Uzman rehberliği olmayan internet tabanlı terapötik müdahalelerin kaygı ve depresyon belirtileri üzerindeki etkinliği: Sistematik derleme

Yıl 2025, Cilt: 9 Sayı: 1, 85 - 105, 25.04.2025

Elif Sena Ergin , Esra Zıvralı Yarar

https://doi.org/10.57127/kpd.26024438.1286555

Öz

Teknoloji kullanımı pek çok alanda olduğu gibi ruh sağlığı alanında da birçok gelişmeye yol açmıştır. Özellikle internet tabanlı terapötik müdahaleler ruh sağlığını iyileştirmeyi hedefleyerek bir uzman rehberliğinde ya da kişinin kendi başına kullanabileceği web siteleri ve telefon uygulamaları ile yaygın şekilde kullanılmaya başlanmıştır. Bu sistematik derlemenin amacı uzman desteği olmayan internet tabanlı müdahalelerin depresyon ve anksiyete belirtileri üzerindeki etkinliğini araştıran ve aktif kontrol grubu kullanan randomize kontrollü çalışmaları incelemektir. Bu amaçla Medline, PsycINFO ve Web of Science veri tabanlarında 8 Aralık 2021 tarihine kadar yayınlanmış ilgili çalışmalar taranmış ve kriterleri karşılayan 13 çalışma derlemeye dahil edilmiştir. Müdahalelerin etkinliğine dair bulgular, internet müdahalesiyle depresyon ve anksiyete belirtilerindeki düşüşün on üç çalışma arasından sekizinde (%61.5) müdahale ve aktif kontrol grupları arasında farklılaşmadığına işaret etmektedir. Müdahale gruplarında aktif kontrol grubuna kıyasla daha fazla iyileşme bulan beş çalışmada (%38.5) katılımcıların yaş ortalamasının 40’tan küçük olduğu ve müdahale öncesi orta seviye depresyon belirtileri gösterdikleri görülmüştür. Bulgular, rehbersiz çevrimiçi bilişsel davranışçı terapi müdahalelerinin depresyon ve anksiyete belirtilerinin azaltılmasında etkili olabileceğini göstermektedir. Bununla birlikte, yüksek katılımcı kayıp oranları ve örneklem çeşitliliği, sonuçların genellenebilirliği konusunda sınırlılıklar oluşturmaktadır.

Anahtar Kelimeler

sistematik inceleme , anksiyete , depresyon , internet tabanlı müdahale

Etik Beyan

BEYANLAR Etik Kurul Onayı Etik izin gerektirmeyen, sistematik derleme çalışmasıdır. Çıkar Çatışması Beyanı Bu makalenin tüm yazarları, makaleye ilişkin herhangi bir çıkar çatışması olmadığını beyan ederler. Onam Formu Araştırma türüne uygun değildir. Proje/Ödenek Bilgisi Bu çalışma herhangi bir proje kapsamında gerçekleştirilmemiş ve herhangi bir fon veya ödenek kullanılmamıştır. Data Paylaşımı/Uygunluğu Çalışma kapsamında katılımcılardan elde edilen herhangi bir veri yoktur. Yazar(lar)ın Katkısı [ESE], sistematik derleme sürecini (makale tarama, seçme ve eleme) yürüterek verileri topladı; bulguları sentezleyip yorumladı; makalenin ilk taslağını, giriş, yöntem ve sonuç bölümleri dâhil olmak üzere yazdı. [EZY], derleme süreci boyunca yöntemsel rehberlik sağladı; özellikle giriş ve tartışma bölümlerinin geliştirilmesi olmak üzere metni gözden geçirdi ve düzenlemeler yaptı. Tüm yazarlar makalenin son halini gözden geçirdi ve onayladı.

Teşekkür

Yazar Notu: Bu çalışma Ankara Sosyal Bilimler Üniversitesi Klinik Psikoloji Tezsiz Yüksek Lisans Bitirme Projesi olarak hazırlanmıştır.

The efficacy of internet-based therapeutic interventions without expert guidance on symptoms of anxiety and depression: A systematic review

Öz

The use of technology has led to many developments in the field of mental health as in many other fields. In particular, Internet-based therapeutic interventions are widely used through websites and mobile applications either with or without guidance. The aim of this systematic review is to examine randomized controlled trials that investigated the efficacy of internet-based interventions without guidance on depression and anxiety symptoms in comparison to an active control group. For this purpose, relevant studies from Medline, PsycINFO, and Web of Science databases until December 08, 2021 were reviewed, 13 studies that met the criteria were included in the review. Findings on the efficacy of interventions indicate that the reduction in depression and anxiety symptoms with the internet intervention did not differ between the intervention and active control groups in eight of the thirteen studies (61.5%). In five studies (38.5%) that found greater improvement in the intervention groups compared to the active control group, the average age of the participants was less than 40 and they had moderate symptoms of depression before the intervention. The findings suggest that unguided online cognitive behavioral therapy interventions may be effective in reducing depression and anxiety symptoms. However, high dropout rates and sample diversity pose limitations on the generalizability of the results.

Anahtar Kelimeler

systematic review , anxiety , depression , internet-based intervention

Etik Beyan

DECLARATIONS Ethics Committee Approval This is a systematic review study that does not require ethical approval. Declaration of Conflict of Interest All authors of this article declare that they have no conflict of interest regarding the article. Consent Form It is not suitable for the type of research. Project/Funding Information This study was not conducted within the scope of any project and no funds or grants were used. Data Sharing/Appropriateness There is no data obtained from the participants within the scope of the study. Author(s) Contribution [ESE] conceived and designed the analysis; collected the data by conducting the systematic review process including article screening and selection; performed the analysis by synthesizing and interpreting the findings; wrote the first draft of the paper including the introduction, methods, and results sections. [EZY] provided methodological guidance throughout the review process; revised and edited the manuscript, particularly contributing to the refinement of the introduction and discussion sections. All authors reviewed and approved the final manuscript.

Teşekkür

Author’s Note: This study was prepared as a Graduation Project for Ankara Social Sciences University Clinical Psychology Non-Thesis Master's Degree.

Kaynakça

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). Andersson, G. (2018). Internet interventions: Past, present and future. Internet Interventions, 12, 181–188.
• Andersson, G., Estling, F., Jakobsson, E., Cuijpers, P. ve Carlbring, P. (2011). Can the patient decide which modules to endorse? An open trial of tailored internet treatment of anxiety disorders. Cognitive Behaviour Therapy, 40(1), 57–64.
• Andersson, G. ve Titov, N. (2014). Advantages and limitations of Internet-based interventions for common mental disorders. World Psychiatry, 13(1), 4–11.
• Andersson, G., Titov, N., Dear, B. F., Rozental, A. ve Carlbring, P. (2019). Internet-delivered psychological treatments: From innovation to implementation. World Psychiatry, 18(1), 20–28.
• Arean, P. A., Hallgren, K. A., Jordan, J. T., Gazzaley, A., Atkins, D. C., Heagerty, P. J. ve Anguera, J. A. (2016). The use and effectiveness of mobile apps for depression: Results from a fully remote clinical trial. Journal of Medical Internet Research, 18(12), e330.
• Baldwin, P. A., Sanatkar, S., Clarke, J., Fletcher, S., Gunn, J., Wilhelm, K., Campbell, L., Zwar, N., Harris, M., Lapsley, H., Hadzi-Pavlovic, D., Christensen, H. ve Proudfoot, J. (2020). A web-based mental health intervention to improve social and occupational functioning in adults with type 2 diabetes (The Springboard Trial): 12-month outcomes of a randomized controlled trial. Journal of Medical Internet Research, 22(12).
• Barak, A., Klein, B. ve Proudfoot, J. G. (2009). Defining Internet-Supported Therapeutic Interventions. Annals of Behavioral Medicine, 38(1), 4–17.
• Barrantes, R. ve Vargas, E. (2019). Different paths and same destinations? An analysis of the convergence in Internet usage patterns between different age groups. The Electronic Journal of Information Systems in Developing Countries, 85(6).
• Batterham, P. J., Calear, A. L., Farrer, L., Gulliver, A. ve Kurz, E. (2021). Efficacy of a transdiagnostic self-help internet intervention for reducing depression, anxiety, and suicidal ideation in adults: Randomized controlled trial. Journal of Medical Internet Research, 23(1), e22698.
• Baumeister, H., Reichler, L., Munzinger, M. ve Lin, J. (2014). The impact of guidance on Internet-based mental health interventions—A systematic review. Internet Interventions, 1(4), 205–215.
• Beatty, L. ve Binnion, C. (2016). a systematic review of predictors of, and reasons for, adherence to online psychological ınterventions. International Journal of Behavioral Medicine, 23(6), 776–794.
• Beatty, L., Kemp, E., Coll, J. R., Turner, J., Butow, P., Milne, D., Yates, P., Lambert, S., Wootten, A., Yip, D. ve Koczwara, B. (2019). Finding my way: Results of a multicentre RCT evaluating a web-based self-guided psychosocial intervention for newly diagnosed cancer survivors. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 27(7), 2533–2544.
• Brown, M., O’Neill, N., Woerden, H. van, Eslambolchilar, P., Jones, M. ve John, A. (2016). Gamification and adherence to web-based mental health ınterventions: A systematic review. JMIR Mental Health, 3(3), e5710.
• Carlbring, P., Gunnarsdóttir, M., Hedensjö, L., Andersson, G., Ekselius, L. ve Furmark, T. (2007). Treatment of social phobia: Randomised trial of internet-delivered cognitive-behavioural therapy with telephone support. The British Journal of Psychiatry: The Journal of Mental Science, 190, 123–128.
• Clarke, J., Sanatkar, S., Baldwin, P. A., Fletcher, S., Gunn, J., Wilhelm, K., Campbell, L., Zwar, N., Harris, M., Lapsley, H., Hadzi-Pavlovic, D., Christensen, H. ve Proudfoot, J. (2019). Aweb-based cognitive behavior therapy ıntervention to ımprove social and occupational functioning in adults with type 2 diabetes (the springboard trial): Randomized controlled trial. Journal of Medical Internet Research, 21(5), e12246.
• Cowpertwait, L. ve Clarke, D. (2013). Effectiveness of web-based psychological ınterventions for depression: A meta-analysis. International Journal of Mental Health and Addiction, 11(2), 247–268.
• Deady, M., Mills, K. L., Teesson, M. ve Kay-Lambkin, F. (2016). An online ıntervention for co-occurring depression and problematic alcohol use in young people: Primary outcomes from a randomized controlled trial. Journal of Medical Internet Research, 18(3), e71.
• Donker, T., Griffiths, K. M., Cuijpers, P. ve Christensen, H. (2009). Psychoeducation for depression, anxiety and psychological distress: A meta-analysis. BMC Medicine, 7(1), 1–9.
• Encyclopedia of Survey Research Methods. (2008). Sage Publications, Inc.
• Eysenbach, G. (2005). The law of attrition. Journal of Medical Internet Research, 7(1), e402.
• Furukawa, T. A., Noma, H., Caldwell, D. M., Honyashiki, M., Shinohara, K., Imai, H., Chen, P., Hunot, V. ve Churchill, R. (2014). Waiting list may be a nocebo condition in psychotherapy trials: A contribution from network meta-analysis. Acta Psychiatrica Scandinavica, 130(3), 181–192.
• Gall, M. D., Borg, W. R. ve Gall, J. P. (1996). Educational research: An introduction. Longman Publishing.
• Hauk, N., Hüffmeier, J. ve Krumm, S. (2018). Ready to be a silver surfer? a meta-analysis on the relationship between chronological age and technology acceptance. Computers in Human Behavior, 84, 304–319.
• Humer, E., Haid, B., Schimböck, W., Reisinger, A., Gasser, M., Eichberger-Heckmann, H., Stippl, P., Pieh, C. ve Probst, T. (2021). Provision of psychotherapy one year after the beginning of the covıd-19 pandemic in austria. International Journal of Environmental Research and Public Health, 18(11), 5843.
• Jack, S. J. ve Ronan, K. R. (2008). Bibliotherapy: Practice and research. School Psychology International, 29(2), 161–182.
• Josephine, K., Josefine, L., Philipp, D., David, E. ve Harald, B. (2017). Internet- and mobile-based depression interventions for people with diagnosed depression: A systematic review and meta-analysis. Journal of Affective Disorders, 223, 28–40.
• Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R. ve Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617–627.
• Lattie, E. G., Adkins, E. C., Winquist, N., Stiles-Shields, C., Wafford, Q. E. ve Graham, A. K. (2019). Digital mental health ınterventions for depression, anxiety, and enhancement of psychological well-being among college students: Systematic review. Journal of Medical Internet Research, 21(7), e12869.
• Ma, Y., She, Z., Siu, A., Zeng, X. ve Liu, X. (2018). Effectiveness of online mindfulness-based ınterventions on psychological distress and the mediating role of emotion regulation. Frontiers in Psychology, 9, 2090.
• Martin, A., Kilpatrick, M., Scott, J., Cocker, F., Dawkins, S., Brough, P. ve Sanderson, K. (2020). Protecting the mental health of small-to-medium enterprise owners: A randomized control trial evaluating a self-administered versus telephone supported intervention. Journal of Occupational and Environmental Medicine, 62(7), 503.
• Mohr, D. C., Burns, M. N., Schueller, S. M., Clarke, G. ve Klinkman, M. (2013). Behavioral intervention technologies: Evidence review and recommendations for future research in mental health. General Hospital Psychiatry, 35(4), 332–338.
• Mohr, D. C., Cuijpers, P. ve Lehman, K. (2011). Supportive accountability: A model for providing human support to enhance adherence to ehealth ınterventions. Journal of Medical Internet Research, 13(1), e1602.
• Mojtabai, R., Olfson, M., Sampson, N. A., Jin, R., Druss, B., Wang, P. S., Wells, K. B., Pincus, H. A. ve Kessler, R. C. (2011). Barriers to mental health treatment: Results from the National Comorbidity Survey Replication. Psychological Medicine, 41(8), 1751–1761.
• Morgan, A. J., Jorm, A. F. ve Mackinnon, A. J. (2012). Email-based promotion of self-help for subthreshold depression: Mood memos randomised controlled trial. The British Journal of Psychiatry: The Journal of Mental Science, 200(5), 412–418.
• Musiat, P., Conrod, P., Treasure, J., Tylee, A., Williams, C. ve Schmidt, U. (2014). Targeted prevention of common mental health disorders in university students: Randomised controlled trial of a transdiagnostic trait-focused web-based ıntervention. Plos One, 9(4).
• Musiat, P., Johnson, C., Atkinson, M., Wilksch, S. ve Wade, T. (2022). Impact of guidance on intervention adherence in computerised interventions for mental health problems: A meta-analysis. Psychological Medicine, 52(2), 229–240.
• Nilsson, A., Sörman, K., Klingvall, J., Ovelius, E., Lundberg, J. ve Hellner, C. (2019). MyCompass in a Swedish context lessons learned from the transfer of a self-guided intervention targeting mental health problems. BMC Psychiatry, 19(1), 51.
• Özer, Ö. ve Ceyhan, A. . (2021). Kendi kendine yardım temelli çevrimiçi psikososyal destek platformunun geliştirilmesi. Afet ve Risk Dergisi, 4(2), Article 2.
• Pratap, A., Renn, B. N., Volponi, J., Mooney, S. D., Gazzaley, A., Arean, P. A. ve Anguera, J. A. (2018). Using mobile apps to assess and treat depression in hispanic and latino populations: Fully remote randomized clinical trial. Journal of Medical Internet Research, 20(8), e10130.
• Proudfoot, J., Clarke, J., Birch, M., Whitton, A., Parker, G., Manicavasagar, V., Harrison, V., Christensen, H. ve Hadzi-Pavlovic, D. (2013). Impact of a mobile phone and web program on symptom and functional outcomes for people with mild-to-moderate depression, anxiety and stress: A randomised controlled trial. BMC Psychiatry, 13(1), 312.
• Richards, D. ve Richardson, T. (2012). Computer-based psychological treatments for depression: A systematic review and meta-analysis. Clinical Psychology Review, 32(4), 329–342.
• Sander, L., Rausch, L. ve Baumeister, H. (2016). Effectiveness of ınternet-based ınterventions for the prevention of mental disorders: A systematic review and meta-Analysis. JMIR Mental Health, 3(3), e6061.
• Santomauro, D. F., Herrera, A. M. M., Shadid, J., Zheng, P., Ashbaugh, C., Pigott, D. M., Abbafati, C., Adolph, C., Amlag, J. O., Aravkin, A. Y., Bang-Jensen, B. L., Bertolacci, G. J., Bloom, S. S., Castellano, R., Castro, E., Chakrabarti, S., Chattopadhyay, J., Cogen, R. M., Collins, J. K., … Ferrari, A. J. (2021). Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. The Lancet, 398(10312), 1700–1712.
• Schaub, M., Sullivan, R., Haug, S. ve Stark, L. (2012). Web-based cognitive behavioral self-help intervention to reduce cocaine consumption in problematic cocaine users: Randomized controlled trial. Journal of Medical Internet Research, 14(6), e166.
• Smith, B. (2013). Depression and motivation. Phenomenology and the Cognitive Sciences, 12(4), 615–635. Thiagarajan, T. ve Newson, J. (2023). The Mental State of the World in 2022 (Mental Health Million Project, p. 50). Sapien Labs. https://mentalstateoftheworld.report/wp-content/uploads/2023/02/Mental-State-of-the-World-2022.pdf
• Välimäki, M., Anttila, K., Anttila, M. ve Lahti, M. (2017). Web-Based Interventions Supporting Adolescents and Young People With Depressive Symptoms: Systematic Review and Meta-Analysis. JMIR mHealth and uHealth, 5(12), e8624.
• Vickers, A. J. ve de Craen, A. J. M. (2000). Why use placebos in clinical trials? A narrative review of the methodological literature. Journal of Clinical Epidemiology, 53(2), 157–161.
• Vos, T., Lim, S. S., Abbafati, C., Abbas, K. M., Abbasi, M., Abbasifard, M., Abbasi-Kangevari, M., Abbastabar, H., Abd-Allah, F., Abdelalim, A., Abdollahi, M., Abdollahpour, I., Abolhassani, H., Aboyans, V., Abrams, E. M., Abreu, L. G., Abrigo, M. R. M., Abu-Raddad, L. J., Abushouk, A. I., … Murray, C. J. L. (2020). Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10258), 1204–1222.
• Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270–277.
• Yang, D., Hur, J.-W., Kwak, Y. B. ve Choi, S.-W. (2018). A systematic review and meta-analysis of applicability of web-based ınterventions for ındividuals with depression and quality of life ımpairment. Psychiatry Investigation, 15(8), 759–766.