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      IAPT and the internet: the current and future role of therapist-guided internet interventions within routine care settings

      discussion
      1 , 2 , *
      Cognitive Behaviour Therapist
      Cambridge University Press
      digital psychological therapy, dissemination, IAPT, implementation, internet interventions, therapist training

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          Abstract

          Compared with the traditional face-to-face format, therapist-guided internet interventions offer a different approach to supporting clients in learning skills to manage and overcome mental health difficulties. Such interventions are already in use within IAPT (Improving Access to Psychological Therapies) and other routine care settings, but given their potential to deliver treatment more efficiently and therefore increase availability and access to evidence-based interventions, their use is likely to increase significantly over the coming years. This article outlines what is meant by therapist-guided internet interventions and why an online format is thought to be advantageous for clients, therapists, services, and communities more broadly. It reviews the current evidence in the context of common therapist beliefs about internet-based treatment. It aims to identify gaps where further research is required, particularly in relation to the broader implementation of these treatments in IAPT and other routine clinical services. Specifically, it emphasises the importance of choosing the right programmes, providing adequate therapist training in their use, and considering practical and organisational issues, all of which are likely to determine the success of implementation efforts.

          Key learning aims

          1. To understand what therapist-guided internet interventions are and their potential advantages.

          2. To understand the current evidence base for these interventions.

          3. To learn where further research is needed with regard to both the interventions themselves, and to their broader implementation in IAPT.

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          Most cited references53

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          Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis

          During the last two decades, Internet-delivered cognitive behavior therapy (ICBT) has been tested in hundreds of randomized controlled trials, often with promising results. However, the control groups were often waitlisted, care-as-usual or attention control. Hence, little is known about the relative efficacy of ICBT as compared to face-to-face cognitive behavior therapy (CBT). In the present systematic review and meta-analysis, which included 1418 participants, guided ICBT for psychiatric and somatic conditions were directly compared to face-to-face CBT within the same trial. Out of the 2078 articles screened, a total of 20 studies met all inclusion criteria. Results showed a pooled effect size at post-treatment of Hedges g = .05 (95% CI, -.09 to .20), indicating that ICBT and face-to-face treatment produced equivalent overall effects. Study quality did not affect outcomes. While the overall results indicate equivalence, there have been few studies of the individual psychiatric and somatic conditions so far, and for the majority, guided ICBT has not been compared against face-to-face treatment. Thus, more research, preferably with larger sample sizes, is needed to establish the general equivalence of the two treatment formats.
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            Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: An updated meta-analysis

            A 2010 meta-analysis of internet-delivered CBT (iCBT) RCTs argued 'computer therapy for the anxiety and depressive disorders was effective, acceptable and practical health care' without data on effectiveness or practicality in routine practice.
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              • Record: found
              • Abstract: not found
              • Article: not found

              The impact of guidance on Internet-based mental health interventions — A systematic review

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                Author and article information

                Journal
                Cogn Behav Therap
                Cogn Behav Therap
                CBT
                Cognitive Behaviour Therapist
                Cambridge University Press (Cambridge, UK )
                1754-470X
                2020
                08 April 2020
                : 13
                : e4
                Affiliations
                1Department of Experimental Psychology, University of Oxford , Oxford, UK
                2Oxford Health NHS Foundation Trust , Oxford, UK
                Author notes
                [* ]Corresponding author. Email: graham.thew@ 123456psy.ox.ac.uk
                Author information
                https://orcid.org/0000-0003-2851-1315
                Article
                S1754470X20000033
                10.1017/S1754470X20000033
                8442601
                34567240
                395ebbc4-ddef-422d-ab87-4bc116c97c18
                © British Association for Behavioural and Cognitive Psychotherapies 2020

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 31 July 2019
                : 21 December 2019
                : 30 January 2020
                Page count
                References: 56, Pages: 11
                Categories
                Service Models and Forms of Delivery

                digital psychological therapy,dissemination,iapt,implementation,internet interventions,therapist training

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