Implementing internet delivered cognitive behavioural therapy for depression and anxiety in adults: A mixed-methods systematic review (Preprint)

Abstract

A mixed methods systematic review, utilising a convergent synthesis design, was conducted to investigate the implementation of internet-delivered cognitive behavioural therapy (iCBT) for depression and anxiety in adults. Two domains of inquiry guided this effort, centring on 1) aspects that research articles postulate as important for the implementation of iCBT and 2) aspects relevant to the day-to-day running of iCBT services. Forty (N=40) articles were identified as eligible for mixed-methods review. Data were analysed qualitatively using the descriptive-interpretive approach. The first domain highlighted the impact of therapist and patient attitudes when implementing iCBT, the superiority of guided iCBT over unguided, its non-inferiority to equivalent face-to-face treatments, and its utility outside of the original target of mild-moderate depression and/or anxiety. Three sub-domains were identified under domain two; 1) the management of iCBT in the workplace, detailing the importance of managing the iCBT service, related staff and their motivations around using it 2) the practice of iCBT in the workplace, describing the therapeutic aspects of iCBT provision such as the provision of support, the background of supporters and screening procedures, 3) contextual considerations, detailing the impact of governmental legislation on therapy conduced over the internet, the lack of an iCBT workforce as a limiting factor and the costings associated with iCBT provision. Broadly, the findings describe several aspects that should be taken to account when researchers or practitioners implement iCBT as part of their work. However, the findings should also be interpreted with caution; few of the included studies were conducted with the sole aim of evaluating the implementation of iCBT, highlighting the need for more implementation-specific research in this area.