Efficacy of internet-based cognitive behavioral therapy on somatic symptom disorder and common related functional disorders: A meta-analysis of randomized controlled trials.

INTRODUCTION

Cognitive behavioral therapy (CBT) is recommended for somatic symptom disorder (SSD) and functional somatic syndromes. Face-to-face CBT is limited by accessibility barriers. Internet-based CBT (iCBT) addresses the aforementioned limitations. This study aimed to evaluate the efficacy of iCBT in SSD and common functional somatic syndromes.

METHODS

A meta-analysis was conducted, following the PRISMA statement for study screening. Databases including PubMed, Embase, and CENTRAL. The primary outcomes included somatic symptoms and health anxiety. Secondary outcomes included mood-related outcomes, functioning, and sleep.

RESULTS

A total of 23 studies were included (1746 iCBT-group vs 1553 control-group patients). Post-treatment, iCBT showed no significant effect difference vs. other psychotherapies (Hedges'g [95% CI]: general symptoms = 0.09 [-0.11; 0.28]; health anxiety: = 0.18 [-0.17; 0.52]), but outperformed waitlisting across most symptoms (Hedges'g [95% CI]: general symptoms = 0.30 [0.12; 0.48]; gastrointestinal = 0.62 [0.35; 0.88]; fatigue = 0.47 [0.25; 0.68]; health anxiety = 0.71 [0.26; 1.16]). The effect of iCBT was not significantly different or slightly higher than treatment as usual after treatment (Hedges'g [95% CI]: gastrointestinal = 0.41 [0.23; 0.58]; fatigue = 0.65 [-0.51; 1.82]; fibromyalgia = 0.27 [0.00; 0.55]). The pooled adverse event rate in the iCBT group was 27%, with no serious adverse events reported.

DISCUSSION: The iCBT is an effective intervention for SSD and common functional somatic syndromes. However, heterogeneity still exists among subtypes, and personalized plans need to be formulated.