{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T01:22:39Z","timestamp":1790904159630,"version":"4.1.0"},"reference-count":47,"publisher":"Royal College of Psychiatrists","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Br J Psychiatry"],"abstract":"<jats:sec id=\"S0007125026106539_as1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Internet-based interventions vary with respect to the level of support provided, and the impact of support levels on outcomes has been unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125026106539_as2\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To evaluate the relative effectiveness and acceptability of support levels in internet-based cognitive\u2013behavioural therapy (iCBT) for depression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125026106539_as3\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      This network meta-analysis included randomised controlled trials of stand-alone iCBT for adults with elevated levels of depressive symptoms, identified via systematic searches of PubMed, EMBASE, PsycINFO and the Cochrane Library (1 January 2025). The primary outcome was post-intervention effectiveness. The secondary outcome was study drop-out risk. Risk of bias was assessed with Cochrane RoB-2. A frequentist random-effects model was conducted (preregistered at\n                      <jats:uri xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/osf.io\/amw4r\">https:\/\/osf.io\/amw4r<\/jats:uri>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125026106539_as4\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We included 141 trials with 169 comparisons (\n                      <jats:italic>n<\/jats:italic>\n                      = 32 197). iCBT with therapeutic support had the greatest effect in terms of reducing depressive symptoms compared with care-as-usual (\n                      <jats:italic>g<\/jats:italic>\n                      = 0.42; 95% CI: 0.30 to 0.55). Such interventions outperformed offers with minimal coaching (encouragement only;\n                      <jats:italic>g<\/jats:italic>\n                      = 0.19, 95% CI: 0.03\u20130.35) and technical support (\n                      <jats:italic>g<\/jats:italic>\n                      = 0.27, 95% CI: 0.08\u20130.45) but had similar effects to those with full coaching (i.e. standardised feedback), automated support, on-demand support or no support. Interventions providing technical support represented the least effective iCBT format and were not statistically superior to care as usual (\n                      <jats:italic>g<\/jats:italic>\n                      = 0.15, 95% CI: \u22120.02 to 0.33). For acceptability, iCBT with minimal coaching showed the lowest drop-out rate (risk ratio = 1.13, (95% CI: 0.88\u20131.46), whereas technical support showed the highest (risk ratio = 1.6, 95% CI: 1.21\u20132.15). With pre-intervention human contact, all support levels were similarly effective; without it, therapeutic support outperformed other types of support (\n                      <jats:italic>g<\/jats:italic>\n                      = 0.32\u20130.68) and drop-out risks increased.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125026106539_as5\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Low-intensity supported iCBT can be as effective as therapist-guided iCBT when initial human contact is present. Evidence regarding the potential harms of no-human support is needed before implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/bjp.2026.10653","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T04:06:37Z","timestamp":1779422797000},"page":"1-9","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":3,"title":["Impact of support levels on effectiveness and drop-out of internet-based interventions for depression: network meta-analysis"],"prefix":"10.1192","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5023-6949","authenticated-orcid":false,"given":"Lingyao","family":"Tong","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/008xxew50","id-type":"ROR","asserted-by":"publisher"}],"name":"Vrije Universiteit Amsterdam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga 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Published by Cambridge University Press on behalf of Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}