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Therapist-supported internet-based cognitive behaviour therapy yields similar effects as face-to-face therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis
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Providing therapist-guided cognitive behaviour therapy via the Internet (ICBT) has advantages, but a central research question is to what extent similar clinical effects can be obtained as with gold-standard face-to-face cognitive behaviour therapy (CBT). In a previous meta-analysis published in this journal, which was updated in 2018, we found evidence that the pooled effects for the two formats were equivalent in the treatment of psychiatric and somatic disorders, but the number of published randomized trials was relatively low (n=20). As this is a field that moves rapidly, the aim of the current study was to conduct an update of our systematic review and meta-analysis of the clinical effects of ICBT vs. face-to-face CBT for psychiatric and somatic disorders in adults. We searched the PubMed database for relevant studies published from 2016 to 2022. The main inclusion criteria were that studies had to compare ICBT to face-to-face CBT using a randomized controlled design and targeting adult populations. Quality assessment was made using the Cochrane risk of bias criteria (Version 1), and the main outcome estimate was the pooled standardized effect size (Hedges' g) using a random effects model. We screened 5,601 records and included 11 new randomized trials, adding them to the 20 previously identified ones (total n=31). Sixteen different clinical conditions were targeted in the included studies. Half of the trials were in the fields of depression/depressive symptoms or some form of anxiety disorder. The pooled effect size across all disorders was g=0.02 (95% CI: -0.09 to 0.14) and the quality of the included studies was acceptable. This meta-analysis further supports the notion that therapist-supported ICBT yields similar effects as face-to-face CBT.
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“over the past two decades, diagnosis-specific internet interventions have been thoroughly investigated, with moderate to large effects [9].”
From Transdiagnostic and tailored internet intervention to improve mental health among university students: Research protocol for a randomized controlled trial (2024) · cites this paper as [9]
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“Meta-analytic studies have shown that there are no differences between online and face-to-face CBT (Hedman-Lagerlöf et al., 2023).”
From Feasibility, acceptability, and preliminary efficacy of a blended transdiagnostic group CBT for the treatment of emotional disorders (2025) · cites this paper as Hedman-Lagerlöf et al., 2023
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“One way to lower the threshold for access to such treatment is to offer internet interventions, which have shown treatment effects for CBT that are equivalent to face-to-face treatment for diagnosis-specific depression, anxiety, and a variety of other conditions [9].”
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“Therapist‐guided internet‐based CBT (ICBT) has demonstrated effects comparable to traditional face‐to‐face CBT, including for PD (Hedman‐Lagerlöf et al. 2023; Pauley et al. 2023).”
From Internet‐Based Acceptance and Commitment Therapy With Interoceptive Exposure for Panic Disorder: A Randomized Controlled Trial and Working Alliance Analysis. (2026) · cites this paper as Hedman‐Lagerlöf et al. 2023
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Self-citationA new era in Internet interventions: The advent of Chat-GPT and AI-assisted therapist guidance
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Self-citationBeyond the Heart: The Significance of Depression in Cardiac Surgery
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“…ICBT produces outcomes equivalent to face-to-face cognitive behaviour therapy (CBT) for a range of psychiatric and somatic conditions (Hedman-Lagerl ¨ of et al., 2023), with additional advantages in cost-effectiveness (K ¨ ahlke et al., 2022), accessibility, and scalability (Vernmark…”
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Sennerstam, V., Föyen, L. F., Kontio, E., Svärdman, F., Lekander, M., Lindsäter, E., & Hedman‐Lagerlöf, E. (2025) · Psychotherapy and Psychosomatics · doi:10.1159/000546221 · Cited by 7
“Both treatments were delivered online, a well-researched administration format that typically yields clinical effects on par with face-to-face CBT [20].”
Self-citationEimontas, J., Medeišienė, J., Baranova, K., Biliūnaitė, I., Pakalniškienė, V., Zrumaitė, S., Hilbig, J., & Andersson, G. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119406 · Cited by 8
Self-citationvan Lotringen, C. M., ten Klooster, P. M., Austin, J., Westerhof, G. J., Kelders, S. M., & Noordzij, M. L. (2024) · BMC Digital Health · doi:10.1186/s44247-024-00132-6 · Cited by 8
Fi, B., Sumin, A. N., Garganeeva, N. P., Ларева, Н. В., Петрова, М. М., Петрунько, О. В., Попонина, Т. М., Repin, A. N., & Собенников, В. С. (2024) · Complex Issues of Cardiovascular Diseases · doi:10.17802/2306-1278-2024-13-3s-222-253 · Cited by 8
Nævdal, R., Vis, C., & Kenter, R. M. F. (2025) · Internet Interventions · doi:10.1016/j.invent.2025.100881 · Cited by 6
Bjarke, J., Gjestad, R., & Nordgreen, T. (2025) · JMIR Mental Health · doi:10.2196/68165 · Cited by 7
“Systematic reviews have found the effect of guided ICBT for depression and anxiety disorders to be no different from that of face-to-face CBT [17-19].”
de la Vega, R., Bartels, S. L., & Wicksell, R. (2024) · European Journal of Pain · doi:10.1002/ejp.2262 · Cited by 6
Wall, H., Hansson, H., Zetterlind, U., Kvillemo, P., & Elgán, T. H. (2024) · Journal of Medical Internet Research · doi:10.2196/52118 · Cited by 7
“A recent review by Hedman-Lagerlöf et al [30] concluded that therapist-supported internet-based cognitive behavioral therapy for adults yielded similar effects as face-to-face therapy.”
Hoppe, J. M., Weise, C., Kleinstäuber, M., Skalkidou, A., Vegelius, J. R., Comasco, E., Gröndal, M., Kaltsouni, E., Sundström, F., Sampaio, F., et al. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-091649 · Cited by 10
“48 Indeed, recent years have seen the development of ICBT for premenstrual syndromes with promising results.”
Self-citationSemonella, M., Marchesi, G., Andersson, G., Dekel, R., Pietrabissa, G., & Vilchinsky, N. (2024) · Digital Health · doi:10.1177/20552076231225082 · Cited by 8
“14,15 Hence, such interventions provide a solution that might be complementary, or even an alternative, to face-to-face treatment.”
Self-citationValidation of the Italian Version of the Web Screening Questionnaire for Common Mental Disorders
Pietrabissa, G., Semonella, M., Marchesi, G., Mannarini, S., Castelnuovo, G., Andersson, G., & Rossi, A. A. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13041170 · Cited by 6
Self-citationKrause, N., Derad, C., von Glasenapp, B., Riemann-Lorenz, K., Meyer, B., Asendorf, T., Temmes, H., van de Loo, M., Gold, S., Schubert, C., et al. (2025) · Multiple Sclerosis · doi:10.1177/13524585251356410 · Cited by 6
“41 The multiple behaviour change intervention may have had differential physiological effects based on the chosen domain of behaviour change.”
Witte, N. A. J. D., Best, P., Torous, J. B., Mulvenna, M. D., Assche, E. V., Mathiasen, K., Kleiboer, A. M., Carlbring, P., & Daele, T. V. (2026) · Internet Interventions · doi:10.1016/j.invent.2026.100927 · Cited by 6
Self-citationHlynsson, J. I., Mechler, J., Lindqvist, K., Andersson, G., & Carlbring, P. (2026) · Internet Interventions · doi:10.1016/j.invent.2026.100960 · Cited by 6
Self-citationReinebo, G., Gustafsson-Björverud, L., Parling, T., Andersson, G., Jansson‐Fröjmark, M., & Lundgren, T. (2024) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2024.1297631 · Cited by 5
Self-citationBeck, C. D., Peynenburg, V. A., Patterson, T., Titov, N., Dear, B. F., & Hadjistavropoulos, H. D. (2024) · Internet Interventions · doi:10.1016/j.invent.2024.100709 · Cited by 5
“ICBT is known to be effective for treating a variety of mental health disorders (Andersson et al., 2019; Hedman-Lagerl ¨ of et al., 2023), with increasing reports of therapist-assisted ICBT being available as part of routine care in various parts of the world (Etzelmueller et al., 2020).”
BackgroundAlbor, Y., González, N., Benjet, C. L., Salamanca-Sanabria, A., la Rosa, C. H.-D., Eslava-Torres, V. G., García-Alfaro, M. C., Melchor-Audirac, A., Montoya-Montero, L. I., & Suárez, K. (2024) · JMIR Formative Research · doi:10.2196/63298 · Cited by 7
“Digital interventions for mental health are proliferating especially in the high-income English-speaking countries with results that show comparable results to face to face interventions [37] at lower costs and greater reach.”
(2025) · doi:10.2196/67171 · Cited by 5
“…behavioral therapy (iCBT), has rapidly grown over the past 2 decades [1]. iCBT interventions have shown to be effective in reducing symptoms of depression [2] and anxiety [3,4], with outcomes comparable with traditional face-to-face CBT when professional guidance is included as a component [5,6].”
Hlynsson, J. I., Bergström, J., & Carlbring, P. (2025) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2025.100967 · Cited by 3
Self-citationStaples, L., Dear, B. F., Nielssen, O. B., & Titov, N. (2025) · Internet Interventions · doi:10.1016/j.invent.2025.100865 · Cited by 4
“…via the internet or by telephone is effective, acceptable to patients, and can be successfully delivered to very large numbers of patients as part of routine care (Etzelmueller et al., 2020; Hadjistavropoulos et al., 2014; Hedman-Lagerl ¨ of et al., 2023; Staples et al., 2022; Titov et al., 2020).”
Sextl-Plötz, T., Titzler, I., Schmidt-Hantke, J., Denninger, M., Steubl, L., Baumeister, H., Ebert, D. D., & Zarski, A. (2025) · Digital Health · doi:10.1177/20552076251377943 · Cited by 4
“12 Both approaches, however, have their respective limitations, such as dependency on time and location for FTF interventions, and lack of personal contact and overemphasis on self-help in IMIs.”
Hadjistavropoulos, H. D., Peynenburg, V. A., Sapkota, R. P., Titov, N., & Dear, B. F. (2024) · Internet Interventions · doi:10.1016/j.invent.2024.100758 · Cited by 4
Benjet, C. L., Zainal, N. H., Albor, Y., Alvis–Barranco, L., Tapias, N. E. C., Contreras‐Ibáñez, C. C., Morelos, J. C., Cudris–Torres, L., de la Peña, F. R., González, N., et al. (2025) · JMIR Mental Health · doi:10.2196/64251 · Cited by 4
Self-citationSapkota, R. P., Gretton, A., Wilhelms, A., Bisby, M. A., Dear, B. F., Titov, N., & Hadjistavropoulos, H. D. (2025) · Internet Interventions · doi:10.1016/j.invent.2025.100852 · Cited by 4
Chandra, S. S., Bisby, M. A., Scott, A. J., Titov, N., & Dear, B. F. (2025) · Pain · doi:10.1097/j.pain.0000000000003784 · Cited by 5
Unveiling the enigma of anxiety disorders and depression: from pathogenesis to treatment
Pan, H., Xia, T., Zhang, Y., Zhang, H., Xu, M., Guo, J., Liu, Y., Bai, X.-Y., Liu, Q., Liu, W.-Z., et al. (2025) · Science China Life Sciences · doi:10.1007/s11427-025-3024-y · Cited by 5
Sapkota, R. P., Peynenburg, V. A., Dear, B. F., Titov, N., & Hadjistavropoulos, H. D. (2025) · SSM - Mental Health · doi:10.1016/j.ssmmh.2025.100561 · Cited by 4
Vernmark, K., Hursti, T. J., Blom, V., Asplund, R. P., Nathanson, E., Engelro, L., Radvogin, E., & Andersson, G. (2024) · Clinical Psychology in Europe · doi:10.32872/cpe.12899 · Cited by 4
“The effects are long-lasting (Andersson et al., 2018) and similar to face-to-face treatment (Hedman‐Lagerlöf et al., 2023).”
Self-citationGeležėlytė, O., Guogaitė, G., Nomeikaitė, A., Bisson, J. I., Lewis, C., & Kazlauskas, E. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-06097-0 · Cited by 5
“In a meta-analysis Hedman-Lagerlöf et al. [9] found that therapist-sup-ported ICBT for psychiatric and somatic disorders yielded similar effects as face-to-face CBT.”
MethodWüllner, S., Hecker, T., Flottmann, P., & Hermenau, K. (2025) · PLOS mental health. · doi:10.1371/journal.pmen.0000270 · Cited by 3
Fisher, A. C., Bisby, M. A., Hathway, T., Rezwan, A., Ayre, J., Muscat, D. M., Titov, N., & Dear, B. F. (2025) · Advances in Mental Health · doi:10.1080/18387357.2025.2536801 · Cited by 4
Jiménez-Orenga, N., Díaz-García, A., Lorente-Català, R., González-Robles, A., Paredes-Mealla, M., García-Palacios, A., & Bretón-López, J. (2025) · Internet Interventions · doi:10.1016/j.invent.2025.100823 · Cited by 3
Semonella, M., Marchesi, G., Castelnuovo, G., Andersson, G., & Pietrabissa, G. (2024) · Digital Health · doi:10.1177/20552076241258419 · Cited by 4
Self-citationTrillingsgaard, T., Hansen, F. G., & Fentz, H. N. (2025) · Journal of Marital and Family Therapy · doi:10.1111/jmft.12762 · Cited by 3
Thiblin, E., Lundgren, J., Bergqvist, M., Huynh, T. N. T., Reuther, C., Rösler, S., Woodford, J., & von Essén, L. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06897-y · Cited by 3
“However, guided iCBT interventions for psychiatric and somatic disorders in adults show overall equivalent effect sizes as face-to-face therapy [77], and a high level of patient-therapist alliance is reported in iCBT interventions for depression and anxiety disorders in adults [78, 79].”
Hlynsson, J. I., Kristjánsson, T., Andersson, G., & Carlbring, P. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1568141 · Cited by 3
Self-citationDemetry, Y., Lindegaard, T., Geranmayeh, A., Amiri, M. A., Wasteson, E., Andersson, G., & Shahnavaz, S. (2026) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2026.100576 · Cited by 3
“…has accumulated evidence for its efficacy in its traditional format (Cuijpers et al., 2013) and its internet-based format (Andersson et al., 2019; Hedman-Lagerl ¨ of et al., 2023), the evidence is mostly based on Western, Educated, Industrialized, Rich, and Democratic (WEIRD) participants…”
Self-citationHlynsson, J. I., Gustafsson, O., & Carlbring, P. (2024) · Clinical Psychology in Europe · doi:10.32872/cpe.12083 · Cited by 3
“For the eight instances when data was provided, a Fisher's exact test comparing the propensity for data being differentially missing between the first four and latter four instances revealed non-significant differences for both the PHQ-9 ( p = .168) and GAD-7 ( p = .204).”
MethodSelf-citation
Metadata
- Authors
- Hedman‐Lagerlöf, E., Carlbring, P., Svärdman, F., Riper, H., Cuijpers, P., & Andersson, G.
- Affiliations
- Karolinska Institutet (SE)
- Stockholm University (SE)
- Amsterdam Public Health (NL)
- Vrije Universiteit Amsterdam (NL)
- Linköping University (SE)
- Venue
- World Psychiatry
- Publisher
- Wiley
- Published
- 2023-05-09
- Volume
- 22
- Issue
- 2
- Pages
- 305-314
- ISSN
- 1723-8617 (ISSN-L)
- 2051-5545
- PMC
- PMC10168168
- OpenAlex
- W4376133551
- Cited by
- 259
- References
- 45
- Citations by year
- 2026: 82 · 2025: 86 · 2024: 58 · 2023: 32
- FWCI
- 8.76
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- World Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (publishedVersion, other-oa)
- Funders
- Yale University
- 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
- internet-based cognitive behavioral therapy, digital mental health interventions, depression, anxiety disorders, somatic diseases, treatment efficacy comparison, adults
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