face to Face COGNITIVE BEHAVIORAL THERAPY

2005

Internet Text-based (Swedish II)

Bergstrom

ADAA

WCBT = Face to Face COGNITIVE BEHAVIORAL THERAPY

2004

FearFighter (U.K.)

Marks et al

Psychological Medicine

WCBT = Face to Face COGNITIVE BEHAVIORAL THERAPY

2003

FearFighter (U.K.)

Marks et al

Br. Jou of Psychiatry

WCBT: Post > Pre

2003

Internet Text-based (Swedish I)

Carlbring et al

J Beh Ther Exp Psychi

WCBT = Applied Relaxationc

2002

5 Module Prog

Richards & Alvarenga

Cognitive Behaviour Therapy

WCBT: Post > Pre

2002

Internet Text-based (Australia)

Klein

Dissertation

WCBT > Control

2001

FearFighter (U.K.)

Kenwright et al

Br. Jou of Psychiatry

WCBT = Face to Face COGNITIVE BEHAVIORAL THERAPY

2001

Internet Text-based (Swedish I)

Carlbring et al

Behavior Therapy

WCBT > Control

Highlights of WCBT Research for Depression

WCBT has effectively treated Major Depression in several studies. Randomized controlled trials with large samples have demonstrated impressive effectiveness of WCBT for depression (e.g., Clarke et al 2005). And when compared to treatment-as-usual, WCBT has produced much better outcomes, even for moderate and severe depression, even after 6 months, and even when many of the users had never used computers before (e.g., Proudfoot et al 2004). Cost-effectiveness studies have further identified WCBT as a costeffective treatment for depression, even when the price of the treatment in substantial (~$180/user) and the valuation of change is modest (McCrone et al, 2004).

Because of results like these, a WCBT package for depression was the first approved by the National Institute for Health and Clinical Excellence (NICE) in the UK in 2002.

Notes:

  1. Note that, in turn, FCBT has performed comparably to medications, the most common treatments for these disorders.
  2. Note that one of the principle researchers in successful Swedish projects, Per Carlbring PhD, is presently consulting on Learn to Live projects.


Sources

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Andrews G, Cuijpers P, Craske MG, McEvoy P, Titov N (2010) Computer Therapy for the Anxiety and Depressive Disorders Is Effective, Acceptable and Practical Health Care: A Meta-Analysis. PLoS ONE 5(10): e13196.

Andrews G, Davies M, Titov N. (2011). Effectiveness randomized controlled trial of face to face versus Internet cognitive behaviour therapy for social phobia. Aust N Z J Psychiatry.2011 Apr;45(4):337-40. Epub 2011 Feb 16.

Barlow, D.H. (2002). Anxiety and its Disorders. New York: Guilford Press.

Bergstrom, J. (2005). Internet-based CBT for panic disorder in a psychiatric setting. Presentation at Anxiety Disorders Association of America Annual Conference.

Bergström J, Andersson G, Ljótsson B, Rück C, Andréewitch S, Karlsson A, Carlbring P, Andersson E, Lindefors N (2010). Internet- versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting: a randomised trial. BMC Psychiatry 2010, 10:54

Carlbring, P., Ekselius, L., Anderrson, G. (2003). Treatment of panic disorder via the internet: A randomized trial of CBT vs. applied relaxation. Journal of Behavior Therapy & Experimental Psychiatry, 34: 129-140.

Carlbring P, Gunnarsdottir, M., Hedensjo, L., Anderrson, Ekselius, L., Furmark, T. (2007). Treatment of Social Phobia: Randomized trial of internet delivered cognitve-behavioral therapy with telephone support. British Journal of Psychiatry, 190:123-128.

Carlbring P, Nilsson-Ihrfelt E, Waara J, Kollenstam C, Buhrman M, Kaldo V, Soderberg M, Ekselius L, Andersson G. (2005). Treatment of panic disorder: Live therapy vs. self-help via the Internet. Behav Res Ther,43:1321-33.

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Furmark, T., Carlbring, P., Hedman, E., Sonnenstein, A., Clevberger, P., Bohman, B., et al. (2009). Guided and unguided self-help for social anxiety disorder: randomized controlled trial. British Journal of Psychiatry, 195, 440e447.

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