Musiat, P., & Tarrier, N. (2014). Collateral outcomes in e-mental health: A systematic review of the evidence for added benefits of computerized cognitive behavior therapy interventions for mental health. Psychological Medicine, 44(15), 3137-3150. doi: 10.1017/S0033291714000245. PMID: 25065947.
Although many studies have discussed the potential additional benefits of e-mental health programs, no study has reviewed the evidence to see if these potential benefits exist. In this study, the authors conducted a systematic review of studies comparing computerized cognitive behavioral therapy (cCBT) to waitlist controls or other interventions. They tracked multiple outcomes assessing the potential added benefits of cCBT, including cost-effectiveness, geographic and time flexibility, waiting time for treatment, stigma, therapist time, help-seeking behaviors, and treatment satisfaction. The authors located a total of 95 studies. Evidence from multiple studies supported the cost-effectiveness of cCBT. The costs of cCBT were less than usual care, especially if patients already owned the needed computer equipment. Less evidence existed to support the geographic and time flexibility of cCBT. Additionally, only weak evidence suggested that cCBT decreased waiting time for treatment. No studies addressed whether cCBT decreased the stigma of mental health treatment. Required therapist time also varied greatly across studies. Less therapist time was required in studies using a completely computerized intervention, but many studies used cCBT as an adjunct to in-person treatment. Treatment satisfaction was high across studies, but most only surveyed patients completing treatment. Because of high attrition rates in studies of cCBT, treatment satisfaction may be overestimated. Results from this systematic review suggest that more research is required to investigate the potential additional benefits of e-mental treatments.