The Efficacy and Effectiveness of Online CBT - Jeroen Ruwaard
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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

interapy.nl
10.07.2015 Views

136 Chapter 7. General Discussionassociated with brief treatment duration. In the routine practice study, duration oftreatment ranged from 8 to 22 weeks, which is considerably less than the averageduration of treatment in Dutch specialised mental healthcare (1 year; Hilderink &Van ’t Land, 2009).Practicability. Online CBT provides an excellent tool to maintain treatment fidelity,since its treatment manual is computerised and highly standardised. It has beenargued that treatment manuals enable therapists to administer treatments moreeffectively, reduce idiosyncrasy in therapeutic methods, increase the therapists’ focuson specific treatment goals and techniques, and reduce differences in the qualityof treatment delivery (Crits-Christoph et al., 1991). Our data underscore thesesuggestions. In our routine practice data, only 2% of the variance in outcome wasattributable to differences between therapists. As illustrated in Figure 7.4, therapistsgenerally achieved similar positive outcomes.One particular advantage of online CBT is that therapists have time to reflect onthe best possible feedback, due to the asynchronous nature of the therapeutic dialogue.Before sending their feedback, they can consult the help files that are provided by thetreatment manual to find motivating phrases, discuss a case with colleagues, or callfor supervision, if needed. As a result, the quality of feedback can be increased. Inour trials, the treatments were provided by therapists who were relatively young andinexperienced. Yet, the outcomes of their treatments were on a par with the outcomesof treatments of experienced therapists. In our view, the extra time provided by theasynchronous therapeutic dialogue played a key part in this result.7.4 Suggestions for future researchReplication studies. Although the efficacy of the new interventions was demonstrated,these findings should be confirmed in replication research. Each of theseinterventions was tested in just one RCT. It might be argued that the aggregatedevidence of the five related studies strengthen the evidence of each individual intervention.However, according to the criteria of empirically validated treatment (e.g.,Chambless, 1993), the new interventions should be considered experimental until atleast one other group design study has been completed. Ideally, these replications will

7.4. Suggestions for future research 13716Pre Post 6WK17 18Pre Post 6WK19200−1−211 12 13 14 15Standardized Mean Change0−1−26 7 8 9100−1−21 23 450−1−2Pre Post 6WKPre Post 6WKTimePre Post 6WKFigure 7.4: Mean pre-test to six week follow-up changes in primary symptom severity(standardised scores) as observed for clients of the twenty most active therapists inthe routine practice dataset (number of clients per therapist ranges from 21 to 151).be conducted by independent research groups. In our studies, we evaluated the treatmentsthat we also developed. Although this is almost common practice in internetintervention research, independent replications would significantly strengthen thepresent evidence base.Comparative trials. In the clinical trials, the treatments have been evaluated exclusivelyby comparison with waiting-list comparison groups. Any reference to theequivalence of online CBT and face-to-face therapy is based on comparisons of effectsizes that were collected in different contexts. There is a clear need for direct comparisonsbetween online CBT and alternative treatment options, preferably in the form oflarge-sample equivalence trials that are conducted in naturalistic settings.

7.4. Suggestions for future research 13716Pre Post 6WK17 18Pre Post 6WK19200−1−211 12 13 14 15St<strong>and</strong>ardized Mean Change0−1−26 7 8 9100−1−21 23 450−1−2Pre Post 6WKPre Post 6WKTimePre Post 6WKFigure 7.4: Mean pre-test to six week follow-up changes in primary symptom severity(st<strong>and</strong>ardised scores) as observed for clients <strong>of</strong> the twenty most active therapists inthe routine practice dataset (number <strong>of</strong> clients per therapist ranges from 21 to 151).be conducted by independent research groups. In our studies, we evaluated the treatmentsthat we also developed. Although this is almost common practice in internetintervention research, independent replications would significantly strengthen thepresent evidence base.Comparative trials. In the clinical trials, the treatments have been evaluated exclusivelyby comparison with waiting-list comparison groups. Any reference to theequivalence <strong>of</strong> online <strong>CBT</strong> <strong>and</strong> face-to-face therapy is based on comparisons <strong>of</strong> effectsizes that were collected in different contexts. <strong>The</strong>re is a clear need for direct comparisonsbetween online <strong>CBT</strong> <strong>and</strong> alternative treatment options, preferably in the form <strong>of</strong>large-sample equivalence trials that are conducted in naturalistic settings.

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