Internet-based CBT modestly reduces anxiety and depression in breast cancer survivors

OBJECTIVE: Evaluating the effects of Internet-based cognitive behavioral therapy (I-CBT) on anxiety and depression in breast cancer (BC) survivors. METHODS: Systematic searches were conducted on eight Chinese and English databases from inception to July 20, 2024, for relevant randomized controlled trials. The quality of included trials was evaluated using the Cochrane risk of bias (ROB 2.0) tool, and meta-analysis was conducted using RevMan 5.4 software. RESULTS: Seven studies, including 1016 BC survivors, were included. This meta-analysis found that I-CBT possessed significant effects on anxiety (SMD = - 0.14, 95% CI (- 0.27, - 0.01), P = 0.03) and depression (SMD = - 0.19, 95% CI (- 0.31, - 0.06), P = 0.003); subgroup analyses revealed that self-guided I-CBT significantly improved depression (SMD = - 0.21, 95% CI (- 0.38, - 0.04), P = 0.02); I-CBT lasting 8-12 weeks was effective for anxiety (SMD = - 0.2, 95% CI (- 0.36, - 0.04), P = 0.02) and depression (SMD = - 0.18, 95% CI (- 0.34, - 0.02), P = 0.02); I-CBT with one session per week was effective for depression (SMD = - 0.16, 95% CI (- 0.3, - 0.01), P = 0.04). CONCLUSION: I-CBT had significant effects on anxiety and depression in BC survivors. The individual factors of a self-guided format, an 8-12 week duration, and one session per week each demonstrated greater efficacy for I-CBT in BC survivors; however, further research is needed to validate our conclusion and the long-term efficacy of I-CBT. IMPLICATIONS FOR CANCER SURVIVORS: I-CBT is advisable for BC survivors because of its significant effectiveness on anxiety and depression, and an autonomous and time-flexibility I-CBT program is recommended.