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A meta-analysis of internet-based cognitive behavioral therapy for military and veteran populations

BACKGROUND: Military and veteran populations are unique in their trauma exposures, rates of mental illness and comorbidities, and response to treatments. While reviews have suggested that internet-based Cognitive Behavioral Therapy (iCBT) can be useful for treating mental health conditions, the exte...

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Autores principales: Liu, Jenny JW, Ein, Natalie, Forchuk, Callista, Wanklyn, Sonya G., Ragu, Suriya, Saroya, Samdarsh, Nazarov, Anthony, Richardson, J. Don
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10068715/
https://www.ncbi.nlm.nih.gov/pubmed/37013501
http://dx.doi.org/10.1186/s12888-023-04668-1
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author Liu, Jenny JW
Ein, Natalie
Forchuk, Callista
Wanklyn, Sonya G.
Ragu, Suriya
Saroya, Samdarsh
Nazarov, Anthony
Richardson, J. Don
author_facet Liu, Jenny JW
Ein, Natalie
Forchuk, Callista
Wanklyn, Sonya G.
Ragu, Suriya
Saroya, Samdarsh
Nazarov, Anthony
Richardson, J. Don
author_sort Liu, Jenny JW
collection PubMed
description BACKGROUND: Military and veteran populations are unique in their trauma exposures, rates of mental illness and comorbidities, and response to treatments. While reviews have suggested that internet-based Cognitive Behavioral Therapy (iCBT) can be useful for treating mental health conditions, the extent to which they may be appropriate for military and veteran populations remain unclear. The goals of the current meta-analysis are to: (1) substantiate the effects of iCBT for military and veteran populations, (2) evaluate its effectiveness compared to control conditions, and (3) examine potential factors that may influence their effectiveness. METHODS: This review was completed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting and Cochrane review guidelines. The literature search was conducted using PsycInfo, Medline, Embase, and Proquest Dissertation & Theses on June 4, 2021 with no date restriction. Inclusion criteria included studies that: (1) were restricted to adult military or veteran populations, (2) incorporated iCBT as the primary treatment, and (3) evaluated mental health outcomes. Exclusion criteria included: (1) literature reviews, (2) qualitative studies, (3) study protocols, (4) studies that did not include a clinical/analogue population, and (5) studies with no measure of change on outcome variables. Two independent screeners reviewed studies for eligibility. Data was pooled and analyzed using random-effects and mixed-effects models. Study data information were extracted as the main outcomes, including study condition, sample size, and pre- and post-treatment means, standard deviations for all assessed outcomes, and target outcome. Predictor information were also extracted, and included demographics information, the types of outcomes measured, concurrent treatment, dropout rate, format, length, and delivery of intervention. RESULTS: A total of 20 studies and 91 samples of data were included in the meta-analysis. The pooled effect size showed a small but meaningful effect for iCBT, g = 0.54, SE = 0.04, 95% CI (0.45, 0.62), Z = 12.32, p < .001. These effects were heterogenous across samples, (I(2) = 87.96), Q(90) = 747.62, p < .001. Predictor analyses found length of intervention and concurrent treatment to influence study variance within sampled studies, p < .05. Evaluation of iCBT on primary outcomes indicated a small but meaningful effect for PTSD and depression, while effects of iCBT on secondary outcomes found similar results with depression, p < .001. CONCLUSIONS: Findings from the meta-analysis lend support for the use of iCBT with military and veteran populations. Conditions under which iCBT may be optimized are discussed. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12888-023-04668-1.
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spelling pubmed-100687152023-04-03 A meta-analysis of internet-based cognitive behavioral therapy for military and veteran populations Liu, Jenny JW Ein, Natalie Forchuk, Callista Wanklyn, Sonya G. Ragu, Suriya Saroya, Samdarsh Nazarov, Anthony Richardson, J. Don BMC Psychiatry Research BACKGROUND: Military and veteran populations are unique in their trauma exposures, rates of mental illness and comorbidities, and response to treatments. While reviews have suggested that internet-based Cognitive Behavioral Therapy (iCBT) can be useful for treating mental health conditions, the extent to which they may be appropriate for military and veteran populations remain unclear. The goals of the current meta-analysis are to: (1) substantiate the effects of iCBT for military and veteran populations, (2) evaluate its effectiveness compared to control conditions, and (3) examine potential factors that may influence their effectiveness. METHODS: This review was completed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting and Cochrane review guidelines. The literature search was conducted using PsycInfo, Medline, Embase, and Proquest Dissertation & Theses on June 4, 2021 with no date restriction. Inclusion criteria included studies that: (1) were restricted to adult military or veteran populations, (2) incorporated iCBT as the primary treatment, and (3) evaluated mental health outcomes. Exclusion criteria included: (1) literature reviews, (2) qualitative studies, (3) study protocols, (4) studies that did not include a clinical/analogue population, and (5) studies with no measure of change on outcome variables. Two independent screeners reviewed studies for eligibility. Data was pooled and analyzed using random-effects and mixed-effects models. Study data information were extracted as the main outcomes, including study condition, sample size, and pre- and post-treatment means, standard deviations for all assessed outcomes, and target outcome. Predictor information were also extracted, and included demographics information, the types of outcomes measured, concurrent treatment, dropout rate, format, length, and delivery of intervention. RESULTS: A total of 20 studies and 91 samples of data were included in the meta-analysis. The pooled effect size showed a small but meaningful effect for iCBT, g = 0.54, SE = 0.04, 95% CI (0.45, 0.62), Z = 12.32, p < .001. These effects were heterogenous across samples, (I(2) = 87.96), Q(90) = 747.62, p < .001. Predictor analyses found length of intervention and concurrent treatment to influence study variance within sampled studies, p < .05. Evaluation of iCBT on primary outcomes indicated a small but meaningful effect for PTSD and depression, while effects of iCBT on secondary outcomes found similar results with depression, p < .001. CONCLUSIONS: Findings from the meta-analysis lend support for the use of iCBT with military and veteran populations. Conditions under which iCBT may be optimized are discussed. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12888-023-04668-1. BioMed Central 2023-04-03 /pmc/articles/PMC10068715/ /pubmed/37013501 http://dx.doi.org/10.1186/s12888-023-04668-1 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Liu, Jenny JW
Ein, Natalie
Forchuk, Callista
Wanklyn, Sonya G.
Ragu, Suriya
Saroya, Samdarsh
Nazarov, Anthony
Richardson, J. Don
A meta-analysis of internet-based cognitive behavioral therapy for military and veteran populations
title A meta-analysis of internet-based cognitive behavioral therapy for military and veteran populations
title_full A meta-analysis of internet-based cognitive behavioral therapy for military and veteran populations
title_fullStr A meta-analysis of internet-based cognitive behavioral therapy for military and veteran populations
title_full_unstemmed A meta-analysis of internet-based cognitive behavioral therapy for military and veteran populations
title_short A meta-analysis of internet-based cognitive behavioral therapy for military and veteran populations
title_sort meta-analysis of internet-based cognitive behavioral therapy for military and veteran populations
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10068715/
https://www.ncbi.nlm.nih.gov/pubmed/37013501
http://dx.doi.org/10.1186/s12888-023-04668-1
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