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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
Open accessAbstract
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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Cites
Quantifying heterogeneity in a meta‐analysis
Higgins, J. P. T., & Thompson, S. G. (2002) · Statistics in Medicine · doi:10.1002/sim.1186 · Cited by 36,763
Carlbring, P., Andersson, G., Cuijpers, P., Riper, H., & Hedman-Lagerlöf, E. (2018) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2017.1401115 · Cited by 1,232
Self-citationAndersson, G., Cuijpers, P., Carlbring, P., Riper, H., & Hedman, E. (2014) · World Psychiatry · doi:10.1002/wps.20151 · Cited by 1,077
Self-citationInternet-Delivered Psychological Treatments
Andersson, G. (2016) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-021815-093006 · Cited by 595
Self-citationCuijpers, P., Noma, H., Karyotaki, E., Cipriani, A., & Furukawa, T. A. (2019) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2019.0268 · Cited by 539
Self-citationDepression in adults: recognition and management
(2017) · Clinical pharmacist · doi:10.1211/cp.2017.20202439 · Cited by 396
Treatment of panic disorder: live therapy vs. self-help via the Internet
Carlbring, P., Nilsson-Ihrfelt, E., Waara, J., Kollenstam, C., Buhrman, M., Kaldo, V., Söderberg, M., Ekselius, L., & Andersson, G. (2005) · Behaviour Research and Therapy · doi:10.1016/j.brat.2004.10.002 · Cited by 372
Self-citationStein, D. J., Shoptaw, S. J., Vigo, D. V., Lund, C., Cuijpers, P., Bantjes, J., Sartorius, N., & Maj, M. (2022) · World Psychiatry · doi:10.1002/wps.20998 · Cited by 331
Self-citationWagner, B., Horn, A. B., & Maercker, A. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.06.032 · Cited by 311
SPEK, V., NYKLÍČEK, I., SMITS, N., CUIJPERS, P., RIPER, H., KEYZER, J., & POP, V. (2007) · Psychological Medicine · doi:10.1017/s0033291707000542 · Cited by 307
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Research works printed but not linked: 2
- National Institute for Health and Care Excellence, 2011, Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults
- Higgins JPT, 2011, Cochrane handbook for systematic reviews of interventions. Version 5.1.0
Cited by
Sorted by citations
Linardon, J., Torous, J. B., Firth, J., Cuijpers, P. J., Messer, M., & Fuller‐Tyszkiewicz, M. (2024) · World Psychiatry · doi:10.1002/wps.21183 · Cited by 260
“Empirically validated components of psychological interventions that were once delivered solely in-person have now been translated for delivery via low-cost, private and scalable digital tools 10,11 .”
MethodSelf-citationDigital interventions in mental health: An overview and future perspectives
Löchner, J., Carlbring, P., Schuller, B. W., Torous, J. B., & Sander, L. (2025) · Internet Interventions · doi:10.1016/j.invent.2025.100824 · Cited by 182
“…meta-analyses have been conducted, particularly of iCBT (internet-based cognitive behavioural therapy) and self-help interventions, which have shown the equivalence of face-to-face therapies (Andersson et al., 2014; Hedman-Lagerl ¨ of et al., 2023; Cuijpers et al., 2019; Hennemann et al., 2018).”
Self-citationA new era in Internet interventions: The advent of Chat-GPT and AI-assisted therapist guidance
Carlbring, P., Hadjistavropoulos, H. D., Kleiboer, A. M., & Andersson, G. (2023) · Internet Interventions · doi:10.1016/j.invent.2023.100621 · Cited by 140
Self-citationDigital mental health interventions for the treatment of depression: A multiverse meta-analysis
Plessen, C. Y., Panagiotopoulou, O. M., Tong, L., Cuijpers, P., & Karyotaki, E. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.10.018 · Cited by 53
Self-citationThe Artificial Third: Utilizing ChatGPT in Mental Health
Tal, A., Elyoseph, Z., Haber, Y., Angert, T., Gur, T., Simon, T., & Asman, O. (2023) · The American Journal of Bioethics · doi:10.1080/15265161.2023.2250297 · Cited by 47
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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