The Efficacy and Effectiveness of Online CBT - Jeroen Ruwaard

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