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Expert Rev Neurother. 2018 Jan;18(1):21-28. doi: 10.1080/14737175.2018.1400381. Epub 2017 Nov 8.

Long-term effects of internet-supported cognitive behaviour therapy.

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a Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden.
b Department of Clinical Neuroscience, Psychiatry Section , Karolinska Institutet , Stockholm , Sweden.
c Department of Clinical Psychology , Stockholm University , Stockholm , Sweden.
d UCL Institute of Child Health , University College London , London , England.


Internet-supported and therapist-guided cognitive behaviour therapy (ICBT) is effective for a range of problems in the short run, but less is known about the long-term effects with follow-ups of two years or longer. Areas covered: This paper reviews studies in which the long-term effects of guided ICBT were investigated. Following literature searches in PubMed and other sources meta-analytic statistics were calculated for 14 studies involving a total of 902 participants, and an average follow-up period of three years. Studies were from Sweden (n = 11) or the Netherlands (n = 3). Long-term outcome studies were found for panic disorder, social anxiety disorder, generalized anxiety disorder, depression, mixed anxiety and depression, obsessive-compulsive disorder, pathological gambling, stress and chronic fatigue. The duration of the treatments was usually short (8-15 weeks). The pre-to follow-up effect size was Hedge's g = 1.52, but with a significant heterogeneity. The average symptom improvement across studies was 50%. Treatment seeking in the follow-up period was not documented and few studies mentioned negative effects. Expert commentary: While effects may be overestimated, it is likely that therapist-supported ICBT can have enduring effects. Long-term follow-up data should be collected for more conditions and new technologies like smartphone-delivered treatments.


Internet delivery; anxiety; cognitive behaviour therapy; depression; long-term effects; somatic problems

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