Evidence map›Paper›PMID 33957075›Full record

SynthesisThe lancet. Psychiatry2021

Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data.

Toshi A Furukawa, Aya Suganuma, Edoardo G Ostinelli, Gerhard Andersson, Christopher G Beevers, Jason Shumake, Thomas Berger, Florien Willemijn Boele, Claudia Buntrock, Per Carlbring and 70 more

Registry-linked trialOpen access · bronzeAbstract readNetwork Meta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The lancet. Psychiatry, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07059234 (The Motor Activity - Subjective Energy), which is not on this map. Cited by 112 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
112citing papers in PubMed, 11 pooled it
28.9field-weighted citation impact, top 1% of its field
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.

NCT07059234 narecruitingnot on this mapstarted 2025, after this paper: background citation

The Motor Activity - Subjective Energy (MASE) Project: Neurobiological and Digital Phenotyping Towards Digital Mental Health Interventions in Depression

TypeinterventionalSponsorUniversity of BernRan2025 to 2027Enrolled180ConditionsDepressive Disorder, MajorArmsNon-exercise activity
3 · Its place in the literature

Who cites it

112 citing papers in PubMed, 11 syntheses or guidelines pooled it, 255 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Pooled it
  9. Pooled it
  10. Pooled it
  11. Pooled it
  12. Trial
  13. Trial
  14. Trial
  15. Trial
  16. Trial
  17. Trial
  18. Trial
  19. Trial
  20. Trial

52 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

80 authors at 20 institutions in 12 countries.

Toshi A FurukawaDepartment of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan. Electronic address: furukawa@kuhp.kyoto-u.ac.jp.
Aya SuganumaDepartment of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.
Edoardo G OstinelliDepartment of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
Gerhard AnderssonDepartment of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden.
Christopher G BeeversDepartment of Psychology and Institute for Mental Health Research, University of Texas at Austin, Austin, TX, USA.
Jason ShumakeDepartment of Psychology and Institute for Mental Health Research, University of Texas at Austin, Austin, TX, USA.
Thomas BergerDepartment of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
Florien Willemijn BoelePatient Centred Outcomes Research Group, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
Claudia BuntrockDepartment of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
Per CarlbringDepartment of Psychology, Stockholm University, Stockholm, Sweden.
Isabella ChoiCentral Clinical School, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
Helen ChristensenBlack Dog Institute and University of New South Wales, Prince of Wales Hospital, Sydney, NSW, Australia.
Andrew MackinnonBlack Dog Institute and University of New South Wales, Prince of Wales Hospital, Sydney, NSW, Australia.
Jennifer DahneDepartment of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
Marcus J H HuibersDepartment of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
David D EbertDepartment for Sport and Health Sciences, Chair for Psychology & Digital Mental Health Care, Technical University Munich, Germany.
Louise FarrerCentre for Mental Health Research, The Australian National University, Canberra, Australia.
Nicholas R ForandDepartment of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
Daniel R StrunkDepartment of Psychology, The Ohio State University, Columbus, OH, USA.
Iony D EzawaDepartment of Psychology, The Ohio State University, Columbus, OH, USA.
Erik ForsellDepartment of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
Viktor KaldoDepartment of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
Anna GeraedtsSoulve Innovations, Utrecht, Netherlands.
Simon GilbodyDepartment of Health Sciences, University of York, York, UK.
Elizabeth LittlewoodDepartment of Health Sciences, University of York, York, UK.
Sally BrabynDepartment of Health Sciences, University of York, York, UK.
Heather D HadjistavropoulosDepartment of Psychology, University of Regina, Regina, SK, Canada.
Luke H SchneiderAnxiety Treatment and Research Clinic, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
Robert JohanssonDepartment of Psychology, Stockholm University, Stockholm, Sweden.
Robin KenterDepartment of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway.
Marie KiviDepartment of Psychology, University of Gothenburg, Gothenburg, Sweden.
Cecilia BjörkelundPrimary Health Care, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
Annet KleiboerDepartment of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Heleen RiperDepartment of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Jan Philipp KleinDepartment of Psychiatry and Psychotherapy, Luebeck University, Luebeck, Germany.
Johanna SchröderInstitute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Björn MeyerResearch Department, GAIA AG, Hamburg, Germany.
Steffen MoritzDepartment of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Lara BückerDepartment of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Ove LintvedtNorwegian Center for E-health research, Tromsø, Norway.
Peter JohanssonDepartment of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden.
Johan LundgrenDepartment of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden.
Jeannette MilgromParent-Infant Research Institute and Austin Health, Melbourne School of Psychological Sciences, University of Melbourne, VIC, Australia.
Alan W GemmillParent-Infant Research Institute and Austin Health, Melbourne School of Psychological Sciences, University of Melbourne, VIC, Australia.
David C MohrCenter for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL, USA.
Jesus Montero-MarinDepartment of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
Javier Garcia-CampayoAragon Institute for Health Research, Miguel Servet University Hospital, Zaragoza, Spain; Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain.
Stephanie NobisKlinikum Osnabrück, Osnabrück, Germany.
Anna-Carlotta ZarskiDepartment of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
Kathleen O'MooreBlack Dog Institute and University of New South Wales, Prince of Wales Hospital, Sydney, NSW, Australia.
Alishia D WilliamsDepartment of Psychology, Faculty of Science, The University of New South Wales, Sydney, NSW, Australia.
Jill M NewbySchool of Psychology, University of New South Wales at the Black Dog Institute, Sydney, NSW, Australia.
Sarah PeriniClinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW, Australia.
Rachel PhillipsFaculty of Medicine, School of Public Health, Imperial College London, London, UK.
Justine SchneiderSchool of Sociology & Social Policy and Institute of Mental Health, University of Nottingham, Nottingham, UK.
Wendy PotsDepartment of Psychology, Health & Technology, University of Twente, Enschede, Netherlands.
Nicole E PughPrivate practice, Vancouver, BC, Canada.
Derek RichardsUniversity of Dublin, Trinity College, School of Psychology, E-mental Health Research Group, Dublin, Ireland; SilverCloud Health, Clinical Research & Innovation, Dublin, Ireland.
Isabelle M RossoMcLean Hospital, Belmont, MA, USA.
Scott L RauchMcLean Hospital, Belmont, MA, USA.
Lisa B SheeberOregon Research Institute, Eugene, OR, USA.
Jessica SmithImperial Clinical Trials Unit, Imperial College London, London, UK.
Viola SpekSchool of Applied Psychology, Fontys University of Applied Science, Eindhoven, Netherlands.
Victor J PopDepartment of Medical & Clinical Psychology, Tilburg University, Tilburg, Netherlands.
Burçin ÜnlüPsyQ Online, Haarlem, Netherlands.
Kim M P van BastelaarAmsterdam University Medical Centre, Amsterdam, Netherlands.
Sanne van LuenenDepartment of Clinical Psychology, Leiden University, Leiden, Netherlands.
Nadia GarnefskiDepartment of Clinical Psychology, Leiden University, Leiden, Netherlands.
Vivian KraaijDepartment of Clinical Psychology, Leiden University, Leiden, Netherlands.
Kristofer VernmarkDepartment of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden.
Lisanne WarmerdamNational Health Care Institute, Diemen, Netherlands.
Annemieke van StratenDepartment of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Pavle ZagorscakDepartment of Education and Psychology, Freie Universität Berlin, Berlin, Germany.
Christine KnaevelsrudDepartment of Education and Psychology, Freie Universität Berlin, Berlin, Germany.
Manuel HeinrichDepartment of Education and Psychology, Freie Universität Berlin, Berlin, Germany.
Clara MiguelDepartment of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Andrea CiprianiDepartment of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
Orestis EfthimiouDepartment of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Eirini KaryotakiDepartment of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
Pim CuijpersDepartment of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Vrije Universiteit Amsterdam · NLFreie Universität Berlin · DELeiden University · NLLinköping University · SEUniversity of York · GBUNSW Sydney · AUFriedrich-Alexander-Universität Erlangen-Nürnberg · DEImperial College London · GBKyoto University · JPMcLean Hospital · USPrince of Wales Hospital · AUStockholm Health Care Services · SEStockholm University · SEThe Ohio State University · USUniversität Hamburg · DEUniversity of Bern · CHUniversity of Gothenburg · SEUniversity of Oxford · GBAustin Health · AUAustralian National University · AU

Funding

Technology Enabled Services for Coordinated Care of Depression in Healthcare SettingsP50MH119029 · NIMH · NORTHWESTERN UNIVERSITY AT CHICAGO · PI DAVID CURTIS MOHR · 2020 to 2026
$10.7M
LifeSense: Transforming Behavioral Assessment of Depression Using Personal Sensing TechnologyR01MH111610 · NIMH · NORTHWESTERN UNIVERSITY AT CHICAGO · PI KORDING, KONRAD P., MOHR, DAVID CURTIS · 2017 to 2020
$3.2M
Development and Testing of a Depression-Specific Behavioral Activation Mobile App Paired with Nicotine Replacement Therapy Sampling for Smoking Cessation Treatment Via Primary CareK23DA045766 · NIDA · MEDICAL UNIVERSITY OF SOUTH CAROLINA · PI DAHNE, JENNIFER RENEE · 2018 to 2022
$1.0M
NIDA NIH HHS K23 DA045766NIMH NIH HHS P50 MH119029NIMH NIH HHS R01 MH111610Wellcome Trust
6 · The paper itself

Abstract

backgroundInternet cognitive behavioural therapy (iCBT) is a viable delivery format of CBT for depression. However, iCBT programmes include training in a wide array of cognitive and behavioural skills via different delivery methods, and it remains unclear which of these components are more efficacious and for whom.

methodsWe did a systematic review and individual participant data component network meta-analysis (cNMA) of iCBT trials for depression. We searched PubMed, PsycINFO, Embase, and the Cochrane Library for randomised controlled trials (RCTs) published from database inception to Jan 1, 2019, that compared any form of iCBT against another or a control condition in the acute treatment of adults (aged ≥18 years) with depression. Studies with inpatients or patients with bipolar depression were excluded. We sought individual participant data from the original authors. When these data were unavailable, we used aggregate data. Two independent researchers identified the included components. The primary outcome was depression severity, expressed as incremental mean difference (iMD) in the Patient Health Questionnaire-9 (PHQ-9) scores when a component is added to a treatment. We developed a web app that estimates relative efficacies between any two combinations of components, given baseline patient characteristics. This study is registered in PROSPERO, CRD42018104683.

findingsWe identified 76 RCTs, including 48 trials contributing individual participant data (11 704 participants) and 28 trials with aggregate data (6474 participants). The participants' weighted mean age was 42·0 years and 12 406 (71%) of 17 521 reported were women. There was suggestive evidence that behavioural activation might be beneficial (iMD -1·83 [95% credible interval (CrI) -2·90 to -0·80]) and that relaxation might be harmful (1·20 [95% CrI 0·17 to 2·27]). Baseline severity emerged as the strongest prognostic factor for endpoint depression. Combining human and automated encouragement reduced dropouts from treatment (incremental odds ratio, 0·32 [95% CrI 0·13 to 0·93]). The risk of bias was low for the randomisation process, missing outcome data, or selection of reported results in most of the included studies, uncertain for deviation from intended interventions, and high for measurement of outcomes. There was moderate to high heterogeneity among the studies and their components.

interpretationThe individual patient data cNMA revealed potentially helpful, less helpful, or harmful components and delivery formats for iCBT packages. iCBT packages aiming to be effective and efficient might choose to include beneficial components and exclude ones that are potentially detrimental. Our web app can facilitate shared decision making by therapist and patient in choosing their preferred iCBT package.

fundingJapan Society for the Promotion of Science.

Indexed as

Cognitive Behavioral TherapyDepressive DisorderInternetHumansOutcome Assessment, Health CareRandomized Controlled Trials as TopicSystems Analysis

Identifiers

PMID33957075
PMCPMC8838916
OpenAlexW3159498050

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

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.