Antidepressants have long been used as medications for depression, although now treatment plans often combine psychotherapy with pharmacotherapy. Cognitive behavioural therapy (CBT), in fact, has been shown in studies to be as effective as antidepressants in reducing symptoms of depression.
However, traditional face-to-face CBT is not always readily available especially in remote areas or in resource-limited settings. As such, healthcare systems have learned to innovate by using electronically delivered CBC, or eCBT, which is accessible via internet or smartphone apps. This web-based method, according to a new systematic review (Luo et al. 2020), is just as effective as face-to-face CBC and should be used if patients and therapists so desire.
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With digital technology's widening reach, as well as increased availability of smartphones and other mobile devices, the use of eCBT should be given "serious consideration" as a means to maximise accessibility for depression therapies, emphasises the review team, whose research is an article in press in the journal EClinicalMedicine.
Compared to face-to-face CBT, web-based treatment offers a more cost-effective option as this eliminates travel time, transport expenses, as well as the need to skip work or make childcare arrangements. In addition to flexibility and ease of access, eCBT allows patients to receive therapy without worrying about stigma attached to mental illness and being seen attending psychiatric service, the review team points out.
This systematic review was performed primarily to compare the effectiveness of eCBT with the traditional face-to-face CBT in treating individuals with depression. The authors also assessed differences in global functionality, participant satisfaction, affordability between remote and face-to-face CBT.
A total of 17 randomised controlled trials (RCTs) that compared face-to-face CBT with therapist-supported eCBT were included in the review. There were no restrictions in terms of age, sex, or ethnicity of study participants.
The review team's key findings include:
- eCBT was more effective than face-to-face CBT in reducing depression symptom severity.
- No remarkable differences between the two methods of treatment in terms of participant satisfaction.
- Results did not differ when stratified by subgroups such as participant age and location of study.
Specifically, one RCT highlighted how eCBT could help with bringing treatment cost down: eCBT's total costs were $501.18 (€440.78) lower per patient compared to face-to-face.
The authors, however, noted some important limitations in their systematic review, including small studies with inordinate outcomes, and high heterogeneity in the meta-analysis that cannot be explained by subgroup analyses. "Overall, the results should be analysed with caution due to the risk of bias present," the authors wrote.
Source: The Lancet