Evidence map›Paper›PMID 29540243›Full record

SynthesisPsychological medicine2018

Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis.

Eirini Karyotaki, Lise Kemmeren, Heleen Riper, Jos Twisk, Adriaan Hoogendoorn, Annet Kleiboer, Adriana Mira, Andrew Mackinnon, Björn Meyer, Cristina Botella and 17 more

2 registry-linked trialsAbstract readMeta-AnalysisReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Psychological medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 76 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
76citing papers in PubMed, 9 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05294614 naunknown statusnot on this mapstarted 2022, after this paper: background citation

Implementation of a Psychological Online Intervention for Low to Moderate Depression in Primary Health Care: a Study Protocol

TypeinterventionalSponsorUniversitat Jaume IRan2022 to 2023Enrolled420ConditionsDepressive Disorder, Depressive Symptoms, DepressionArms"Sonreír es diveritdo" - Smiling is fun
NCT07113548 narecruitingnot on this mapstarted 2025, after this paper: background citation

PERSONAE: a Personalized Adaptation of Stepped Care Internet-based Cognitive Behavioral Therapy for Depression - A Randomized Controlled Trial

TypeinterventionalSponsorRegion of Southern DenmarkRan2025 to 2027Enrolled175ConditionsDepression - Major Depressive DisorderArmsPersonalized iCBT for depression, Standard iCBT
3 · Its place in the literature

Who cites it

76 citing papers in PubMed, 9 syntheses or guidelines pooled it.

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  20. Innovations to improve outcomes and uptake of psychotherapies for mental disorders: a state-of-the-art review.World psychiatry : official journal of the World Psychiatric Association (WPA) · 2026
    Article

16 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

27 authors.

Eirini KaryotakiDepartment of Clinical Psychology,VU Amsterdam and Institute for Public Health Research,Amsterdam,the Netherlands.
Lise KemmerenDepartment of Psychiatry,GGZ inGeest and VU University Medical Centre, Amsterdam Public Health research institute,Amsterdam,the Netherlands.
Heleen RiperDepartment of Clinical Psychology,VU Amsterdam and Institute for Public Health Research,Amsterdam,the Netherlands.
Jos TwiskDepartment of Epidemiology and Biostatistics and Amsterdam Institute for Public Health Research,VU University Amsterdam,Amsterdam,the Netherlands.
Adriaan HoogendoornDepartment of Psychiatry,GGZ inGeest and VU University Medical Centre, Amsterdam Public Health research institute,Amsterdam,the Netherlands.
Annet KleiboerDepartment of Clinical Psychology,VU Amsterdam and Institute for Public Health Research,Amsterdam,the Netherlands.
Adriana MiraDepartment of Psychology and Technology,Jaume University,Castellon,Spain.
Andrew MackinnonBlack Dog Institute and University of New South Wales, Prince of Wales Hospital,Sydney,Australia.
Björn MeyerResearch Department, Germany and Department of Psychology,City University,Gaia AG, Hamburg, London,UK.
Cristina BotellaDepartment of Psychology and Technology,Jaume University,Castellon,Spain.
Elizabeth LittlewoodDepartment of Health Sciences,University of York,York,UK.
Gerhard AnderssonDepartment of Behavioural Sciences and Learning,Sweden Institute for Disability Research, Linköping University,Linköping,Sweden.
Helen ChristensenBlack Dog Institute and University of New South Wales, Prince of Wales Hospital,Sydney,Australia.
Jan P KleinDepartment of Psychiatry and Psychotherapy,Lübeck University,Lübeck,Germany.
Johanna SchröderDepartment of Psychiatry and Psychotherapy,University Medical Center Hamburg-Eppendorf,Hamburg,Germany.
Juana Bretón-LópezDepartment of Psychology and Technology,Jaume University,Castellon,Spain.
Justine ScheiderInstitute of Mental Health, University of Nottingham,Nottingham,UK.
Kathy GriffithsResearch School of Psychology, College of Biology, Medicine & Environment, Australian National University,Canberra,Australia.
Louise FarrerCentre for Mental Health Research, The Australian National University,Canberra,Australia.
Marcus J H HuibersDepartment of Clinical Psychology,VU Amsterdam and Institute for Public Health Research,Amsterdam,the Netherlands.
Rachel PhillipsDepartment of Primary Care and Public Health Sciences,King's College London,London,UK.
Simon GilbodyDepartment of Health Sciences,University of York,York,UK.
Steffen MoritzDepartment of Psychiatry and Psychotherapy,University Medical Center Hamburg-Eppendorf,Hamburg,Germany.
Thomas BergerDepartment of Clinical Psychology and Psychotherapy,University of Bern,Bern,Switzerland.
Victor PopCoRPS - Center of Research on Psychology in Somatic diseases, Tilburg University,Tilburg,the Netherlands.
Viola SpekCoRPS - Center of Research on Psychology in Somatic diseases, Tilburg University,Tilburg,the Netherlands.
Pim CuijpersDepartment of Clinical Psychology,VU Amsterdam and Institute for Public Health Research,Amsterdam,the Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundLittle is known about potential harmful effects as a consequence of self-guided internet-based cognitive behaviour therapy (iCBT), such as symptom deterioration rates. Thus, safety concerns remain and hamper the implementation of self-guided iCBT into clinical practice. We aimed to conduct an individual participant data (IPD) meta-analysis to determine the prevalence of clinically significant deterioration (symptom worsening) in adults with depressive symptoms who received self-guided iCBT compared with control conditions. Several socio-demographic, clinical and study-level variables were tested as potential moderators of deterioration.

methodsRandomised controlled trials that reported results of self-guided iCBT compared with control conditions in adults with symptoms of depression were selected. Mixed effects models with participants nested within studies were used to examine possible clinically significant deterioration rates.

resultsThirteen out of 16 eligible trials were included in the present IPD meta-analysis. Of the 3805 participants analysed, 7.2% showed clinically significant deterioration (5.8% and 9.1% of participants in the intervention and control groups, respectively). Participants in self-guided iCBT were less likely to deteriorate (OR 0.62, p < 0.001) compared with control conditions. None of the examined participant- and study-level moderators were significantly associated with deterioration rates.

conclusionsSelf-guided iCBT has a lower rate of negative outcomes on symptoms than control conditions and could be a first step treatment approach for adult depression as well as an alternative to watchful waiting in general practice.

Indexed as

Cognitive Behavioral TherapyInternetTelemedicineDepressionDepressive DisorderHumansOutcome Assessment, Health CareDepressioniCBTinternet-based treatmentself-guided psychotherapy

Identifiers

PMID29540243
PMCPMC6190066

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.