认知行为治疗联合药物治疗强迫症疗效的meta分析

目的:通过对随机对照试验的数据进行meta分析,比较药物联合认知行为治疗(CBT)与单纯药物或CBT治疗对强迫症的疗效,为临床实践提供选择依据.方法:检索PubMed、Embase和Central数据库,收集比较药物联合CBT与单纯药物或CBT治疗强迫症疗效的随机对照试验,选取联合治疗组与单纯治疗组的耶鲁-布朗强迫量表测量数据并采用均差作为效应量,应用RevMan5软件进行meta分析.结果:共纳入7项符合标准的研究,合计样本量468人.排除可能引起异质性的1组数据后,3组数据比较了药物联合CBT与单纯药物治疗的疗效且无异质性(Q=0.48,P＞0.1),结果显示联合治疗组对强迫症状的改善优于单纯药物组(MD =6.46,Z=5.03,P≤0.05);7组数据比较了药物治疗联合CBT与单纯CBT的疗效且无异质性(Q=9.08,P＞0.1),结果显示联合治疗组与单纯CBT组对强迫症状的改善没有差别(MD =0.87,Z=1.22,P＞0.05).结论:鉴于目前结果,推测对于强迫症状的改善,药物治疗联合CBT优于单纯药物治疗而与单纯CBT相当,但仍需进一步研究证实.     

有氧运动对抑郁症患者认知功能干预效果的meta分析

目的:系统评价有氧运动对抑郁症患者认知功能的干预效果。方法:检索PubMed、Web of Science、EBSCO host、Cochrane Library、中国知网、万方数据库,收集从建库至2021年7月公开发表的有氧运动干预抑郁症患者认知功能的随机对照试验,采用Stata软件进行数据分析。结果:共纳入12项随机对照试验,985例抑郁症患者。Meta分析结果显示,有氧运动可改善抑郁症患者的视觉学习与记忆(SMD=0.30,95%CI:0.15～0.45,P<0.001)、执行功能(SMD=-0.37,95%CI:-0.66～-0.07,P<0.05),对信息处理速度、工作记忆、注意/警觉性、言语学习与记忆以及推理与问题解决改善效果不明显(均P>0.05);停止有氧运动干预后,试验组视觉学习与记忆评分与对照组差异无统计学意义(P>0.05);亚组分析结果显示,中、高强度并持续12～16周的有氧运动对视觉学习与记忆改善效果最佳(SMD=0.24、0.34、0.32,95%CI:0.01～0.48、0.14～0.54、0.15～0.49),中等强度并持续4～8...     

认知行为疗法联合药物治疗惊恐障碍疗效Meta分析

目的:比较认知行为疗法(CBT)联合药物治疗与单纯药物治疗对惊恐障碍的疗效。方法:对CBT联合药物治疗与单纯药物治疗惊恐障碍的对照研究进行系统评价,使用Revman 5.2进行Meta分析。结果:共纳入6项符合标准的随机对照研究,合计样本量329人。6组数据比较了CBT联合药物治疗与单纯药物治疗惊恐障碍的有效率和显效率,结果显示,联合治疗组的有效率(OR=3.28,Z=2.75,P<0.05)与显效率(OR=2.85,Z=3.90,P<0.05)均优于单纯药物组;5组数据比较了CBT联合药物治疗与单纯药物治疗惊恐障碍的治愈率,结果显示,联合治疗组的治愈率优于单纯药物组(OR=2.08,Z=2.82,P<0.05)。结论:鉴于目前结果推测对于惊恐障碍的改善,认知行为疗法联合药物治疗优于单纯药物治疗,但仍需进一步研究证实。     

体育锻炼对老年人工作记忆干预效果的meta分析

目的:系统评价体育锻炼对老年人工作记忆的干预效果。方法:检索七大电子数据库中关于体育锻炼干预老年人工作记忆的随机对照试验,采用PEDro量表对纳入文献进行方法学质量评价,采用Stata14.0软件进行meta分析、偏倚检验。结果:共纳入21项研究,1558个样本量。研究表明体育锻炼对老年人工作记忆的总体效应量为0.34(P<0.001),对老年人工作记忆的干预效果具有统计学意义。锻炼类型(Q=21.07)、频次(Q=11.58)、时间(Q=8.62)对干预效果起调节作用(均P<0.05),干预周期(Q=1.19)、强度(Q=5.68)、年龄(Q=3.68)对干预效果没有调节作用(均P>0.05)。结论:体育锻炼可以有效改善老年人的工作记忆,身心运动、中等时间、高频率的锻炼效果最好。     

认知行为治疗改善精神分裂症患者生活质量的随机单盲对照试验

目的:探讨认知行为治疗对精神分裂症患者生活质量的效果及相关因素,为寻找有效改善精神分裂症患者生活质量的方法提供依据。方法:本研究为单盲随机对照临床试验。选取符合美国精神障碍诊断与统计手册第4版(DSM-IV)中精神分裂症诊断标准的医院门诊和住院患者共120例,随机分配到认知行为治疗组(CBT组,n=60)和支持性心理治疗组(ST组,n=60),在药物治疗基础上分别接受15次认知行为治疗和支持性心理治疗。在基线采用世界卫生组织生存质量量表简表(WHOQOL-BREF)、阳性和阴性症状量表(PANSS)、应付方式问卷(CSQ)、非理性信念量表(IBS)及自编药物副反应问卷对两组患者进行盲法评定。第12周、24周采用WHOQOL-BREF和自编药物副反应问卷对患者进行随访评估。结果:第12周,CBT组患者WHOQOL-BREF总分各因子分均高于基线[(77.0±13.9)vs.(73.1±13.8),(22.4±4.5)vs.(21.5±4.7),(18.9±4.1)vs.(17.8±4.3),(9.3±2.2)vs.(8.9±2.3),(26.4±5.0)vs.(24.7±5.3),均P0.05],而ST组患者仅环境因子有显著改善[(23.9±4.7)vs.(25.0±5.2),P0.05],其余因子差异无统计学意义(P0.05)。第24周,两组在WHOQOL-BREF的社会关系和环境因子分上组间效应显著(F=6.77,7.21,均P0.05),CBT组得分均高于ST组。Logis-tic回归分析发现,基线应对方式分数较低、接受CBT及男性对患者的生活质量有正性预测作用(B=-0.25,2.31,-1.64,均P0.05)。结论:认知行为治疗能够有效改善精神分裂症患者的生活质量,且基线应对方式得分相对更低、能接受认知行为治疗及男性患者更容易从治疗中获得生活质量的改善。     

正念干预对癌症患者创伤后成长干预效果的meta分析

目的:评价正念干预(MBI)对癌症患者创伤后成长(PTG)的干预效果。方法:计算机检索Cochrane library、PubMed、Embase、Web of Science、CBM、VIP、WangFang Data和CNKI数据库中MBI对癌症患者PTG的随机对照试验(RCT)。两名研究者按照纳入排除标准独立筛选文献、进行文献质量评价并从中提取数据,采用RevMan 5.3软件进行数据分析。结果:共纳入9篇RCT,合计822例患者。Meta分析结果显示,实施MBI后,干预组患者的PTG水平优于对照组,差异有统计学意义[MD=7.27,95%CI=(4.75~9.79),P<0.001],干预效果能维持到干预后3个月[MD=8.64,95%CI=(7.20~10.08),P<0.001]。与对照组相比,线上干预模式对癌症患者PTG的改善效果不明显,差异无统计学意义[MD=3.59,95%CI=(-1.22~8.41),P>0.05],而面对面的小组干预模式能促进癌症患者PTG水平的提高[MD=7.87,95%CI=(5.19~10.54),P<0.001]。结论:正念干预有助于提高癌症患者的创伤后成长水平,面对面小组干预模式比线上干预模式在提升患者的创伤后成长水平上效果更佳。     

移动网络认知行为治疗对社交焦虑者的干预

目的：针对社交焦虑个体进行的网络认知行为治疗干预已经积累了相当多的有效性证据,但对基于智能手机的移动网络干预的有效性研究仍然数量很少。本研究开发了针对社交焦虑的移动网络认知行为治疗课程。方法：在全国范围内公开招募了100名社交焦虑者按照2:2:1的比例随机分配到移动组、网页组和等待组进行干预。结果：经过10周的干预,完成干预的移动组(n=31)与网页组(n=22)的被试,其社交焦虑水平与等待组(n=15)相比,均得到了明显改善(其中移动组P_SIAS<0.01, d_SIAS=0.95;移动组P_SPS=0.08, d_SPS=0.73);两个干预组的干预效果之间不存在显著差异。结论：本研究验证了移动网络认知行为治疗干预社交焦虑的有效性,为此前已经通过网页形式得到验证的本土化网络干预方案后续在移动平台的进一步推广提供了支持性证据。     

认知行为疗法对癌症复发恐惧干预效果的meta分析

目的:评价认知行为疗法对癌症复发恐惧的治疗效果。方法:检索中国期刊网全文数据库(CNKI)、万方数据库、Pubmed、EMBASE、Web of Science、CINAHL、Cochrane等数据库中有关认知行为疗法对癌症复发恐惧的随机对照试验,运用stata15.0软件进行meta分析。结果:纳入19项随机对照实验或类实验研究,meta分析显示认知行为疗法对减轻癌症复发恐惧有显著效果(Hedges′s=15.76,95%CI:-0.81～-0.63,P<0.001),且干预后6个月仍有效果(Hedges′s=3.22,95%CI:-0.64～-0.23,P<0.001)。认知行为疗法以团体形式、面对面模式、总时长在6～8周、单次时长大于90 min对减轻癌症复发恐惧效果最佳(均P<0.001)。结论:认知行为疗法可降低癌症复发恐惧水平,且不同干预模式、形式、单次时长和总时长的认知行为疗法对复发恐惧水平效果存在一定差异。     

贫血与产后抑郁关系的meta分析

目的:系统评价产妇贫血与产后抑郁的关系。方法:检索PubMed、Web of Science、Embase、Cochrane Library、CINAHL Plus、PsycINFO、中国生物医学文献数据库、中国知网、万方、维普数据库中探讨产妇贫血与产后抑郁关系的研究,检索时限均为建库至2020年2月20日,并对纳入的文献进行质量评价与数据提取,采用RevMan 5.3与Stata 14.0软件进行meta分析。结果:最终纳入8篇文献,共78 637例患者。纳入文献质量评价均在中等及以上。meta分析显示产妇贫血与产后抑郁呈正关联(OR=2.08,95%CI:1.55~2.80,P<0.001);同时,亚组分析显示,不同地区[欧洲(OR=2.91)、亚洲(OR=1.82)]、抑郁评估期[产后6周及以下(OR=1.93)、产后6周以上(OR=2.48)]、贫血评估期[产后6周及以下(OR=2.17)、产后6周以上(OR=2.02)]、产妇贫血界定标准[Hb (OR=1.93)、其他(OR=2.48)]、产妇抑郁症状测量工具[EPDS (OR=2.01)、其他(OR=2.64)]中产妇贫血均与产后抑郁呈正关联。结论:产妇贫血与产后抑郁的风险增加有关。     

日本对老年性痴呆的治疗和保健

日本对老年性痴呆的治疗和保健ＡｓａｉＨｏｓｐｉｔａｌＫｕｎｉｈｉｋｏＡｓａｉＭ．Ｄ．一、介绍：日本人的期望寿命是全世界最长的：男性为７７．０岁，女性为８３．６岁。目前，约有１５．６％的日本人在６５岁以上，据估计，到２０００年这一比例将上升至１６．３％...     

认知行为治疗对改善乳腺癌患者术后抑郁以及生活质量的Meta分析

目的:通过Meta分析的方法评价认知行为治疗(cognitive behavioral therapy,CBT)对改善乳腺癌患者术后抑郁以及生活质量的效果.方法:手动检索Cochrane Library,EMBASE,PubMed,Web of Science英文数据库以及中国生物医学文摘数据库(CBM)、维普数据库(VIP)、万方数据库及中国知网数据库(CNKI),纳入认知行为疗法改善术后抑郁以及生活质量的随机对照研究,评价结果包括焦虑自评量表(Self-Rating Anxiety Scale,SAS)评分,抑郁自评量表(Self-Rating Depression Scale,SDS)评分、生活质量核心问卷(Quality of Life-Core 30 Questionnaire,QLQ-C30)总分以及各个项目的评分进行Meta分析.结果:共纳入17篇文献,纳入患者1645例,认知行为护理组832例,对照组813例.与对照组比较,行为认知疗法可以改善乳腺癌患者术后抑郁以及焦虑情绪评分,差异有统计学意义(P<0.05).同时行为认知疗法可以降低患者术后QLQ-C30各个项目评分,差异有统计学意义(P<0.05).结论:认知行为疗法可以改善乳腺癌患者术后抑郁以及焦虑情绪,改善患者生活质量.     

The efficacy of telephone-delivered cognitive behavioral therapy in people with chronic illnesses and mental diseases: A meta-analysis

COVID-19 pandemic led to an increase of remote treatments, such as telephone-delivery cognitive behavioral therapy (T-CBT). To our knowledge, no meta-analyses studied the effect of T-CBT in chronic and/or mental illnesses on multiple psychological outcomes. Therefore, our study aims to evaluating the efficacy of T-CBT compared to other interventions (treatment as usual, TAU, or face-to-face CBT). Each effect size (ES) was calculated in Hedges' g and pooled together to produce a mean ES for each outcome (depression, anxiety, mental and physical QoL, worry, coping, and sleep disturbances). The meta-analysis included 33 studies with a randomized controlled trial design. A large ES was found when comparing the efficacy of T-CBT against TAU on depression (g = 0.84, p < 0.001), whereas a moderate ES was found on anxiety (g = 0.57; p < 0.001), and a small effect on mental quality of life (g = 0.33, p < 0.001), sleep disturbances (g = 0.37, p = 0.042), coping (g = 0.20, p = 0.016) and worry (g = 0.43, p = 0.001). The meta-analysis comparing the efficacy of T-CBT and CBT on depression revealed a not significant pooled ES (g = 0.06, p = 0.466). The results provided evidence that T-CBT could be to be more effective than TAU conditions in multiple psychological outcomes, and as efficient as face-to-face CBT in treating depression.     

Effectiveness of treatments for people living with severe dementia: A systematic review and meta-analysis of randomised controlled clinical trials

BackgroundDementia is a progressive neurodegenerative syndrome that has no cure. Although a significant proportion of people with dementia progress into the severe stages of the disease, evidence on the clinical effectiveness of treatments for people with severe dementia remains limited.AimsTo systematically review the effectiveness of pharmacological and non-pharmacological treatments for people living with severe dementia and assess the quality of the evidence.MethodWe searched MEDLINE, EMBASE, PsycINFO, CINAHL and online clinical trial registers up to January 2022, for Randomised Controlled Trials (RCT) in people living with severe dementia. Quality and risk of bias were assessed independently by two authors.ResultsA total of 30 trials met our inclusion criteria of which 14 evaluated the effectiveness of pharmacological treatments, and 16 evaluated a non-pharmacological intervention. Pharmacological treatments: Meta-analyses indicated that pharmacological treatments (donepezil: 10 mg, 5 mg; galantamine: 24 mg; memantine: 10 mg) are associated with better outcomes compared to placebo for: severity of symptoms (standardized mean difference (SMD) 0.37, 95% CI 0.26–0.48; 4 studies; moderate-certainty evidence), activities of daily living (SMD 0.15, 95% CI 0.04–0.26; 5 studies; moderate-certainty evidence), and clinical impression of change (Relative Risk (RR) 1.34, 95% CI 1.14–1.57; 4 studies; low-certainty evidence). Pharmacological treatments were also more likely to reduce mortality compared to placebo (RR 0.60, 95% CI 0.40–0.89; 6 studies; low-certainty evidence). Non-pharmacological treatments: Five trials were included in the meta-analyses of non-pharmacological interventions (multi-sensory stimulation, needs assessment, and activities-based interventions); results showed that non-pharmacological interventions may reduce neuropsychiatric symptoms of dementia compared to usual care (SMD −0.33, 95% CI −0.59 to −0.06; low certainty evidence).ConclusionsThere is moderate-certainty evidence that pharmacological treatments may decrease disease severity and improve function for people with severe dementia. Non-pharmacological treatments are probably effective in reducing neuropsychiatric symptoms but the quality of evidence remains low. There is an urgent need for high-quality evidence for other outcomes and for developing service-user informed interventions for this under-served group.     

重复经颅磁刺激对脑卒中患者运动功能康复效果的系统评价

背景：现有各项研究对重复经颅磁刺激应用于脑卒中患者运动功能康复效果的观点不一。 目的：系统评价重复经颅磁刺激对脑卒中患者运动功能障碍的治疗效果。 方法：计算机检索Cochrane Central Register of Controlled Trials、PubMed数据库、ISI Web of science、Medline、EMBASE、中国生物医学文献数据库、中国知识资源总库、维普中文科技期刊全文数据库、万方数据库中关于重复经颅磁刺激改善脑卒中患者运动功能障碍的随机对照试验,搜索时限从建库至2013年7月。按照Cochrane系统评价员手册推荐方法逐一评价纳入研究的质量,提取有效数据,对符合质量要求的文献数据进行Meta分析。采用RevMan 5.1软件和GRADEprofiler 3.6软件对最终纳入的文献数据进行统计学分析。 结果与结论：最终纳入23篇文献(干预组n=400,对照组n=301)。定量分析7项研究,其余作描述性研究。Meta分析2个结局指标Fugl-Meyer运动量表评分和Barthel指数,结果显示,干预组治疗后Fugl-Meyer运动评分[SMD=0.48,95%CI(0.10,0.86)]及Barthel指数[SMD=1.38,95%CI(0.68,2.09)]显著高于对照组。依据GRADE系统推荐分级方法评价结局指标级别,2个结局指标均为低质量。现有研究显示,重复经颅磁刺激能改善脑卒中患者的运动功能和日常生活活动能力。鉴于纳入文献质量不高,尚需进一步开展大样本﹑多中心﹑设计科学﹑操作规范的高质量临床随机对照试验,以验证重复经颅磁刺激对脑卒中后患者运动功能障碍的治疗效果。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

The efficiency and safety of trastuzumab for advanced gastric and gastroesophageal cancer: a meta-analysis of five randomized controlled trials

A meta-analysis was performed to examine the efficiency and safety of trastuzumab in patients with advanced gastric and gastroesophageal cancer (AGC). By searching multiple databases from 1990 to March 2016, all randomized controlled trials (RCTs) which compared the effect of trastuzumab-combined chemotherapy (TC) versus chemotherapy alone (CT) in gastric cancer would be included. Five RCTs with a total of 875 patients were included. Trastuzumab can improve the overall survival (OS) rate, progression-free survival (PFS), one-year survival rate, two-year survival rate and overall response rate (ORR) of patients with AGC. There were no difference between the two arms in terms of grade 3/4 adverse effects, such as vomiting, nausea, neutropenia, thrombocytopaenia and anemia. Diarrhea increased in TC group. Trastuzumab can significantly improve the survival rate, PFS, ORR of patients with AGC. It is safe and feasible and can be tolerated. It needs further prospective multinational multicenter RCTs with large samples to define the clinical benefits of trastuzumab.     

他汀类药物治疗血管性认知障碍的Meta分析

背景：国外研究显示,没有确切证据证明他汀类药物对血管性认知障碍的治疗有效。而国内有关他汀类药物对血管性痴呆疗效的研究样本量均较小,无法得出确切结论。 目的：采用Cochrane协作网推荐的方法对他汀类药物对血管性认知功能障碍的疗效进行Meta分析。 方法：计算机检索CNKI、万方、维普、CBM及Pubmed数据库,检索时间从建库至2013年1月,查找有关他汀类药物对血管性认知功能障碍疗效的随机对照试验,并手工检索进行相关补充。按纳入和排除标准选择文献,提取资料,进行方法学评估后,采用Revman5软件进行Meta分析。 结果与结论：通过检索最终纳入15个符合标准的随机对照试验,共计1 203例患者,其中他汀组616例,对照组587例,采用固定和随机效应模型对疗效指标简易智能量表及日常生活自理量表(包括14项评分法或Barthel指数评分)进行结果合并。与对照组相比,他汀组的简易智能量表评分(14个随机对照试验1 112例患者),MD=3.02,95%CI：2.26至3.77,P < 0.000 1;日常生活自理量表评分14项评分法(7个随机对照试验,513例患者),MD=-4.14,95%CI：-6.11至-2.18,P < 0.000 1;Barthel 指数评分(2个随机对照试验,171例患者),MD=11.62,95%CI：9.78至13.46,P < 0.001。纳入文献中共提及不良反应14例,对照组1例,他汀组13例,均为阿托伐他汀引起,他汀组不良反应率2.1%,无严重不良反应。现有文献证据表明,他汀类药物可以改善血管性认知障碍患者的认知功能,且安全性良好。但进一步的结论尚需更高质量的随机对照试验进行验证。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

Psychological interventions decrease unintended pregnancies: A meta-analysis of randomized controlled trials

Objective

Despite innovations in contraceptive methods, unintended pregnancies remain common. Researchers have examined psychological approaches to decrease unintended pregnancies through contraceptive use. These interventions have involved applying aspects of social cognitive theory, the health belief model and self-determination theory. Research findings on the effects of these psychological approaches show conflicting evidence. The aim of this meta-analysis was to clarify the impact of these psychological interventions on unintended pregnancies

Design

Meta-analysis of randomized controlled trials (RCTs) of psychological interventions intended to prevent unwanted pregnancies through an increase in the use of contraceptive methods

Methods

A systematic search of databases and article reference lists led to 26 relevant RCTs with a total of 31,222 participants

Results

The odds ratio for pregnancy in the psychological intervention condition = .83, 95% CI [.75, .93]. The results also showed that the longer an intervention's follow-up period was, the less the prevention effect. Quality assessment of included studies indicated that all used a treatment manual and reported attrition. It also showed that most studies reported the reasons for drop-out and assessed the facilitators' adherence to the intervention protocol. The proportion of variability due to chance amongst studies was I² = 22%. Duval and Tweedie's Trim and Fill showed a difference between the observed and the adjusted values. The adjusted value, representing a conservative estimate of effect size, was OR = .891, 95% CI [.777, .999]

Conclusions

Altogether, these results support the efficacy of psychological interventions aimed at preventing unintended pregnancy through contraception.     

正念疗法对产后抑郁患者干预效果的meta分析

目的:探讨正念疗法对产后抑郁患者的干预效果。方法:检索PubMed、Cochrane Library、EMbase、Web of Science、CNKI、万方数据库,检索正念疗法对产后抑郁患者疗效的相关文献,纳入随机对照试验,由2名研究人员根据纳入/排除标准提取数据,并根据Cochrane Handbook5.1.0手册进行文献质量评价。结果:共纳入6篇随机对照试验(RCT)和2篇自身对照研究的文献,合计404名患者。Meta分析结果显示,与常规护理方法相比,正念疗法能有效缓解产妇的抑郁和焦虑情绪。接受正念疗法的产后抑郁患者抑郁水平明显低于常规护理组[MD=3.01,95%CI(2.29,3.72),P<0.05]。结论:正念疗法能改善产后抑郁患者的焦虑、抑郁情绪。     

The efficacy of internet-based cognitive behavioural therapy for social anxiety disorder: A systematic review and meta-analysis

Social anxiety disorder (SAD) is one of the most common lifelong anxiety disorders. Although cognitive behavioural therapy (CBT) has proven to be effective in treating people with SAD, it may not be available for a considerable proportion of patients. Internet-based CBT (ICBT) is more accessible than face-to-face treatment. This meta-analysis evaluated the efficacy of ICBT in patients with SAD. We searched five databases, PubMed, Cochrane Central Register of Controlled Trials, Health Management Information Consortium, Ovid MEDLINE and EMBASE, and identified 20 eligible randomized controlled trials published from inception to 25 July 2020, with the outcome data from 1,743 participants. The results indicated that ICBT had a significant positive effect on patients with SAD compared with the control groups (g = −0.55). A subgroup analysis revealed that ICBT and CBT had an equal effect on treating patients with SAD (g = −0.18). There was also no difference between ICBT and ICBT plus other therapies in the treatment of patients with SAD (g = −0.07). The effect size of ICBT on patients with SAD was maintained at the 6-month follow-up (g = −0.08) and at the 12-month follow-up (g = −0.17). The findings of this review demonstrated that ICBT can significantly reduce SAD symptoms and that ICBT and face-to-face CBT produce equivalent effects. The results of this meta-analysis contributed to the literature on ICBT for the treatment of patients with SAD, although numerous aspects of ICBT were identified for future investigations.