The Efficacy and Effectiveness of Online CBT - Jeroen Ruwaard

106 Chapter 6. Online CBT in Routine Clinical PracticeIntroductionIn the past decade, there has been a rapid expansion in the research and developmentof internet-based psychotherapeutic interventions. As a result, we now know thatonline interventions are feasible and efficacious in the prevention and treatment of awide variety of common mental health disorders (Cuijpers, van Straten, & Andersson,2008; Andersson & Cuijpers, 2009; Cuijpers et al., 2009; Andrews, Cuijpers, Craske,McEvoy, & Titov, 2010). Although effect sizes vary with program characteristics (e.g.,whether human support is included, or whether the aim is prevention or treatment),the benefits of various approaches are clear. Within the field, there is general agreementthat online interventions are pivotal in improving the accessibility and uptake ofevidence-based care (F. Griffiths et al., 2006).While the benefits of online interventions have been firmly established in controlledresearch, the performance of these interventions in routine clinical practice is lessclear (Andersson et al., 2009). Online interventions do not fit traditional healthcaresystems, and raise legal, ethical, and professional issues that are only partially resolvedby current guidelines (Childress, 2000). Consequently, the implementation of onlinetreatment in routine clinical practice has progressed slowly, which has limited theoptions for effectiveness research. Some interventions have been evaluated in realworldcontexts, with positive results (Christensen, Griffiths, Korten, et al., 2004;Ritterband et al., 2008; Riper et al., 2009; Marks et al., 2003; Kaldo, Larsen, &Andersson, 2004; Bergström et al., 2009, 2010; Postel, ter Huurne, de Haan, & deJong, 2009). However, the current evidence base with regard to the effectiveness ofonline interventions in routine practice is small. Large-sample effectiveness studies areneeded before wide-scale dissemination of online interventions can be recommended.In this article, we present a study of the outcome of online therapist-assistedcognitive behavioral treatment (CBT) of 1500 patients, who were treated for symptomsof depression, panic disorder, posttraumatic stress, or burnout at a Dutch online mentalhealth clinic. The efficacy of these treatments was previously demonstrated in sevenrandomized controlled trials, which included a total of 629 participants. (Lange etal., 2001; Lange, van de Ven, & Schrieken, 2003; Knaevelsrud & Maercker, 2007,2009; Wagner et al., 2006; Wagner & Maercker, 2007; Ruwaard et al., 2007, 2009,