Remote cognitive‐behavioral therapy for generalized anxiety disorder: A preliminary meta‐analysis
Open accessAbstract
Background: Generalized anxiety disorder (GAD) is a chronic mental health condition that results in significant individual, societal, and economic burden. While cognitive behavioral therapy (CBT) is well established as an efficacious treatment for GAD, individuals have identified several logistical barriers to accessing face‐to‐face CBT. Remotely delivered treatments address many of these treatment barriers. Methods: The aim of the current study was to synthesize the current literature on the efficacy of remote CBT for GAD using a meta‐analytic approach. Relevant articles were identified through an electronic database search and 10 studies (with 11 remote conditions and 1071 participants) were included in the meta‐analysis. Results: Within‐group findings indicate that remote CBT for GAD results in large effect sizes from pretreatment to posttreatment ( g = 1.30; 95% confidence interval [CI]: 1.03−1.58). Both low intensity and high intensity remote CBT interventions were found to result in large effect sizes ( g = 1.36; 95% CI: 1.11−1.61 and g = 0.83; 95% CI: 0.20−1.47, respectively), with no significant differences between the treatment formats ( Q 1 = 2.28, p = 0.13). Between‐group effect sizes were medium in size at posttreatment ( g = 0.76; 95% CI: 0.47−1.06). Conclusions: These findings have potential implications for the delivery of evidence‐based treatment for GAD and the inclusion of remote methods in stepped care treatment approaches.
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Technologically enhanced interventions generally result in equivalent outcomes to in-person treatment for GAD specifically.
“and GAD specifically (Trenoska Basile et al., 2022)”
From Treatment histories, barriers, and preferences for individuals with symptoms of generalized anxiety disorder (2024) · cites this paper as Trenoska Basile et al., 2022
The Discussion reports that remote CBT for GAD produced a pooled within-group effect size in the same range as that reported for face-to-face CBT. That supports broadly similar results, but not equivalent outcomes: the Conclusion calls for direct comparisons with face-to-face treatment. Page numbers are not available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThere is limited evidence examining high-intensity remote treatments for generalized anxiety disorder.
“there is limited evidence examining high-intensity remote treatments for this condition [50]”
From Internet videoconferencing delivered cognitive behavior therapy for generalized anxiety disorder: protocol for a randomized controlled trial (2022) · cites this paper as [50]
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Cites
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2013) · doi:10.1176/appi.books.9780890425596 · Cited by 116,369 · see citing works
The PRISMA 2020 statement: An updated guideline for reporting systematic reviews
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., et al. (2021) · BMJ · doi:10.1136/bmj.n71 · Cited by 108,283 · see citing works
Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139 · see citing works
A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.10.1092 · Cited by 31,765 · see citing works
Development and validation of the Penn State Worry Questionnaire
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990) · Behaviour Research and Therapy · doi:10.1016/0005-7967(90)90135-6 · Cited by 5,099 · see citing works
A Nonparametric “Trim and Fill” Method of Accounting for Publication Bias in Meta-Analysis
Duval, S., & Tweedie, R. (2000) · Journal of the American Statistical Association · doi:10.1080/01621459.2000.10473905 · Cited by 2,955 · see citing works
How to select, calculate, and interpret effect sizes.
Durlak, J. (2009) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsp004 · Cited by 1,487 · see citing works
Adherence in Internet Interventions for Anxiety and Depression
Christensen, H., Griffiths, K. M., & Farrer, L. (2009) · Journal of Medical Internet Research · doi:10.2196/jmir.1194 · Cited by 1,133 · see citing works
Andrews, G., Basu, A., Cuijpers, P., Craske, M. G., McEvoy, P., English, C. L., & Newby, J. M. (2018) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2018.01.001 · Cited by 922 · see citing works
Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers, M. B., Smits, J. A. J., & Hofmann, S. G. (2018) · Depression and Anxiety · doi:10.1002/da.22728 · Cited by 846 · cited 2× · see citing works
“The efficacy of cognitive behavioral therapy (CBT) for the treatment of GAD is well established, with large effect sizes (g = 1.01) found in recent meta‐analyses (Carpenter et al., 2018).”
BackgroundResultInfluentialEfficacy of the third wave of behavioral therapies: A systematic review and meta- analysis
Öst, L.-G. (2008) · Behaviour Research and Therapy · doi:10.1016/j.brat.2007.12.005 · Cited by 727 · see citing works
A Nonparametric "Trim and Fill" Method of Accounting for Publication Bias in Meta-Analysis
Duval, S., & Tweedie, R. L. (2000) · Journal of the American Statistical Association · doi:10.2307/2669529 · Cited by 694 · see citing works
Ruscio, A. M., Hallion, L. S., Lim, C. C. W., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Andrade, L. H., Borges, G., Bromet, E. J., Bunting, B., et al. (2017) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2017.0056 · Cited by 492 · see citing works
Selecting Studies and Collecting Data
Higgins, J. P., & Deeks, J. J. (2008) · Cochrane Handbook for Systematic Reviews of Interventions · doi:10.1002/9780470712184.ch7 · Cited by 467 · see citing works
Dear, B. F., Titov, N., Sunderland, M., McMillan, D., Anderson, T., Lorian, C., & Robinson, E. (2011) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2011.582138 · Cited by 282 · see citing works
Robinson, E., Titov, N., Andrews, G., McIntyre, K., Schwencke, G., & Solley, K. (2010) · PLoS ONE · doi:10.1371/journal.pone.0010942 · Cited by 277 · see citing works
Varker, T., Brand, R. M., Ward, J., Terhaag, S., & Phelps, A. (2019) · Psychological Services · doi:10.1037/ser0000239 · Cited by 261 · see citing works
Economic Burden of Anxiety Disorders: A Systematic Review and Meta-Analysis
Konnopka, A., & König, H. (2020) · PharmacoEconomics · doi:10.1007/s40273-019-00849-7 · Cited by 259 · see citing works
Dear, B. F., Staples, L. G., Terides, M. D., Karin, E., Zou, J., Johnston, L., Gandy, M., Fogliati, V. J., Wootton, B. M., McEvoy, P. M., et al. (2015) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2015.09.003 · Cited by 230 · see citing works
Self-citationAndersson, G., Paxling, B., Roch-Norlund, P., Östman, G., Norgren, A., Almlöv, J., Georén, L., Breitholtz, E., Dahlin, M., Cuijpers, P. J., et al. (2012) · Psychotherapy and Psychosomatics · doi:10.1159/000339371 · Cited by 181 · see citing works
Remote cognitive-behavior therapy for obsessive-compulsive symptoms: A meta-analysis.
Wootton, B. M. (2016) · Clinical Psychology Review · doi:10.1016/j.cpr.2015.10.001 · Cited by 162 · see citing works
Self-citationPaxling, B., Almlöv, J., Dahlin, M., Carlbring, P., Breitholtz, E., Eriksson, T., & Andersson, G. (2011) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2011.576699 · Cited by 147 · see citing works
Titov, N., Andrews, G., Robinson, E., Schwencke, G., Johnston, L., Solley, K., & Choi, I. (2009) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/00048670903179269 · Cited by 147 · see citing works
Brenes, G. A., Danhauer, S. C., Lyles, M. F., Hogan, P. E., & Miller, M. E. (2015) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2015.1154 · Cited by 143 · see citing works
Videoconferencing psychological therapy and anxiety: a systematic review
Berryhill, M. B., Halli-Tierney, A., Culmer, N., Williams, N., Betancourt, A., King, M., & Ruggles, H. (2019) · Family Practice · doi:10.1093/fampra/cmy072 · Cited by 143 · see citing works
Anxiety Management for Persistent Generalised Anxiety
Butler, G., Cullington, A., Hibbert, G. A., Klimeš, I., & Gelder, M. (1987) · The British Journal of Psychiatry · doi:10.1192/bjp.151.4.535 · Cited by 130 · see citing works
A Systematic Review of Videoconference‐Delivered Psychological Treatment for Anxiety Disorders
Rees, C. S., & Maclaine, E. (2015) · Australian Psychologist · doi:10.1111/ap.12122 · Cited by 115 · see citing works
Richards, D., Richardson, T., Timulak, L., & McElvaney, J. (2015) · Internet Interventions · doi:10.1016/j.invent.2015.07.003 · Cited by 111 · cited 4× · see citing works
“Results are also consistent with other reviews in the field that have explored low intensity remote CBT for GAD (e.g., Andrews et al., 2018; Richards et al., 2015) and high intensity remote treatment for other anxiety disorders (e.g., Rees & Maclaine, 2015; Varker et al., 2019).”
BackgroundResultInfluentialGoetter, E. M., Frumkin, M. R., Palitz, S. A., Swee, M. B., Baker, A. W., Bui, E., & Simon, N. M. (2020) · Psychological Services · doi:10.1037/ser0000254 · Cited by 101 · see citing works
Carl, J. R., Miller, C. B., Henry, A. L., Davis, M. L., Stott, R., Smits, J. A. J., Emsley, R., Gu, J., Shin, O., Otto, M. W., et al. (2020) · Depression and Anxiety · doi:10.1002/da.23079 · Cited by 86 · see citing works
Hadjistavropoulos, H. D., Pugh, N. E., Nugent, M., Hesser, H., Andersson, G., Ivanov, M., Butz, C. G., Marchildon, G. P., Asmundson, G. J. G., Klein, B., et al. (2014) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2014.09.018 · Cited by 60 · see citing works
Do Patients Prefer Face-to-Face or Internet-Based Therapy?
Berle, D., Starčević, V., Milicevic, D., Hannan, A., Dale, E., Brakoulias, V., & Viswasam, K. (2014) · Psychotherapy and Psychosomatics · doi:10.1159/000367944 · Cited by 41 · see citing works
Miller, C. B., Gu, J., Henry, A. L., Davis, M. L., Espie, C. A., Stott, R., Heinz, A. J., Bentley, K. H., Goodwin, G. M., Gorman, B. S., et al. (2021) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2020.101609 · Cited by 40 · see citing works
Remote cognitive behavioral therapy for panic disorder: A meta-analysis.
Efron, G., & Wootton, B. (2021) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2021.102385 · Cited by 27 · see citing works
Self-citationThéberge-Lapointe, N., Marchand, A., Langlois, F., Gosselin, P., & Watts, S. (2015) · European Review of Applied Psychology · doi:10.1016/j.erap.2014.10.001 · Cited by 24 · see citing works
Hoge, E. A., Oppenheimer, J. E., & Simon, N. M. (2004) · Focus · doi:10.1176/foc.2.3.346 · Cited by 19 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Prevalence of body dysmorphic disorder: A systematic review and meta-analysis
McGrath, L. R., Oey, L. T., McDonald, S., Berle, D., & Wootton, B. M. (2023) · Body Image · doi:10.1016/j.bodyim.2023.06.008 · Cited by 69 · see citing works
Self-citationTele-Neuropsychology: From Science to Policy to Practice
Sperling, S. A., Acheson, S. K., Fox‐Fuller, J. T., Colvin, M. K., Harder, L., Cullum, C. M., Randolph, J. J., Carter, K. R., Espe‐Pfeifer, P., Lacritz, L. H., et al. (2023) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acad066 · Cited by 34 · see citing works
Oey, L. T., McDonald, S., McGrath, L., Dear, B. F., & Wootton, B. M. (2023) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2023.2250073 · Cited by 22 · see citing works
Self-citationRemote cognitive behaviour therapy for social anxiety disorder: A meta-analysis
Winter, H. R., Norton, A. R., Burley, J., & Wootton, B. M. (2023) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2023.102787 · Cited by 22 · see citing works
Self-citationBasile, V. T., Newton‐John, T., & Wootton, B. M. (2024) · Journal of Clinical Psychology · doi:10.1002/jclp.23665 · Cited by 15 · see citing works
Self-citationLiu, S., Xiao, H., Duan, Y., Shi, L., Wang, P., Cao, L., Li, H., Huang, X., & Qiu, C. (2025) · Translational Psychiatry · doi:10.1038/s41398-025-03414-3 · Cited by 7 · see citing works
Wu, J., Tsai, Y.-Y., Chen, Y.-J., Hsiao, F., Hsu, C., Lin, K., & Liao, L. (2024) · Medical & Biological Engineering & Computing · doi:10.1007/s11517-024-03209-6 · Cited by 9 · see citing works
Bioengineering an AI-augmented platform for remote mental health interventions
Wu, J., Chen, Y.-J., Lin, K., Ching, C. T., Wang, H., Chen, Y., Juan, Y.-C., & Liao, L. (2025) · Results in Engineering · doi:10.1016/j.rineng.2025.105931 · Cited by 5 · see citing works
Basile, V. T., Newton-John, T., McDonald, S., & Wootton, B. M. (2024) · British Journal of Clinical Psychology · doi:10.1111/bjc.12482 · Cited by 4 · see citing works
Self-citationJi, N., Lu, S., Xu, B., Guan, X., Xian, Z., Geng, D., & Gao, D. (2025) · Neurological Sciences · doi:10.1007/s10072-025-07988-0 · Cited by 3 · see citing works
Psychological rehabilitation: cognitive behavioral therapy
Солохина, Т. А., & Михайловна, Л. Е. (2025) · Реабилитология. · doi:10.17749/2949-5873/rehabil.2024.27 · Cited by 3 · see citing works
Trenoska Basile, V., Newton-John, T., & Wootton, B. M. (2022) · Trials · doi:10.1186/s13063-022-06520-5 · Cited by 2 · see citing works
“While low-intensity remote treatments have been demonstrated to be efficacious in the treatment of GAD, with several studies demonstrating medium to large pooled effects across studies [2, 43], there is limited evidence examining high-intensity remote treatments for this condition [50].”
BackgroundSelf-citationBrief remote cognitive behaviour therapy for generalized anxiety disorder: An open trial
Basile, V. T., Newton-John, T. R. O., McDonald, S., & Wootton, B. M. (2024) · British Journal of Clinical Psychology · doi:10.1111/bjc.12516 · Cited by 2 · see citing works
Self-citationPeptidomics analysis of serum in patients suffered from generalized anxiety disorder
Zhang, J., Dong, S., Li, W., Wang, X., Jing, X., Zhang, Y., & Guo, X. (2025) · Scientific Reports · doi:10.1038/s41598-025-32707-2 · Cited by 2 · see citing works
Uma análise dos transtornos de ansiedade: ansiedade generalizada, pânico e ansiedade social
Silva, V. M., de Sousa, M. R., & Neto, C. M. (2023) · Revista Eletrônica Acervo Médico · doi:10.25248/reamed.e13531.2023 · Cited by 2 · see citing works
Dunn, I. B. J. M. D., Power, E., Casey, L. J., & Wootton, B. M. (2025) · PLoS ONE · doi:10.1371/journal.pone.0316857 · Cited by 1 · see citing works
Self-citationExercise and Psychotherapy in the Treatment of Anxiety Disorders
Loomes, M., & Rosenbaum, S. (2023) · Advances in psychology, mental health, and behavioral studies (APMHBS) book series · doi:10.4018/978-1-6684-6040-5.ch001 · Cited by 1 · see citing works
Ardi, Z., Eseadi, C., Yuniarti, E., Yendi, F. M., & Murni, A. W. (2024) · Universal Journal of Public Health · doi:10.13189/ujph.2024.120101 · Cited by 1 · see citing works
Cognitive Behavioral Treatment of Anxiety in Children and Adolescents with ASD
Lincoln, A. J., Bales, S., Woolard, A., & Pryor, F. C. (2022) · IntechOpen eBooks · doi:10.5772/intechopen.108223 · Cited by 1 · see citing works
Staccini, L., Cavadini, D., Gravagnuolo, R., Olivetti, E., Bongiovanni, C., Calati, R., Madeddu, F., Mandelli, L., & Porcelli, S. (2023) · QUADERNI DI PSICOTERAPIA COGNITIVA · doi:10.3280/qpc53-2023oa16934
Janapureddy, R., Koffler, Y., Chew, J., Frings, D., & Gummuluri, K. S. (2024) · doi:10.2196/preprints.56647
Janapureddy, R., Koffler, Y., Chew, J., Frings, D., & Gummuluri, K. S. (2024) · doi:10.2196/preprints.57993
Cognitive behavioural therapists’ experiences of working remotely with language interpreters
Wardman-Browne, J., McPherson, S., & Phillips, C. (2025) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x25100238
The Cognitive-Behavioral Approach in Teletherapy
Manara, K. M., Berticelli, L. Z., Portalino, E. A., & Trentini, C. M. (2026) · Springer eBooks · doi:10.1007/978-3-032-08980-9_5
Teletherapy for the Treatment of Anxiety Disorders
Portalino, E. A., Manara, K. M., Berticelli, L. Z., Cataldo, Q. F., & Trentini, C. M. (2026) · Springer eBooks · doi:10.1007/978-3-032-08980-9_14
Mohamadpour, F., & Askarian, M. (2026) · Health Psychology and Behavioral Medicine · doi:10.1080/21642850.2026.2716444
Liao, G.-J., Li, J., & Liu, S.-Z. (2026) · Pharmacology, Biochemistry and Behavior · doi:10.1016/j.pbb.2026.174269
Telehealth Treatment of Anxiety in Patients With Low-Risk Chest Pain in the Emergency Department
Musey, P. I., Kroenke, K., Connors, J. D. N., Stump, T. E., Chernyak, Y., Prather, K., Montgomery, C., & Monahan, P. O. (2026) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2026.4225
- Authors
- Trenoska Basile, V., Newton‐John, T., & Wootton, B. M.
- Affiliations
- Discipline of Clinical Psychology, Graduate School of Health University of Technology Sydney Ultimo New South Wales Australia
- University of Technology Sydney (AU)
- Corresponding author
- Wootton, Bethany M.
- Venue
- Journal of Clinical Psychology
- Publisher
- Wiley
- Published
- 2022-04-11
- Volume
- 78
- Issue
- 12
- Pages
- 2381-2395
- ISSN
- 0021-9762 (ISSN-L)
- 1097-4679
- PMC
- PMC9790363
- OpenAlex
- W4223455797
- Cited by
- 28
- References
- 36
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 7 · 2023: 7 · 2022: 2
- FWCI
- 1.02
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Clinical Psychology (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- generalized anxiety disorder, telemedicine, treatment efficacy, stepped care, low-intensity intervention
- MeSH terms
- Anxiety, Anxiety Disorders, Humans, Cognitive Behavioral Therapy, Treatment Outcome
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