Tailored internet-based psychological treatment for psychological problems during the COVID-19 pandemic: A randomized controlled trial

Effect of Internet-Based Cognitive Behavioral Therapy on Psychological Distress and Quality of Life Among Breast Cancer Survivors: A Meta-Analysis of Randomized Controlled Trials

OBJECTIVES

This meta-analysis was to critically evaluate the effectiveness of Internet-based Cognitive Behavioral Therapy (ICBT) on psychological distress and quality of life in breast cancer survivors.

METHODS

A search was conducted across eleven databases (PubMed, Web of Science, Embase, Cochrane Library, Scopus, ProQuest, CINAHL, CBM, CNKI, VIP and Wanfang) to identify relevant randomized controlled trials (RCTs) published from databases inception to September 2023. Two reviewers independently conducted study screening, data extraction, and quality assessment of the included studies. Review Manager 5.4 and Stata 18.0 were utilized for analysis.

RESULTS

Ten studies with 1409 patients were included. Meta-analysis indicated that ICBT alleviated anxiety [SMD = -0.34, 95% CI (-0.64, -0.04), p = 0.03] and depression [SMD = -0.43, 95% CI (-0.76, -0.09), p = 0.01] in breast cancer patients. Therapist-guided ICBT outperformed self-guided ICBT, with interventions lasting ≤ 9 weeks better than > 9 weeks, and module quantity didn't affect the results. Additionally, ICBT significantly improved quality of life [SMD = 0.37, 95% CI (0.21, 0.52), p < 0.001], yet didn't reduce fatigue [SMD = -0.13, 95% CI (-0.59, 0.34), p = 0.60], insomnia [MD = -2.24, 95% CI (-5.77, 1.28), p = 0.21], or fear of progression [SMD = -0.10, 95% CI (-0.31, 0.11), p = 0.34].

CONCLUSIONS

ICBT, especially therapist-guided and lasting for ≤ 9 weeks, can effectively relieve anxiety and depression, as well as enhance breast cancer patients' quality of life. Nevertheless, it fails to improve fatigue, insomnia, or fear of progression. High-quality, large-sample studies must be conducted in the future for further validation.

Single session of interpretation bias modification helped to improve fear of COVID-19 and COVID-19-related post-traumatic stress symptoms

BACKGROUND

Post-traumatic stress symptoms (PTSS) are frequently observed in those who have experienced trauma events like the COVID-19 outbreak. The cognitive model of PTSS highlights the relationship between PTSS and negative interpretation bias.

OBJECTIVE

The present study aimed to modify interpretation bias and to improve PTSS as well as PTSS-related fear.

METHODS

59 participants with high PTSS levels were recruited and randomly allocated to either the interpretation modification programme (IMP) intervention group or the interpretation control condition (ICC) control group. PTSS, negative interpretation bias, fear of COVID-19, and depression and anxiety symptoms were assessed before and after training.

FINDINGS

Intention-to-treat analyses showed that compared with ICC, participants receiving IMP generated fewer negative interpretations for ambiguous scenarios, and the group-by-time interaction effect was significant. IMP also illustrated a more significant change in fear after training compared with ICC. Although no effects of training conditions were found on PTSS, the interaction of training conditions with fear reduction could predict PTSS improvement.

CONCLUSIONS

IMP could improve negative interpretations and fear related to COVID-19 and might help to ameliorate PTSS.

CLINICAL IMPLICATIONS

The role of PTSS-related emotion should be considered when exploring the effectiveness of IMP. IMP is a flexible approach that can be tailored to the specific characteristics of the traumatic event, which makes it suitable for a broader range of traumatised individuals.

The latest developments with internet-based psychological treatments for depression

INTRODUCTION

Internet-based psychological treatments for depression have been around for more than 20 years. There has been a continuous line of research with new research questions being asked and studies conducted.

AREAS COVERED

In this paper, the author reviews studies with a focus on papers published from 2020 and onwards based on a Medline and Scopus search. Internet-based cognitive behavior therapy (ICBT) programs have been developed and tested for adolescents, older adults, immigrant groups and to handle a societal crisis (e.g. COVID-19). ICBT works in regular clinical settings and long-term effects can be obtained. Studies on different treatment orientations and approaches such as acceptance commitment therapy, unified protocol, and tailored treatments have been conducted. Effects on quality-of-life measures, knowledge acquisition and ecological momentary assessment as a research tool have been reported. Factorial design trials and individual patient data meta-analysis are increasingly used in association with internet intervention research. Finally, prediction studies and recent advances in artificial intelligence are mentioned.

EXPERT OPINION

Internet-delivered treatments are effective, in particular if therapist guidance is provided. More target groups have been covered but there are many remaining challenges including how new tools like artificial intelligence will be used when treating depression.