Efficacy and Effectiveness of Online CBT
Jeroen Ruwaard
What is Interapy?
• Online Cognitive Behavior Therapy
•Web-based
•Manualized
•Therapist-assisted
Controlled Trials
Trials N
Burnout 1 239
Bulimic symptoms 1 105
Depression 1 54
Panic symptoms 1 58
Posttraumatic stress 4 360
Sexual trauma 1 24
9 840
Primary outcome measures
Treatment Measure
Burnout Oldenburg Burnout Inventory OLBI
Bulimic symptomsEating Disorder Examination Questionnaire
EDE-Q
Depression Beck Depression Inventory BDI
Panic symptoms Panic Disorder Severity Scale PDSS-SR
Posttraumatic Stress Impact of Event Scale IES
Controlled Effects
Recovery (controlled effects)
Routine Clinical Practice
N
Burnout 470
Depression 413
Panic symptoms 139
Posttraumatic stress 478
1500
Symptom reduction
Trials ------- Routine Practice 7 7 7 7 7 7
Clinical Significance
Deteriorated Stable Improved Recovered
Burn-out 1% 37% 29% 34%
Depression 0% 16% 22% 61%
Panic 0% 39% 13% 48%
PTS 0% 23% 26% 51%
0% 29% 23% 49%
Treatment adherence
Limitations
• waiting list comparison groups
• independent evaluations are needed
• uncontrolled follow-ups
Online CBT
• efficacious
• large, clinically significant effects
• acceptable drop-out
• effective in routine practice
www.interapy.nl [email protected]
References (I)A. Lange, J.P. van de Ven, B.A. Schrieken, B. Bredeweg, and P.M. Emmelkamp, Internet-mediated, protocol-driven treatment of psychological dysfunction. Journal of Telemedicine and Telecare 6 (2000): 15-21.
A. Lange, J.P. van de Ven, B. Schrieken, and P.M. Emmelkamp, Interapy, treatment of posttraumatic stress through the Internet: a controlled trial. Journal of Behavior Therapy and Experimental Psychiatry 32 (2001): 73-90.
A. Lange, D. Rietdijk, M. Hudcovicova, J.P. van de Ven, B. Schrieken, and P.M. Emmelkamp, Interapy: a controlled randomized trial of the standardized treatment of posttraumatic stress through the internet. Journal of Consulting and Clinical Psychology 71 (2003): 901-9.
B. Wagner, C. Knaevelsrud, and A. Maercker, Internet-based cognitive-behavioral therapy for complicated grief: a randomized controlled trial. Death Studies 30 (2006): 429-53.
C. Knaevelsrud and A. Maercker, Internet-based treatment for PTSD reduces distress and facilitates the development of a strong therapeutic alliance: a randomized controlled clinical trial. BMC Psychiatry 7 (2007): 13.
References (II)J. Ruwaard, A. Lange, M. Bouwman, J. Broeksteeg, and B. Schrieken, E-Mailed standardized cognitive behavioural treatment of work-related stress: a randomized controlled trial. Cognitive Behaviour Therapy 36 (2007): 179-192.
J. Ruwaard, B. Schrieken, M. Schrijver, J. Broeksteeg, J. Dekker, H. Vermeulen, and A. Lange, Standardized web-based cognitive behavioural therapy of mild to moderate depression: a randomized controlled trial with a long-term follow-up. Cognitive Behaviour Therapy 38 (2009): 206-221.
A. Lange and J. Ruwaard, Ethical dilemmas in online research and treatment of sexually abused adolescents. Journal of Medical Internet Research 12 (2010): e58.
J. Ruwaard, J. Broeksteeg, B. Schrieken, P. Emmelkamp, and A. Lange, Web-based therapist-assisted cognitive behavioral treatment of panic symptoms: A randomized controlled trial with a three-year follow-up. Journal of Anxiety Disorders 24 (2010): 387-396.
J. Ruwaard, A. Lange, J. Broeksteeg, A. Renteria-Agirre, B. Schrieken, C. Dolan, and P. Emmelkamp, Online cognitive behavioral treatment of bulimic symptoms: A randomized controlled trial. Manuscript submitted for publication (copy on file with first author).