Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: An updated meta-analysis

Journal of Anxiety Disorders

Volumn 55, Issue , 2018, Pages 70-78

  Andrews, G ^a   Basu, A ^a   Cuijpers, P ^b   Craske, M G ^c   McEvoy, P ^d,e   English, C L ^f   Newby, J M ^a  

^a UNIVERSITY OF NEW SOUTH WALES   (Australia)

^b VU UNIVERSITY AMSTERDAM   (Netherlands)

^c UNIVERSITY OF CALIFORNIA   (United States)

^d CURTIN UNIVERSITY   (Australia)

^e University of California ^*  (Australia)

^f ST GEORGE'S UNIVERSITY OF LONDON   (United Kingdom)

Author keywords

Anxiety; Cognitive behavioral therapy; Depression; iCBT; Internet CBT

Indexed keywords

ANXIETY DISORDER; CLINICAL EFFECTIVENESS; CLINICAL PRACTICE; COGNITIVE BEHAVIORAL THERAPY; COMPUTER THERAPY; DEPRESSION; FOLLOW UP; GENERALIZED ANXIETY DISORDER; HUMAN; MAJOR DEPRESSION; MENTAL HEALTH CARE; META ANALYSIS; OUTCOME ASSESSMENT; PANIC; PATIENT COMPLIANCE; PATIENT SATISFACTION; QUALITY OF LIFE; RANDOMIZED CONTROLLED TRIAL (TOPIC); REVIEW; SOCIAL PHOBIA; SYSTEMATIC REVIEW; ADULT; COMPUTER ASSISTED THERAPY; INTERNET; MALE; PSYCHOLOGY; SATISFACTION;

ADULT; ANXIETY DISORDERS; COGNITIVE BEHAVIORAL THERAPY; DEPRESSIVE DISORDER; HUMANS; INTERNET; MALE; PATIENT COMPLIANCE; PERSONAL SATISFACTION; QUALITY OF LIFE; THERAPY, COMPUTER-ASSISTED;

EID: 85041562072     PISSN: 08876185     EISSN: 18737897     Source Type: Journal    
DOI: 10.1016/j.janxdis.2018.01.001     Document Type: Review

References (91)

1. Agency for Healthcare Research and Quality, Nonpharmacological versus pharmacological treatment for patients with major depressive disorder: Current state of the evidence. AHRQ Clinician Summary, 15(16), 2016.
2. Allen, A., Newby, J., Mackenzie, A., Smith, J., Boulton, M., Loughnan, S., et al. Internet cognitive–behavioral treatment for panic disorder: Randomised controlled trial and evidence of effectiveness in primary care. British Journal of Psychiatry Open 2:2 (2016), 154–162.
3. Andersson, G., Carlbring, P., Holmström, A., Sparthan, E., Furmark, T., Nilsson-Ihrfelt, E., et al. Internet-based self-help with therapist feedback and in vivo group exposure for social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology 74:4 (2006), 677–686.
4. Andersson, G., Hesser, H., Veilord, A., Svedling, L., Andersson, F., Sleman, O., et al. Randomised controlled non-inferiority trial with 3-year follow-up of internet-delivered versus face-to-face group cognitive behavioral therapy for depression. Journal of Affective Disorders [Internet] 151:3 (2013), 986–994, 10.1016/j.jad.2013.08.022 [cited 8 September 2016] Available from
5. Andersson, G., Cuijpers, P., Carlbring, P., Riper, H., Hedman, E., Guided Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: A systematic review and meta-analysis. World Psychiatry 13:3 (2014), 288–295.
6. Andersson, G., Internet-based self-help for depression: Randomised controlled trial. The British Journal of Psychiatry 187:5 (2005), 456–461.
7. Andersson, G., Carlbring, P., Furmark, T., Therapist experience and knowledge acquisition in internet-delivered CBT for social anxiety disorder: A randomized controlled trial. Public Library Of Science, 7(5), 2012, e37411.
8. Andersson, G., Paxling, B., Roch-Norlund, P., Östman, G., Norgren, A., Almlöv, J., et al. Internet-Based psychodynamic versus cognitive behavioral guided self-help for generalized anxiety disorder: A randomized controlled trial. Psychotherapy and Psychosomatics 81:6 (2012), 344–355.
9. Andrews, G., Cuijpers, P., Craske, M., McEvoy, P., Titov, N., Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: A meta-analysis. Public Library Of Science, 5(10), 2010, e13196.
10. Andrews, G., Davies, M., Titov, N., Effectiveness randomized controlled trial of face to face versus Internet cognitive behaviour therapy for social phobia. Australian & New Zealand Journal of Psychiatry 45:4 (2011), 337–340.
11. Bandelow, B., Reitt, M., Rover, C., Michaelis, S., Gorlich, Y., Wedekind, D., Efficacy of treatments for anxiety disorders: A meta-analysis. International Clinical Psychopharmacology 30 (2015), 183–192.
12. Berger, T., Hohl, E., Caspar, F., Internet-based treatment for social phobia: A randomized controlled trial. Journal of Clinical Psychology 65:10 (2009), 1021–1035.
13. Berger, T., Hämmerli, K., Gubser, N., Andersson, G., Caspar, F., Internet-based treatment of depression: A randomized controlled trial comparing guided with unguided self-help. Cognitive Behaviour Therapy 40:4 (2011), 251–266.
14. Bergström, J., Andersson, G., Ljótsson, B., Rück, C., Andréewitch, S., Karlsson, A., et al. Internet-versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting: A randomised trial. BioMed Central Psychiatry, 10(1), 2010.
15. Botella, C., Gallego, M., Garcia-Palacios, A., Guillen, V., Baños, R., Quero, S., et al. An internet-based self-help treatment for fear of public speaking: A controlled trial. Cyberpsychology, Behavior, and Social Networking 13:4 (2010), 407–421.
16. Carlbring, P., Westling, B., Ljungstrand, P., Ekselius, L., Andersson, G., Treatment of panic disorder via the internet: A randomized trial of a self-help program. Behavior Therapy 32:4 (2001), 751–764.
17. Carlbring, P., Nilsson-Ihrfelt, E., Waara, J., Kollenstam, C., Buhrman, M., Kaldo, V., et al. Treatment of panic disorder: Live therapy vs. self-help via the internet. Behaviour Research and Therapy 43:10 (2005), 1321–1333.
18. Carlbring, P., Bohman, S., Brunt, S., Buhrman, M., Westling, B., Ekselius, L., et al. Remote treatment of panic disorder: A randomized trial of internet-based cognitive behavior therapy supplemented with telephone calls. American Journal of Psychiatry 163:12 (2006), 2119–2125.
19. Carlbring, P., Gunnarsdottir, M., Hedensjo, L., Andersson, G., Ekselius, L., Furmark, T., Treatment of social phobia: Randomised trial of internet-delivered cognitive-behavioral therapy with telephone support. The British Journal of Psychiatry 190:2 (2007), 123–128.
20. Choi, I., Zou, J., Titov, N., Dear, B., Li, S., Johnston, L., et al. Culturally attuned Internet treatment for depression amongst Chinese Australians: A randomised controlled trial. Journal of Affective Disorders 136:3 (2012), 459–468.
21. Christensen, H., Mackinnon, A., Batterham, P., O'Dea, B., Guastella, A., Griffiths, K., et al. The effectiveness of an online e-health application compared to attention placebo or Sertraline in the treatment of Generalised Anxiety Disorder. Internet Interventions 1:4 (2014), 169–174.
22. Christensen, H., Mackinnon, A., Batterham, P., O'Dea, B., Guastella, A., Griffiths, K., et al. The effectiveness of an online e-health application compared to attention placebo or Setraline in the treatment of Generalised Anxiety Disorder. Internet Interventions 16 (2014), 9–174.
23. Christensen, H., Delivering interventions for depression by using the internet: Randomised controlled trial. British Medical Journal, 328(7434), 2004, 265.
24. Comprehensive Meta-Analysis Software (CMA), Meta-analysis.com. 2016 [Internet]. [cited 8 September 2016]. Available from: https://www.meta-analysis.com/.
25. Cuijpers, P., Cristea, I., What if a placebo effect explained all the activity of depression treatments?. World Psychiatry 14:3 (2015), 310–311.
26. Cuijpers, P., Meta-analyses in mental health research: A practical guide. 2016, Vrije Universitieit Amsterdam, Amsterdam.
27. de Graaf, L., Gerhards, S., Arntz, A., Riper, H., Metsemakers, J., Evers, S., et al. Clinical effectiveness of online computerised cognitive-behavioral therapy without support for depression in primary care: Randomised trial. The British Journal of Psychiatry 195:1 (2009), 73–80.
28. Duval, S., Tweedie, R., A nonparametric trim and fill method of accounting for publication bias in meta-analysis. Journal of the American Statistical Association 1:104 (2009), 1338–1350.
29. El Alaoui, S., et al. Effectiveness of internet-based cognitive-behavior therapy for social anxiety disorder in clinical psychiatry. Journal of Consulting and Clinical Psychology 83:5 (2015), 902–914 [Web].
30. El Alaoui, S., et al. Long-term effectiveness and outcome predictors of therapist-guided internet-based Cognitive-behavioral therapy for social anxiety disorder In routine psychiatric care. British Medical Journal Open, 5(6), 2015, e007902 [Web].
31. Farrer, L., Christensen, H., Griffiths, K., Mackinnon, A., Internet-based CBT for depression with and without telephone tracking in a national helpline: Randomised controlled trial. Public Library Of Science, 6(11), 2011, e28099.
32. Furmark, T., Carlbring, P., Hedman, E., Sonnenstein, A., Clevberger, P., Bohman, B., et al. Guided and unguided self-help for social anxiety disorder: Randomised controlled trial. The British Journal of Psychiatry 195:5 (2009), 440–447.
33. Geraedts, A., Kleiboer, A., Twisk, J., Wiezer, N., van Mechelen, W., Cuijpers, P., Long-term results of a web-based guided self-help intervention for employees with depressive symptoms: Randomized controlled trial. Journal of Medical Internet Research, 16(7), 2014, e168.
34. Gilbody, S., Littlewood, E., Hewitt, C., Brierley, G., Tharmanathan, P., Araya, R., et al. Computerised cognitive behaviour therapy (cCBT) as treatment for depression in primary care (REEACT trial): Large scale pragmatic randomised controlled trial. British Medical Journal, 2015, h5627.
35. Hallgren, M., Kraepelien, M., Ojehagen, A., Lindefors, N., Zeebari, Z., Kaldo, V., et al. Physical exercise and internet-based cognitive-behavioral therapy in the treatment of depression: Randomised controlled trial. The British Journal of Psychiatry 207:3 (2015), 227–234.
36. Hedges, L., Vevea, J., Estimating effect size under publication bias: Small sample properties and robustness of a random effects selection model. Journal of Educational and Behavioral Statistics 21:4 (1996), 299–332.
37. Hedman, E., Ljotsson, B., Lindefors, N., Cognitive behavior therapy via the Internet: A systematic review of applications, clinical efficacy and cost-effectiveness. Expert Review of Pharmacoeconomics and Outcomes Research 12:6 (2012), 745–764.
38. Hedman, E., et al. Effectiveness of internet-based cognitive behaviour therapy for panic disorder in routine psychiatric care. Acta Psychiatrica Scandinavica 128:6 (2013), 457–467.
39. Hedman, E., et al. Effectiveness of internet-based cognitive behaviour therapy for depression in routine psychiatric care. Journal of Affective Disorders 155 (2014), 49–58 [Web].
40. Higgins, J., Altman, D., Gotzsche, P., Juni, P., Moher, D., Oxman, A., et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. British Medical Journal, 343(October (2)), 2011, d5928.
41. Ionnidis, J., Patsopoulos, N., Evangelou, E., Uncertainty in heterogeneity estimates in meta-analyses. British Medical Journal (Clinical Research Ed.) 335:7626 (2016), 914–916.
42. Johansson, R., Sjöberg, E., Sjögren, M., Johnsson, E., Carlbring, P., Andersson, T., et al. Tailored vs. standardized internet-based cognitive behavior therapy for depression and comorbid symptoms: A randomized controlled trial. Public Library Of Science, 7(5), 2012, e36905.
43. Jones, S., Hadjistavropoulos, H., Soucy, J., A randomized controlled trial of guided internet-delivered cognitive behaviour therapy for older adults with generalized anxiety. Journal of Anxiety Disorders 37 (2016), 1–9.
44. Kessler, D., Lewis, G., Kaur, S., Wiles, N., King, M., Weich, S., et al. Therapist-delivered internet psychotherapy for depression in primary care: A randomised controlled trial. The Lancet 374:9690 (2009), 628–634.
45. Kiropoulos, L., Klein, B., Austin, D., Gilson, K., Pier, C., Mitchell, J., et al. Is internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT?. Journal of Anxiety Disorders 22:8 (2008), 1273–1284.
46. Kivi, M., Eriksson, M., Hange, D., Petersson, E., Vernmark, K., Johansson, B., et al. Internet-based therapy for mild to moderate depression in swedish primary care: Short term results from the PRIM-NET randomized controlled trial. Cognitive Behaviour Therapy 43:4 (2014), 289–298.
47. Klein, B., Richards, J., A brief internet-based treatment for panic disorder. Behavioral and Cognitive Psychotherapy, 29(01), 2001.
48. Klein, B., Richards, J., Austin, D., Efficacy of internet therapy for panic disorder. Journal of Behavior Therapy and Experimental Psychiatry 37:3 (2006), 213–238.
49. Kraemer, H., Kupfer, D., Size of treatment effects and their importance to clinical research and practice. Biological Psychiatry 59:11 (2006), 990–996.
50. Lintvedt, O., Griffiths, K., Sørensen, K., Østvik, A., Wang, C., Eisemann, M., et al. Evaluating the effectiveness and efficacy of unguided internet-based self-help intervention for the prevention of depression: A randomized controlled trial. Clinical Psychology & Psychotherapy 20:1 (2011), 10–27.
51. Mackenzie, A., Harvey, S., Mewton, L., Andrews, G., Occupational impact of internet-delivered cognitive behaviour therapy for depression and anxiety: Reanalysis of data from five Australian randomised controlled trials. The Medical Journal of Australia 201:7 (2014), 417–419.
52. Mewton, L., Wong, N., Andrews, G., The effectiveness of internet cognitive behavioral therapy for generalised anxiety disorder in clinical practice. Depression and Anxiety 29:10 (2012), 843–849.
53. Moher, D., Liberati, A., Tetzlaff, J., Altman, D., Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. British Medical Journal, 339(July (1)), 2009, b2535.
54. Newby, J., Robins, L., Wilhelm, K., Smith, J., Fletcher, T., Gillis, I., et al. Internet-delivered cognitive behaviour therapy for depression in people with diabetes mellitus: A randomised controlled trial. Journal of Medical Internet Research, 19(5), 2016.
55. Newby, J., Twomey, C., Yuan Li, S., Andrews, G., Transdiagnostic computerised cognitive behavioral therapy for depression and anxiety: A systematic review and meta-analysis. Journal of Affective Disorders 199 (2016), 30–41.
56. O'Moore, K., Newby, J., Andrews, G., Hunter, D., Bennell, K., Smith, J., et al. The effect of internet cognitive behaviour therapy for depression in older adults with knee osteoarthritis: A randomized controlled trial. Arthritis Care and Research 70 (2018), 61–70.
57. Olthius, J.V., Watt, M.C., Bailey, K., Hayden, J.A., Stewart, S.H., Therapist-supported Internet cognitive behavioural therapy for anxiety in adults. Cochrane Database of Systematic Reviews, 2015, 3.
58. Oromendia, P., Orrego, J., Bonillo, A., Molinuevo, B., Internet-based self-help treatment for panic disorder: A randomized controlled trial comparing mandatory versus optional complementary psychological support. Cognitive Behaviour Therapy 45:4 (2016), 270–286.
59. Orsini, N., Bottai, M., Higgins, J., Buchan, I., HETEROGI. Stata module to quantify heterogeneity in a meta-analysis. 2006 [Stata].
60. Paxling, B., Almlöv, J., Dahlin, M., Carlbring, P., Breitholtz, E., Eriksson, T., et al. Guided internet-delivered cognitive behavior therapy for generalized anxiety disorder: A randomized controlled trial. Cognitive Behaviour Therapy 40:3 (2011), 159–173.
61. Perini, S., Titov, N., Andrews, G., Clinician-assisted Internet-based treatment is effective for depression: Randomized controlled trial. Australian & New Zealand Journal of Psychiatry 43:6 (2009), 571–578.
62. Phillips, R., Schneider, J., Molosankwe, I., Leese, M., Foroushani, P., Grime, P., et al. Randomized controlled trial of computerized cognitive behavioral therapy for depressive symptoms: Effectiveness and costs of a workplace intervention. Psychological Medicine 44:04 (2013), 741–752.
63. Richards, J., Klein, B., Austin, D., Internet cognitive behavioral therapy for panic disorder: Does the inclusion of stress management information improve end-state functioning?. Clinical Psychologist 10:1 (2006), 2–15.
64. Richards, D., Timulak, L., O'Brien, E., Hayes, C., Vigano, N., Sharry, J., et al. A randomized controlled trial of an internet-delivered treatment: Its potential as a low-intensity community intervention for adults with symptoms of depression. Behaviour Research and Therapy 75 (2015), 20–31.
65. Robinson, E., Titov, N., Andrews, G., McIntyre, K., Schwencke, G., Solley, K., Internet treatment for generalized anxiety disorder: A randomized controlled trial comparing clinician vs technician assistance. Public Library Of Science, 5(6), 2010, e10942.
66. Rosso, I., Killgore, W., Olson, E., Webb, C., Fukunaga, R., Auerbach, R., et al. Randomized trial of internet-based cognitive behavior therapy for major depressive disorder. Depression and Anxiety 34:3 (2017), 236–245.
67. Ruwaard, J., Schrieken, B., Schrijver, M., Broeksteeg, J., Dekker, J., Vermeulen, H., et al. Standardized web-based cognitive behavioral therapy of mild to moderate depression: A randomized controlled trial with a long-term follow-up. Cognitive Behaviour Therapy 38:4 (2009), 206–221.
68. Ruwaard, J., Broeksteeg, J., Schrieken, B., Emmelkamp, P., Lange, A., Web-based therapist-assisted cognitive behavioral treatment of panic symptoms: A randomized controlled trial with a three-year follow-up. Journal of Anxiety Disorders 24:4 (2010), 387–396.
69. Ruwaard, J., et al. The effectiveness of online cognitive behavioral treatment in routine clinical practice. Public Library Of Science, 7(7), 2012, e40089 [Web].
70. Selmi, P., Computer-administered cognitive-behavioral therapy for depression. American Journal of Psychiatry 147:1 (1990), 51–56.
71. Shafran, R., Clark, D., Fairburn, C., Arntz, A., Barlow, D., Ehlers, A., et al. Mind the gap: Improving the dissemination of CBT. Behaviour Research and Therapy 47:11 (2009), 902–909.
72. Sijbrandij, M., Kunovski, I., Cuijpers, P., Effectiveness of internet-delivered cognitive behavioral therapy for posttraumatic stress disorder: A systematic review and meta-analysis. Depression and Anxiety 33 (2016), 783–791.
73. Smith, J., Newby, J., Burston, N., Murphy, M., Michael, S., Kiln, F., et al. Help from home for depression: A randomised controlled trial comparing internet cognitive behaviour therapy for depression with two self-help books. Internet Interventions 9 (2017), 25–37.
74. Titov, N., Andrews, G., Robinson, E., Schwencke, G., Johnston, L., Solley, K., et al. Clinician-assisted Internet-based treatment is effective for generalized anxiety disorder: Randomized controlled trial. Australian & New Zealand Journal of Psychiatry 43:10 (2009), 905–912.
75. Titov, N., Andrews, G., Davies, M., McIntyre, K., Robinson, E., Solley, K., Internet treatment for depression: A randomized controlled trial comparing clinician vs technician assistance. Public Library Of Science, 5(6), 2010, e10939.
76. Titov, N., Andrews, G., Schwencke, G., Shyness 2: Treating social phobia online: Replication and extension. Australian & New Zealand Journal of Psychiatry 42:7 (2008), 595–605.
77. Titov, N., Andrews, G., Choi, I., Schwencke, G., Mahoney, A., Shyness 3: Randomized controlled trial of guided versus unguided Internet-based CBT for social phobia. Australian & New Zealand Journal of Psychiatry 42:12 (2008), 1030–1040.
78. Titov, N., Andrews, G., Schwencke, G., Drobny, J., Einstein, D., Shyness 1: Distance treatment of social phobia over the Internet. Australian & New Zealand Journal of Psychiatry 42:7 (2008), 585–594.
79. Tulbure, B., Szentagotai, A., David, O., Ștefan, S., Månsson, K., David, D., et al. Internet-delivered cognitive-behavioral therapy for social anxiety disorder in Romania: A randomized controlled trial. Public Library Of Science, 10(5), 2015, e0123997.
80. van Ballegooijen, W., Riper, H., Klein, B., Ebert, D., Kramer, J., Meulenbeek, P., et al. An internet-based guided self-help intervention for panic symptoms: Randomized controlled trial. Journal of Medical Internet Research, 15(7), 2013, e154.
81. Vernmark, K., Lenndin, J., Bjärehed, J., Carlsson, M., Karlsson, J., Öberg, J., et al. Internet administered guided self-help versus individualized e-mail therapy: A randomized trial of two versions of CBT for major depression. Behaviour Research and Therapy 48:5 (2010), 368–376.
82. Wagner, B., Horn, A., Maercker, A., Internet-based versus face-to-face cognitive-behavioral intervention for depression: A randomized controlled non-inferiority trial. Journal of Affective Disorders 152–154 (2014), 113–121.
83. Waller, G., Evidence-based treatment and therapist drift. Behaviour Research and Therapy 47:2 (2009), 119–127.
84. Warmerdam, L., van Straten, A., Twisk, J., Riper, H., Cuijpers, P., Internet-based treatment for adults with depressive symptoms: Randomized controlled trial. Journal of Medical Internet Research, 10(4), 2008, e44.
85. Watts, S., Turnell, A., Kladnitski, N., Newby, J., Andrews, G., Treatment-as-usual (TAU) is anything but usual: A meta-analysis of CBT versus TAU for anxiety and depression. Journal of Affective Disorders 175 (2015), 152–167.
86. Whiteford, H., Ferrari, A., Degenhardt, L., Feigin, V., Vos, T., The global burden of mental, neurological and substance use disorders: An analysis from the global burden of disease study 2010. Public Library Of Science, 10(2), 2015, e0116820.
87. Williams, A., Andrews, G., Effectiveness of internet cognitive behavioral therapy (iCBT) for depression in primary care: A quality assurance study. Public Library Of Science, 8, 2013, e57447.
88. Williams, A., Blackwell, S., Mackenzie, A., Holmes, E., Andrews, G., Combining imagination and reason in the treatment of depression: A randomized controlled trial of internet-based cognitive-bias modification and internet-CBT for depression. Journal of Consulting and Clinical Psychology 81:5 (2013), 793–799.
89. Williams, A., O'Moore, K., Mason, E., Andrews, G., The effectiveness of internet cognitive behaviour therapy (iCBT) for social anxiety disorder across two routine practice pathways. Internet Interventions 1:4 (2014), 225–229.
90. Wims, E., Titov, N., Andrews, G., Choi, I., Clinician-assisted internet-based treatment is effective for panic: A randomized controlled trial. Australian & New Zealand Journal of Psychiatry 44:7 (2010), 599–607.
91. Wright, J., Wright, A., Albano, A., Basco, M., Goldsmith, L., Raffield, T., et al. Computer-assisted cognitive therapy for depression: Maintaining efficacy while reducing therapist time. American Journal of Psychiatry 162:6 (2005), 1158–1164.