Table 3 Moderators of the effectiveness of IM-CBT on psychiatric symptoms and physical distress (n = 44 studies).
Moderator | Psychiatric symptoms | Physical distress | ||||||
|---|---|---|---|---|---|---|---|---|
k | Statistic type | Statistic value (95% CI) | p | k | Statistic type | Statistic value (95% CI) | p | |
Model 1 Psychiatric symptoms | ||||||||
Subgroup differences | – | Q-value | 8.236 | 0.083 | – | – | – | – |
Depressive symptoms | 43 | Hedge’s g | 0.462 (0.323 to 0.601) | <0.001 | – | – | – | – |
Anxiety symptoms | 34 | Hedge’s g | 0.328 (0.199 to 0.456) | <0.001 | – | – | – | – |
Depressive and anxiety symptoms | 7 | Hedge’s g | 0.489 (–0.023 to 1.001) | 0.061 | – | – | – | – |
PTSD symptoms | 3 | Hedge’s g | 0.904 (0.431 to 1.377) | <0.001 | – | – | – | – |
General psychological distress | 10 | Hedge’s g | 0.693 (0.297 to 1.090) | 0.001 | – | – | – | – |
Model 2 Physical distress | ||||||||
Subgroup differences | – | – | – | – | – | Q-value | 3.320 | 0.345 |
Physical symptoms | – | – | – | – | 31 | Hedge’s g | 0.173 (0.076 to 0.271) | <0.001 |
Functional impairment | – | – | – | – | 21 | Hedge’s g | 0.282 (0.164 to 0.400) | <0.001 |
Self-rated ill health | – | – | – | – | 4 | Hedge’s g | 0.062 (–0.297 to 0.421) | 0.735 |
Objective physiological dysfunction | – | – | – | – | 2 | Hedge’s g | 0.047 (–0.332 to 0.427) | 0.807 |
Model 3 Gender | ||||||||
Female percentage (28.81%–100.00%) | 48 | Coefficient | 0.002 (–0.005 to 0.009) | 0.521 | 36 | Coefficient | 0.003 (–0.002 to 0.008) | 0.177 |
Model 4 Chronic disease | ||||||||
Subgroup differences | – | Q-value | 4.560 | 0.714 | – | Q-value | 2.927 | 0.892 |
Chronic pain | 21 | Hedge’s g | 0.391 (0.216 to 0.566) | <0.001 | 21 | Hedge’s g | 0.232 (0.111 to 0.353) | <0.001 |
Cancer | 9 | Hedge’s g | 0.495 (0.099 to 0.892) | 0.014 | 4 | Hedge’s g | 0.162 (–0.046 to 0.370) | 0.128 |
Arthritis | 6 | Hedge’s g | 0.402 (0.094 to 0.709) | 0.010 | 5 | Hedge’s g | 0.165 (–0.042 to 0.373) | 0.119 |
Cardiovascular disease | 4 | Hedge’s g | 0.504 (0.245 to 0.764) | <0.001 | 1 | Hedge’s g | 0.072 (–0.093 to 0.238) | 0.391 |
Diabetes | 2 | Hedge’s g | 0.461 (–0.580 to 1.503) | 0.385 | 1 | Hedge’s g | 0.024 (–0.427 to 0.475) | 0.916 |
Multiple sclerosis | 1 | Hedge’s g | 0.641 (–0.240 to 1.523) | 0.154 | 1 | Hedge’s g | 0.278 (–0.587 to 1.142) | 0.529 |
HIV | 1 | Hedge’s g | –0.200 (–0.906 to 0.506) | 0.578 | 1 | Hedge’s g | 0.154 (–0.546 to 0.855) | 0.666 |
Different chronic diseases | 4 | Hedge’s g | 0.566 (0.230 to 0.902) | 0.001 | 2 | Hedge’s g | –0.009 (–1.070 to 1.051) | 0.986 |
Model 5 Physical or psychiatric comorbidity | ||||||||
Subgroup differences | – | Q-value | 0.033 | 0.857 | – | Q-value | 0.048 | 0.826 |
Yes | 24 | Hedge’s g | 0.441 (0.255 to 0.628) | <0.001 | 16 | Hedge’s g | 0.171 (0.049 to 0.293) | 0.006 |
No | 24 | Hedge’s g | 0.419 (0.264 to 0.573) | <0.001 | 20 | Hedge’s g | 0.190 (0.070 to 0.309) | 0.002 |
Model 6 Medication received for physical condition(s) | ||||||||
Subgroup differences | – | Q-value | 0.114 | 0.735 | – | Q-value | 0.089 | 0.766 |
Yes | 25 | Hedge’s g | 0.400 (0.234 to 0.647) | <0.001 | 18 | Hedge’s g | 0.195 (0.077 to 0.314) | 0.001 |
No | 23 | Hedge’s g | 0.400 (0.283 to 0.517) | <0.001 | 18 | Hedge’s g | 0.170 (0.046 to 0.293) | 0.007 |
Model 7 Surgery received for physical condition(s) | ||||||||
Subgroup differences | – | Q-value | 0.268 | 0.605 | – | Q-value | 0.367 | 0.545 |
Yes | 8 | Hedge’s g | 0.537 (0.069 to 1.005) | 0.024 | 4 | Hedge’s g | 0.095 (–0.201 to 0.391) | 0.530 |
No | 40 | Hedge’s g | 0.410 (0.291 to 0.529) | <0.001 | 32 | Hedge’s g | 0.191 (0.102 to 0.279) | <0.001 |
Model 8 Supplement and/or other received for physical condition(s) | ||||||||
Subgroup differences | – | Q-value | 0.090 | 0.764 | – | Q-value | 0.040 | 0.841 |
Yes | 6 | Hedge’s g | 0.478 (0.094 to 0.862) | 0.015 | 6 | Hedge’s g | 0.197 (–0.072 to 0.466) | 0.151 |
No | 42 | Hedge’s g | 0.416 (0.290 to 0.543) | <0.001 | 30 | Hedge’s g | 0.168 (0.082 to 0.254) | <0.001 |
Model 9 Medication received for psychiatric condition(s) | ||||||||
Subgroup differences | – | Q-value | 3.099 | 0.078 | – | Q-value | 1.478 | 0.224 |
Yes | 13 | Hedge’s g | 0.641 (0.300 to 0.982) | <0.001 | 8 | Hedge’s g | 0.296 (0.055 to 0.536) | 0.016 |
No | 35 | Hedge’s g | 0.323 (0.224 to 0.421) | <0.001 | 28 | Hedge’s g | 0.139 (0.061 to 0.216) | <0.001 |
Model 10 Psychotherapy (non-CBT) received for psychiatric condition(s) | ||||||||
Subgroup differences | – | Q-value | 0.683 | 0.408 | – | Q-value | 0.476 | 0.490 |
Yes | 3 | Hedge’s g | 0.893 (–0.280 to 2.066) | 0.136 | 1 | Hedge’s g | 0.024 (–0.427 to 0.475) | 0.916 |
No | 45 | Hedge’s g | 0.396 (0.289 to 0.503) | <0.001 | 35 | Hedge’s g | 0.186 (0.100 to 0.272) | <0.001 |
Model 11 Main intervention delivery format | ||||||||
Subgroup differences | – | Q-value | 4.030 | 0.133 | – | Q-value | 0.063 | 0.969 |
Videoconference | 3 | Hedge’s g | –0.013 (–0.445 to 0.419) | 0.953 | 3 | Hedge’s g | 0.254 (–0.340 to 0.847) | 0.402 |
Web-based | 42 | Hedge’s g | 0.448 (0.321 to 0.576) | <0.001 | 32 | Hedge’s g | 0.180 (0.093 to 0.267) | <0.001 |
Mobile app | 3 | Hedge’s g | 0.403 (–0.272 to 1.077) | 0.242 | 1 | Hedge’s g | 0.154 (–0.546 to 0.855) | 0.666 |
Model 12 Guidance | ||||||||
Subgroup differences | – | Q-value | 0.055 | 0.814 | – | Q-value | 0.452 | 0.501 |
Guided | 33 | Hedge’s g | 0.434 (0.284 to 0.584) | <0.001 | 25 | Hedge’s g | 0.205 (0.099 to 0.311) | <0.001 |
Unguided | 15 | Hedge’s g | 0.404 (0.204 to 0.603) | <0.001 | 11 | Hedge’s g | 0.144 (0.004 to 0.285) | 0.044 |
Model 13 Intervention length (no. of sessions) | ||||||||
Subgroup differences | – | Q-value | 6.772 | 0.009 | – | Q-value | 1.685 | 0.194 |
Medium/long (≥12 sessions) | 10 | Hedge’s g | 0.186 (0.014 to 0.358) | 0.034 | 7 | Hedge’s g | 0.082 (–0.088 to 0.252) | 0.343 |
Short (<12 sessions) | 38 | Hedge’s g | 0.481 (0.341 to 0.621) | <0.001 | 29 | Hedge’s g | 0.211 (0.116 to 0.307) | <0.001 |
Model 14 Intervention duration (weeks) | ||||||||
Duration in weeks (4–26 weeks) | 48 | Coefficient | 0.005 (–0.021 to 0.032) | 0.697 | 36 | Coefficient | 0.005 (–0.010 to 0.019) | 0.530 |
Model 15 Intervention session number | ||||||||
Session number (4–48 sessions) | 48 | Coefficient | –0.001 (–0.018 to 0.015) | 0.885 | 36 | Coefficient | –0.021 (–0.039 to –0.002) | 0.034 |
Model 16 Intervention frequency | ||||||||
Sessions per week (0.15–4.80) | 48 | Coefficient | –0.044 (–0.207 to 0.119) | 0.597 | 36 | Coefficient | –0.237 (–0.387 to –0.087) | 0.002 |
Model 17 Total number of therapeutic elements | ||||||||
Number of components (2–5) | 48 | Coefficient | 0.063 (–0.087 to 0.213) | 0.407 | 36 | Coefficient | 0.032 (–0.061 to 0.125) | 0.501 |
Model 18 Intervention has behavioral modification element | ||||||||
Subgroup differences | – | Q-value | 19.498 | <0.001 | – | Q-value | – | – |
Yes | 47 | Hedge’s g | 0.442 (0.322 to 0.561) | <0.001 | 36 | Hedge’s g | 0.181 (0.097 to 0.265) | <0.001 |
No | 1 | Hedge’s g | –0.045 (–0.225 to 0.135) | 0.624 | – | Hedge’s g | – | – |
Model 19 Intervention has cognitive restructuring element | ||||||||
Subgroup differences | – | Q-value | 0.486 | 0.486 | – | Q-value | 2.016 | 0.156 |
Yes | 34 | Hedge’s g | 0.454 (0.298 to 0.610) | <0.001 | 27 | Hedge’s g | 0.212 (0.110 to 0.313) | <0.001 |
No | 14 | Hedge’s g | 0.373 (0.208 to 0.539) | <0.001 | 9 | Hedge’s g | 0.078 (–0.075 to 0.232) | 0.318 |
Model 20 Intervention has problem-solving element | ||||||||
Subgroup differences | – | Q-value | 1.508 | 0.220 | – | Q-value | 3.714 | 0.054 |
Yes | 47 | Hedge’s g | 0.433 (0.311 to 0.556) | <0.001 | 35 | Hedge’s g | 0.170 (0.088 to 0.251) | <0.001 |
No | 1 | Hedge’s g | 0.066 (–0.509 to 0.640) | 0.823 | 1 | Hedge’s g | 0.765 (0.165 to 1.366) | 0.012 |
Model 21 Intervention has psychoeducation element | ||||||||
Subgroup differences | – | Q-value | 0.873 | 0.350 | – | Q-value | 0.034 | 0.854 |
Yes | 41 | Hedge’s g | 0.404 (0.271 to 0.537) | <0.001 | 31 | Hedge’s g | 0.176 (0.099 to 0.253) | <0.001 |
No | 7 | Hedge’s g | 0.554 (0.269 to 0.840) | <0.001 | 5 | Hedge’s g | 0.213 (–0.179 to 0.605) | 0.286 |
Model 22 Intervention has mindfulness element | ||||||||
Subgroup differences | – | Q-value | 0.647 | 0.421 | – | Q-value | 0.245 | 0.621 |
Yes | 31 | Hedge’s g | 0.460 (0.305 to 0.614) | <0.001 | 24 | Hedge’s g | 0.173 (0.094 to 0.252) | <0.001 |
No | 17 | Hedge’s g | 0.357 (0.162 to 0.553) | <0.001 | 12 | Hedge’s g | 0.116 (–0.097 to 0.328) | 0.286 |
Model 23 Measurement timepoint | ||||||||
Subgroup differences | – | Q-value | 0.976 | 0.614 | – | Q-value | 2.260 | 0.323 |
Last follow-up (12–48 weeks) | 6 | Hedge’s g | 0.431 (0.258 to 0.605) | <0.001 | 4 | Hedge’s g | 0.088 (–0.071 to 0.246) | 0.278 |
First follow-up (8–36 weeks) | 21 | Hedge’s g | 0.328 (0.176 to 0.480) | <0.001 | 17 | Hedge’s g | 0.075 (–0.858 to 0.391) | 0.391 |
Post-intervention | 48 | Hedge’s g | 0.411 (0.288 to 0.534) | <0.001 | 36 | Hedge’s g | 0.185 (0.118 to 0.252) | <0.001 |
Model 24 Follow-up duration after intervention (weeks) | ||||||||
Duration in weeks (8–48 weeks) | 27 | Coefficient | –0.002 (–0.012 to 0.009) | 0.745 | 21 | Coefficient | –0.003 (–0.014 to 0.007) | 0.560 |
Model 25 Control group type | ||||||||
Subgroup differences | – | Q-value | 3.941 | 0.047 | – | Q-value | 6.177 | 0.013 |
Active | 22 | Hedge’s g | 0.299 (0.160 to 0.437) | <0.001 | 13 | Hedge’s g | 0.049 (–0.064 to 0.163) | 0.394 |
Non-active | 26 | Hedge’s g | 0.535 (0.347 to 0.723) | <0.001 | 23 | Hedge’s g | 0.243 (0.141 to 0.346) | <0.001 |
Model 26 Overall risk of bias | ||||||||
Subgroup differences | – | Q-value | 3.855 | 0.146 | – | Q-value | 0.274 | 0.872 |
High risk | 19 | Hedge’s g | 0.306 (0.145 to 0.467) | <0.001 | 15 | Hedge’s g | 0.159 (0.047 to 0.270) | 0.005 |
Some concerns | 26 | Hedge’s g | 0.530 (0.327 to 0.732) | <0.001 | 17 | Hedge’s g | 0.211 (0.048 to 0.375) | 0.011 |
Low risk | 3 | Hedge’s g | 0.301 (0.170 to 0.431) | <0.001 | 4 | Hedge’s g | 0.177 (–0.013 to 0.367) | 0.068 |
Model 27 Attrition rate at post-intervention | ||||||||
Subgroup differences | – | Q-value | 1.223 | 0.543 | – | Q-value | 2.199 | 0.333 |
High (>20%) | 8 | Hedge’s g | 0.424 (0.130 to 0.717) | 0.005 | 5 | Hedge’s g | 0.068 (–0.136 to 0.271) | 0.517 |
Moderate (5–20%) | 34 | Hedge’s g | 0.443 (0.284 to 0.602) | <0.001 | 25 | Hedge’s g | 0.177 (0.065 to 0.288) | 0.002 |
Low (<5%) | 6 | Hedge’s g | 0.308 (0.123 to 0.494) | 0.001 | 6 | Hedge’s g | 0.274 (0.092 to 0.457) | 0.003 |
Model 28 Intention-to-treat analysis | ||||||||
Subgroup differences | – | Q-value | 0.242 | 0.623 | – | Q-value | 0.321 | 0.571 |
Yes | 36 | Hedge’s g | 0.439 (0.294 to 0.583) | <0.001 | 28 | Hedge’s g | 0.181 (0.106 to 0.255) | <0.001 |
No | 12 | Hedge’s g | 0.377 (0.178 to 0.576) | <0.001 | 8 | Hedge’s g | 0.091 (–0.209 to 0.392) | 0.552 |
