The Efficacy and Effectiveness of Online CBT - Jeroen Ruwaard
The Efficacy and Effectiveness of Online CBT - Jeroen Ruwaard The Efficacy and Effectiveness of Online CBT - Jeroen Ruwaard
130 Chapter 7. General DiscussionPanicPrePostPosttraumatic StressRaw Score0 5 10 155 10 15 20PDSS−RDASS stressBurnout20 25 30 35 40 45 505 10 15 20 25IESBDIDepressionPrePostTimeFigure 7.2: A comparison of RCT and routine practice data of pre- to post-treatmentchanges in primary symptom severity observed in clients, who followed onlineCBT. Solid lines represent mean scores of routine practice clients (Ruwaard, Lange,Schrieken, et al., 2012). Dashed lines represent mean scores of RCT participants, whocompleted online CBT (Ruwaard et al., 2007, 2009, 2010; Ruwaard, Lange, Broeksteeg,et al., 2012; Lange, Rietdijk, et al., 2003). Overall, treatment effects in routinepractice were somewhat stronger than those in the controlled trials, because routinepractice clients had more to gain from treatment. At pre-test, symptom severity levelsof routine practice clients were higher in comparison to those of RCT participants.Standardized mean change0−1−2BurnoutPre Post 6WK 1JRPre Post 6WK 1JRDepressionPanicPre Post 6WK 1JRTimePre Post 6WK 1JRPosttraumatic StressFigure 7.3: Standardised changes in primary symptom severity in the routine practicedataset, from pre-test to one year follow-up.
7.2. Strengths and limitations 1317.2 Strengths and limitations7.2.1 StrengthsTherapist involvement. Our studies complement a field of research that is largelyfocused on the reduction of therapist involvement. The vast majority of studiesof internet-delivered CBT have evaluated self-help or guided self-help formats, inwhich therapist support is either not provided or substantially reduced. The focuson self-management is understandable, given concerns that available resources areinadequate to meet the rising demands for mental healthcare. However, reducedtherapist involvement may also limit the effects of an intervention (Sharp et al.,2000; Palmqvist et al., 2007; Cuijpers et al., 2009). We examined a form of onlinetreatment that matches manualised face-to-face CBT, in which therapist involvementis considered crucial and therefore more extensive. By doing so, we addressed aneglected area in internet intervention research.Large routine practice sample. Until recently, little was known about the performanceof online therapist-assisted CBT in routine clinical practice (Andersson etal., 2009). By demonstrating that the results of controlled trials of online therapistsupportedCBT generalise well to clinical practice, we substantially added to theexisting evidence base. To our knowledge, our study resulted in one of largest routineclinical samples in therapist-assisted online CBT research. Encouragingly, similarfindings with therapist-assisted online CBT are being reported from other onlinevirtual clinics around the world (e.g., Hilvert-Bruce, Rossouw, Wong, Sunderland, &Andrews, 2012; Sunderland, Wong, Hilvert-Bruce, & Andrews, 2012; Bergström etal., 2010). Policymakers, regulatory bodies, and insurance companies may find anargument in these results to support further implementation of online CBT.Acceptable adherence. Poor adherence has been identified as one of the majorchallenges of online interventions. Many participants do not complete full treatment.The problem is most pronounced for self-help interventions. For instance, dropout washuge in the Farvolden et al. (2005) study of a program without therapist involvement,with as few as 12 out of 1161 participants (1%) completing the program. But guided
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- Page 165 and 166: ReferencesAben, I., Verhey, F., Lou
- Page 167 and 168: References 159Bickel, R. (2007). Mu
- Page 169 and 170: References 161apy Research, 1(2), 8
- Page 171 and 172: References 163Hay, P. P., Bacaltchu
- Page 173 and 174: References 165for bulimia nervosa:
- Page 175 and 176: References 167Mond, J. M., Hay, P.
- Page 177 and 178: References 169(2003). The developme
- Page 179 and 180: References 171of change in psycholo
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- Page 183: Dankwoord 175en Janneke Broeksteeg
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130 Chapter 7. General DiscussionPanicPrePostPosttraumatic StressRaw Score0 5 10 155 10 15 20PDSS−RDASS stressBurnout20 25 30 35 40 45 505 10 15 20 25IESBDIDepressionPrePostTimeFigure 7.2: A comparison <strong>of</strong> RCT <strong>and</strong> routine practice data <strong>of</strong> pre- to post-treatmentchanges in primary symptom severity observed in clients, who followed online<strong>CBT</strong>. Solid lines represent mean scores <strong>of</strong> routine practice clients (<strong>Ruwaard</strong>, Lange,Schrieken, et al., 2012). Dashed lines represent mean scores <strong>of</strong> RCT participants, whocompleted online <strong>CBT</strong> (<strong>Ruwaard</strong> et al., 2007, 2009, 2010; <strong>Ruwaard</strong>, Lange, Broeksteeg,et al., 2012; Lange, Rietdijk, et al., 2003). Overall, treatment effects in routinepractice were somewhat stronger than those in the controlled trials, because routinepractice clients had more to gain from treatment. At pre-test, symptom severity levels<strong>of</strong> routine practice clients were higher in comparison to those <strong>of</strong> RCT participants.St<strong>and</strong>ardized mean change0−1−2BurnoutPre Post 6WK 1JRPre Post 6WK 1JRDepressionPanicPre Post 6WK 1JRTimePre Post 6WK 1JRPosttraumatic StressFigure 7.3: St<strong>and</strong>ardised changes in primary symptom severity in the routine practicedataset, from pre-test to one year follow-up.
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