The British journal of psychiatry : the journal of mental science · 2026
Impact of support levels on effectiveness and drop-out of internet-based interventions for depression: network meta-analysis.
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Tong Lingyao, Panagiotopoulou Olga Maria, Radio Marta, Miguel Clara, Harrer Mathias, Andersson Gerhard, Riper Heleen, Cuijpers Pim, Karyotaki Eirini
Аннотация
BACKGROUND: Internet-based interventions vary with respect to the level of support provided, and the impact of support levels on outcomes has been unclear.
AIMS: To evaluate the relative effectiveness and acceptability of support levels in internet-based cognitive-behavioural therapy (iCBT) for depression.
METHOD: This network meta-analysis included randomised controlled trials of stand-alone iCBT for adults with elevated levels of depressive symptoms, identified via systematic searches of PubMed, EMBASE, PsycINFO and the Cochrane Library (1 January 2025). The primary outcome was post-intervention effectiveness. The secondary outcome was study drop-out risk. Risk of bias was assessed with Cochrane RoB-2. A frequentist random-effects model was conducted (preregistered at https://osf.io/amw4r).
RESULTS: We included 141 trials with 169 comparisons (n = 32 197). iCBT with therapeutic support had the greatest effect in terms of reducing depressive symptoms compared with care-as-usual (g = 0.42; 95% CI: 0.30 to 0.55). Such interventions outperformed offers with minimal coaching (encouragement only; g = 0.19, 95% CI: 0.03-0.35) and technical support (g = 0.27, 95% CI: 0.08-0.45) but had similar effects to those with full coaching (i.e. standardised feedback), automated support, on-demand support or no support. Interventions providing technical support represented the least effective iCBT format and were not statistically superior to care as usual (g = 0.15, 95% CI: -0.02 to 0.33). For acceptability, iCBT with minimal coaching showed the lowest drop-out rate (risk ratio = 1.13, (95% CI: 0.88-1.46), whereas technical support showed the highest (risk ratio = 1.6, 95% CI: 1.21-2.15). With pre-intervention human contact, all support levels were similarly effective; without it, therapeutic support outperformed other types of support (g = 0.32-0.68) and drop-out risks increased.
CONCLUSIONS: Low-intensity supported iCBT can be as effective as therapist-guided iCBT when initial human contact is present. Evidence regarding the potential harms of no-human support is needed before implementation.
AIMS: To evaluate the relative effectiveness and acceptability of support levels in internet-based cognitive-behavioural therapy (iCBT) for depression.
METHOD: This network meta-analysis included randomised controlled trials of stand-alone iCBT for adults with elevated levels of depressive symptoms, identified via systematic searches of PubMed, EMBASE, PsycINFO and the Cochrane Library (1 January 2025). The primary outcome was post-intervention effectiveness. The secondary outcome was study drop-out risk. Risk of bias was assessed with Cochrane RoB-2. A frequentist random-effects model was conducted (preregistered at https://osf.io/amw4r).
RESULTS: We included 141 trials with 169 comparisons (n = 32 197). iCBT with therapeutic support had the greatest effect in terms of reducing depressive symptoms compared with care-as-usual (g = 0.42; 95% CI: 0.30 to 0.55). Such interventions outperformed offers with minimal coaching (encouragement only; g = 0.19, 95% CI: 0.03-0.35) and technical support (g = 0.27, 95% CI: 0.08-0.45) but had similar effects to those with full coaching (i.e. standardised feedback), automated support, on-demand support or no support. Interventions providing technical support represented the least effective iCBT format and were not statistically superior to care as usual (g = 0.15, 95% CI: -0.02 to 0.33). For acceptability, iCBT with minimal coaching showed the lowest drop-out rate (risk ratio = 1.13, (95% CI: 0.88-1.46), whereas technical support showed the highest (risk ratio = 1.6, 95% CI: 1.21-2.15). With pre-intervention human contact, all support levels were similarly effective; without it, therapeutic support outperformed other types of support (g = 0.32-0.68) and drop-out risks increased.
CONCLUSIONS: Low-intensity supported iCBT can be as effective as therapist-guided iCBT when initial human contact is present. Evidence regarding the potential harms of no-human support is needed before implementation.