Absolute and relative rates of treatment non-initiation, dropout, and attrition in internet-based and face-to-face cognitive-behavioral therapy: a meta-analysis of randomized controlled trials

Internet-based cognitive-behavioral therapy (ICBT) appears to produce comparable clinical benefits to face-to-face CBT. However, whether these two CBT modalities are equally accepted by patients remains unclear. We conducted a meta-analysis examining absolute and relative rates of treatment non-initiation, dropout, and attrition in ICBT and face-to-face CBT. Thirty trials comparing ICBT to face-to-face CBT for psychiatric and somatic disorders were included. Pooled event rates were calculated to estimate absolute rates of treatment non-initiation, dropout, and attrition. Risk ratios (RR) were computed to compare relative rates between modalities. Absolute rates of treatment non-initiation for ICBT were 8.7% (95% CI = 5.0-14.5) compared to 11.9% for face-to-face CBT (95% CI = 8.3-16.8), which produced a significant RR of 0.58. This effect remained significant in various sensitivity analyses. Absolute rates of treatment dropout were 16.3% (95% CI = 11.8-22.2) for ICBT and 12.0% (95% CI = 7.6-18.5) for face-to-face CBT, while absolute rates of post-treatment and follow-up attrition were 15.2% (95% CI = 11.1-20.4) and 22.3% (95% CI = 16.9-28.8) for ICBT and 14.1% (95% CI = 10.3-19.0) and 23.1% (95% CI = 17.5-29.7) for face-to-face CBT, respectively. These RRs were non-significant. Findings suggest that while ICBT is more readily initiated than face-to-face CBT, both modalities demonstrate comparable rates of treatment completion and study retention across diverse clinical contexts.