Effectiveness of cognitive behavioural self-help for the treatment of depression and anxiety in people with long-term physical health conditions: a systematic review and meta-analysis of randomised controlled trials
Abstract
BACKGROUND: Depression and anxiety are prevalent comorbidities in people with long-term physical health conditions; however, there is limited access to evidence-based treatments for comorbid mental health difficulties. PURPOSE: This study is a meta-analysis examining the effectiveness of cognitive behavioural self-help for physical symptoms, depression and anxiety in people with long-term conditions. METHODS: This study involves a systematic search of electronic databases supplemented by expert contact, reference and citation checking and grey literature. RESULTS: The meta-analysis yielded a small effect size for 11 studies reporting primary outcomes of depression (g = -0.20) and 8 studies anxiety (g = -0.21) with a large effect size (g = -1.14) for 1 study examining physical health symptoms. There were no significant moderators of the main effect. CONCLUSIONS: Limited evidence supports cognitive behavioural self-help for depression, anxiety and physical symptoms in people with long-term conditions. Small effect sizes for depression and anxiety may result from failure to recruit participants with clinical levels of these difficulties at baseline.
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Each risk-of-bias area will be scored 0, 1 or 2, yielding a possible total score of 12, with ratings defined as high (9-12), unclear (4-8) or low risk (0-3).
“Consistent with a previous meta-analysis,81 in order to include quality as a moderator each area addressing risk of bias will be given a score of 0, 1 or 2, indicating bias based on the Risk of Bias tool 2.0,77 yielding a possible total score of 12. The ratings will be defined as high (9–12), unclear (4–8) or low risk (0–3), respectively.”
From Effectiveness and acceptability of cognitive-behavioural therapy based interventions for maternal peripartum depression: A systematic review, meta-analysis and thematic synthesis protocol (2019) · cites this paper as [81]
The “Risk of Bias Within and Across Individual Studies” section supports scoring each area 0, 1 or 2 to include quality as a moderator. It reports a possible total of 16, not 12, and classifies scores of 0–5 as high risk, 6–10 as unclear and 11 or above as low risk—not the claimed ranges. (LLM, conf=0.90)
Experimental — accuracy not yet measuredMost existing ICBT programmes are developed for mental health populations, and smaller effect sizes have been shown for people with physical health conditions than for mental health populations.
“However, most of the existing ICBT programmes are developed for mental health populations, and smaller effect sizes have been shown for people with physical health conditions than for mental health populations.27”
From Guided internet-administered self-help to reduce symptoms of anxiety and depression among adolescents and young adults diagnosed with cancer during adolescence (U-CARE: YoungCan): a study protocol for a feasibility trial (2017) · cites this paper as [27]
The Discussion (page unavailable) reports smaller effect sizes for CBT self-help in people with long-term physical conditions than previous reviews reported for mental health populations. The paper examines both written and Internet-based CBT self-help, however, and does not establish that most existing Internet-based CBT programmes were developed for mental health populations or that the comparison applies specifically to Internet-based programmes. (LLM, conf=0.86)
Experimental — accuracy not yet measuredExcluding high risk of bias RCTs is a technique used in previous systematic reviews and meta-analyses.
“and is a technique used in previous systematic reviews and meta-analyses.80–82”
iCBT has small to large effect sizes on depression (g = −.20), anxiety symptoms (g = −.21), and physical health symptoms (g = −1.14) within adults with somatic conditions.
“Another meta-analysis reported small to large effect sizes of iCBT on depression (g = −.20), anxiety symptoms (g = −.21), and physical health symptoms (g = − 1.14) within adults with somatic conditions [36].”
From Effectiveness and cost-effectiveness of guided Internet- and mobile-based CBT for adolescents and young adults with chronic somatic conditions and comorbid depression and anxiety symptoms (youthCOACHCD): study protocol for a multicentre randomized controlled trial (2020) · cites this paper as [36]
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Pettman, D., O’Mahen, H., Blomberg, O., Svanberg, A. S., von Essen, L., & Woodford, J. (2024) · Figshare · doi:10.6084/m9.figshare.26578820
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Pettman, D., O’Mahen, H., Blomberg, O., Svanberg, A. S., von Essen, L., & Woodford, J. (2024) · Figshare · doi:10.6084/m9.figshare.26578850
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- Authors
- Farrand, P., & Woodford, J.
- Affiliations
- University of Exeter (GB)
- Corresponding author
- Farrand, Paul
- Woodford, Joanne
- Venue
- Annals of Behavioral Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-02-18
- Volume
- 49
- Issue
- 4
- Pages
- 579-593
- ISSN
- 0742-5554 (ISSN-L)
- 0883-6612
- 1532-4796
- OpenAlex
- W2066228128
- Cited by
- 45
- References
- 83
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 16 · 2023: 2 · 2022: 3 · 2021: 4 · 2020: 6 · 2019: 5 · 2018: 1 · 2017: 1 · 2016: 3
- FWCI
- 0.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Behavioral Medicine (publishedVersion)
- 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
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- depression, anxiety, long-term physical health conditions, chronic physical illness, psychiatric comorbidity, somatic symptoms, treatment effectiveness
- MeSH terms
- Anxiety, Chronic Disease, Depression, Humans, Self Care, Cognitive Behavioral Therapy
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