Efficacy and Effectiveness of Online CBT

Jeroen Ruwaard

What is Interapy?

• Online Cognitive Behavior Therapy

•Web-based

•Manualized

•Therapist-assisted

Controlled Trials

Trials N

Burnout 1 239

Bulimic symptoms 1 105

Depression 1 54

Panic symptoms 1 58

Posttraumatic stress 4 360

Sexual trauma 1 24

9 840

Primary outcome measures

Treatment Measure

Burnout Oldenburg Burnout Inventory OLBI

Bulimic symptomsEating Disorder Examination Questionnaire

EDE-Q

Depression Beck Depression Inventory BDI

Panic symptoms Panic Disorder Severity Scale PDSS-SR

Posttraumatic Stress Impact of Event Scale IES

Controlled Effects

Recovery (controlled effects)

Routine Clinical Practice

N

Burnout 470

Depression 413

Panic symptoms 139

Posttraumatic stress 478

1500

Symptom reduction

Trials ------- Routine Practice 7 7 7 7 7 7

Clinical Significance

Deteriorated Stable Improved Recovered

Burn-out 1% 37% 29% 34%

Depression 0% 16% 22% 61%

Panic 0% 39% 13% 48%

PTS 0% 23% 26% 51%

0% 29% 23% 49%

Treatment adherence

Limitations

• waiting list comparison groups

• independent evaluations are needed

• uncontrolled follow-ups

Online CBT

• efficacious

• large, clinically significant effects

• acceptable drop-out

• effective in routine practice

www.interapy.nl research@interapy.nl

References (I)A. Lange, J.P. van de Ven, B.A. Schrieken, B. Bredeweg, and P.M. Emmelkamp, Internet-mediated, protocol-driven treatment of psychological dysfunction. Journal of Telemedicine and Telecare 6 (2000): 15-21.

A. Lange, J.P. van de Ven, B. Schrieken, and P.M. Emmelkamp, Interapy, treatment of posttraumatic stress through the Internet: a controlled trial. Journal of Behavior Therapy and Experimental Psychiatry 32 (2001): 73-90.

A. Lange, D. Rietdijk, M. Hudcovicova, J.P. van de Ven, B. Schrieken, and P.M. Emmelkamp, Interapy: a controlled randomized trial of the standardized treatment of posttraumatic stress through the internet. Journal of Consulting and Clinical Psychology 71 (2003): 901-9.

B. Wagner, C. Knaevelsrud, and A. Maercker, Internet-based cognitive-behavioral therapy for complicated grief: a randomized controlled trial. Death Studies 30 (2006): 429-53.

C. Knaevelsrud and A. Maercker, Internet-based treatment for PTSD reduces distress and facilitates the development of a strong therapeutic alliance: a randomized controlled clinical trial. BMC Psychiatry 7 (2007): 13.

References (II)J. Ruwaard, A. Lange, M. Bouwman, J. Broeksteeg, and B. Schrieken, E-Mailed standardized cognitive behavioural treatment of work-related stress: a randomized controlled trial. Cognitive Behaviour Therapy 36 (2007): 179-192.

J. Ruwaard, B. Schrieken, M. Schrijver, J. Broeksteeg, J. Dekker, H. Vermeulen, and A. Lange, Standardized web-based cognitive behavioural therapy of mild to moderate depression: a randomized controlled trial with a long-term follow-up. Cognitive Behaviour Therapy 38 (2009): 206-221.

A. Lange and J. Ruwaard, Ethical dilemmas in online research and treatment of sexually abused adolescents. Journal of Medical Internet Research 12 (2010): e58.

J. Ruwaard, J. Broeksteeg, B. Schrieken, P. Emmelkamp, and A. Lange, Web-based therapist-assisted cognitive behavioral treatment of panic symptoms: A randomized controlled trial with a three-year follow-up. Journal of Anxiety Disorders 24 (2010): 387-396.

J. Ruwaard, A. Lange, J. Broeksteeg, A. Renteria-Agirre, B. Schrieken, C. Dolan, and P. Emmelkamp, Online cognitive behavioral treatment of bulimic symptoms: A randomized controlled trial. Manuscript submitted for publication (copy on file with first author).