Background: Internet-delivered cognitive behavioral therapy (ICBT) is an effective treatment that can overcome barriers to mental health care. Various research groups have suggested that unguided ICBT (ie, ICBT without therapist support) and other eHealth interventions can be designed to enhance user engagement and thus outcomes. The persuasive systems design framework captures most design recommendations for eHealth interventions, but there is little empirical evidence that persuasive design is related to clinical outcomes in unguided ICBT. Objective: This study aims to provide an updated meta-analysis of randomized controlled trials of unguided ICBT for depression and anxiety, describe the frequency with which various persuasive design principles are used in such interventions, and use meta-regression to explore whether a greater number of persuasive design elements predicts efficacy in unguided ICBT for depression and anxiety. Methods: We conducted a systematic review of 5 databases to identify randomized controlled trials of unguided ICBT for depression and anxiety. We conducted separate random effects meta-analyses and separate meta-regressions for depression and anxiety interventions. Each meta-regression included 2 steps. The first step included, as a predictor, whether each intervention was transdiagnostic. For the meta-regression of ICBT for depression, the first step also included the type of control condition. The number of persuasive design principles identified for each intervention was added as a predictor in the second step to reveal the additional variance in effect sizes explained by persuasive design. Results: Of the 4471 articles we identified in our search, 46 (1.03%) were eligible for inclusion in our analyses. Our meta-analyses showed effect sizes (Hedges g) ranging from 0.22 to 0.31 for depression interventions, depending on the measures taken to account for bias in the results. We found a mean effect size of 0.45 (95% CI 0.33-0.56) for anxiety interventions, with no evidence that the results were inflated by bias. Included interventions were identified as using between 1 and 13 persuasive design principles, with an average of 4.95 (SD 2.85). The meta-regressions showed that a greater number of persuasive design principles predicted greater efficacy in ICBT for depression (R2 change=0.27; B=0.04; P=.02) but not anxiety (R2 change=0.05; B=0.03; P=.17). Conclusions: These findings show wide variability in the use of persuasive design in unguided ICBT for depression and anxiety and provide preliminary support for the proposition that more persuasively designed interventions are more efficacious, at least in the treatment of depression. Further research is needed to clarify the role of persuasive design in ICBT. Trial Registration:

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中文翻译：

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探索说服性设计在成人抑郁和焦虑的无指导互联网认知行为疗法中的作用：系统回顾、荟萃分析和荟萃回归

背景：互联网提供的认知行为疗法（ICBT）是一种有效的治疗方法，可以克服心理健康护理的障碍。各种研究小组建议，可以设计无指导的 ICBT（即没有治疗师支持的 ICBT）和其他电子医疗干预措施来增强用户参与度，从而提高结果。有说服力的系统设计框架涵盖了电子健康干预措施的大多数设计建议，但几乎没有经验证据表明有说服力的设计与无指导的 ICBT 的临床结果相关。目的：本研究旨在提供无指导 ICBT 治疗抑郁和焦虑的随机对照试验的最新荟萃分析，描述在此类干预措施中使用各种有说服力的设计原则的频率，并使用荟萃回归来探讨是否有更多的研究有说服力的设计元素可以预测无指导的 ICBT 对抑郁和焦虑的疗效。方法：我们对 5 个数据库进行了系统回顾，以确定无指导 ICBT 治疗抑郁和焦虑的随机对照试验。我们对抑郁和焦虑干预措施进行了单独的随机效应荟萃分析和单独的荟萃回归。每个元回归包括 2 个步骤。第一步包括作为预测因素，每次干预是否是跨诊断的。对于 ICBT 对抑郁症的元回归，第一步还包括控制条件的类型。在第二步中添加为每个干预措施确定的说服性设计原则的数量作为预测因子，以揭示说服性设计所解释的效应大小的额外方差。结果：在我们搜索中确定的 4471 篇文章中，有 46 篇 (1.03%) 符合纳入我们分析的条件。我们的荟萃分析显示，抑郁症干预措施的效应大小 (Hedges g) 范围为 0.22 至 0.31，具体取决于为解决结果偏差而采取的措施。我们发现焦虑干预的平均效应大小为 0.45 (95% CI 0.33-0.56)，没有证据表明结果因偏见而被夸大。纳入的干预措施被确定为使用 1 至 13 条有说服力的设计原则，平均为 4.95 (SD 2.85)。元回归显示，更多的说服性设计原则预测 ICBT 对抑郁症的疗效更大（R2 变化 = 0.27；B = 0.04；P = 0.02），但不能预测焦虑症（R2 变化 = 0.05；B = 0.03；P = .17）。结论：这些研究结果表明，在无指导的 ICBT 治疗抑郁和焦虑中，说服性设计的使用存在很大差异，并为以下主张提供了初步支持：更有说服力的设计干预措施更有效，至少在抑郁症的治疗中是这样。需要进一步的研究来阐明说服性设计在 ICBT 中的作用。试用注册：

这只是摘要。在 JMIR 网站上阅读全文。JMIR 是互联网时代电子健康和医疗保健领域领先的开放获取期刊。