Computerised therapies for anxiety and depression in children and young people: A systematic review and meta-analysis

Pennant, Mary E.; Loucas, Christina E.; Whittington, Craig; Creswell, Cathy; Fonagy, Peter; Fuggle, Peter; Kelvin, Raphael; Naqvi, Sabrina; Stockton, Sarah; Kendall, Tim

doi:10.1016/j.brat.2015.01.009

Cited by 269Digital Mental Health InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesChild and Adolescent Psychosocial and Emotional Development

Computerised therapies for anxiety and depression in children and young people: A systematic review and meta-analysis

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Pennant, Mary E., Loucas, Christina E., Whittington, Craig, Creswell, Cathy, Fonagy, Peter, Fuggle, Peter, Kelvin, Raphael, Naqvi, Sabrina +2 more·2015·Behaviour Research and Therapy

DOI 10.1016/j.brat.2015.01.009

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Abstract

One quarter of children and young people (CYP) experience anxiety and/or depression before adulthood, but treatment is sometimes unavailable or inadequate. Self-help interventions may have a role in augmenting treatment and this work aimed to systematically review the evidence for computerised anxiety and depression interventions in CYP aged 5-25 years old. Databases were searched for randomised controlled trials and 27 studies were identified. For young people (12-25 years) with risk of diagnosed anxiety disorders or depression, computerised CBT (cCBT) had positive effects for symptoms of anxiety (SMD -0.77, 95% CI -1.45 to -0.09, k = 6, N = 220) and depression (SMD -0.62, 95% CI -1.13 to -0.11, k = 7, N = 279). In a general population study of young people, there were small positive effects for anxiety (SMD -0.15, 95% CI -0.26 to -0.03; N = 1273) and depression (SMD -0.15, 95% CI -0.26 to -0.03; N = 1280). There was uncertainty around the effectiveness of cCBT in children (5-11 years). Evidence for other computerised interventions was sparse and inconclusive. Computerised CBT has potential for treating and preventing anxiety and depression in clinical and general populations of young people. Further program development and research is required to extend its use and establish its benefit in children.

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Computerized CBT programs such as MoodGym, SPARX, and 'Think, Feel, Do' generally have small but positive effects on mental health.
“Furthermore, computerized CBT, such as MoodGym, SPARX, and “Think, Feel, Do” generally have small but positive effects on mental health.96 , 97”
From Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19 (2020) · cites this paper as [96]
The Study characteristics cCBT section identifies MoodGym, SPARX, and Think Feel Do as programs reviewed. The Depression and Anxiety sections report small improvements for young people in general-population studies, but also report larger or uncertain effects in other groups. The claim overgeneralizes the size of the effect and omits the review’s restriction to children and young people; page numbers are unavailable in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Reviews have tended to conclude that effects are better if there is some therapist input and if parents are involved, especially for younger children.
“Importantly, reviews have tended to conclude that effects are better if there is some therapist input97 , 101 and if parents are involved especially for younger children.96 , 97”
From Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19 (2020) · cites this paper as [96]
In “Moderators of effectiveness” (page unavailable), the review says therapist input may be important and parental input may be valuable for children. But its therapist-input subgroup analysis found no significant difference, and it says evidence for computerised parent-focused treatments is limited. The cited review therefore does not establish that either form of input produces better effects. (LLM, conf=0.88)
Experimental — accuracy not yet measured
The efficacy of DHIPSY for some common mental disorders in children and adolescents has been established using meta-analyses.
“The efficacy of DHIPSY for some common mental disorders in children and adolescents has been established using meta-analyses [12,16-19].”
From Mechanisms of Change in Digital Health Interventions for Mental Disorders in Youth: Systematic Review (2021) · cites this paper as [17]
In the past 5 years, a number of literature reviews have highlighted an increase in research and development activities for eMental healthcare technologies for children and adolescents.
“In the past 5 years, a number of literature reviews have highlighted the increase in research and development activities for eMental healthcare technologies for children and adolescents [18-22].”
From eMental Healthcare Technologies for Anxiety and Depression in Childhood and Adolescence: Systematic Review of Studies Reporting Implementation Outcomes (2018) · cites this paper as [21]
DMH tools do not remotely approximate the level of attractiveness and interactivity to which young digital natives have grown accustomed.
“Most importantly, DMH tools do not remotely approximate the level of attractiveness and interactivity to which young “digital natives” have grown accustomed [17,32,43].”
From Use of the Principles of Design Thinking to Address Limitations of Digital Mental Health Interventions for Youth: Viewpoint (2019) · cites this paper as [32]

Analyses comparing DMH interventions for both anxiety and depression with active nontherapeutic controls have generally failed to show superiority of DMH interventions.
“However, analyses comparing DMH interventions for both anxiety and depression with active nontherapeutic controls have generally failed to show superiority of DMH interventions [31,32].”
From Use of the Principles of Design Thinking to Address Limitations of Digital Mental Health Interventions for Youth: Viewpoint (2019) · cites this paper as [32]
Pennant and colleagues showed that face-to-face CBT was more effective than DMH interventions.
“In contrast, Pennant and colleagues [32] showed that face-to-face CBT was more effective than DMH interventions.”
From Use of the Principles of Design Thinking to Address Limitations of Digital Mental Health Interventions for Youth: Viewpoint (2019) · cites this paper as [32]
Most DMH interventions for youth are little more than modified and uploaded CBT manuals and workbooks.
“In the understandable and commendable effort to remain “evidence-based,” most DMH interventions for youth are a little-more-than modified and uploaded CBT manuals and workbooks (eg, MoodGym, Cool Kids, Camp Cope-a-lot, and BRAVE; for a review discussing the evidence base of these DMH interventions, see [32,44]).”
From Use of the Principles of Design Thinking to Address Limitations of Digital Mental Health Interventions for Youth: Viewpoint (2019) · cites this paper as [32]
Problems such as insufficient search processes of the literature, small sample sizes, differences at baseline in study samples, and publication bias play important roles in the quality of youth-focused DMH studies.
“Furthermore, problems such as insufficient search processes of the literature, small sample sizes, differences at baseline in study samples, and publication bias play important roles in the quality of these studies [32,39].”
From Use of the Principles of Design Thinking to Address Limitations of Digital Mental Health Interventions for Youth: Viewpoint (2019) · cites this paper as [32]

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Computer use and attitudes towards computerised therapy amongst young people and parents attending child and adolescent mental health services
Stallard, P., Velleman, S., & Richardson, T. (2010) · Child and Adolescent Mental Health · doi:10.1111/j.1475-3588.2009.00540.x · Cited by 58 · see citing works
Training Non-Threatening Interpretations in Spider Fear
Teachman, B. A., & Addison, L. M. (2007) · Cognitive Therapy and Research · doi:10.1007/s10608-006-9084-z · Cited by 46 · see citing works

Flagged first, then by citations

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Sorted by citations

Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19
Loades, M. E., Chatburn, E., Higson-Sweeney, N., Reynolds, S., Shafran, R., Brigden, A., Linney, C., McManus, M. N., Borwick, C., & Crawley, E. (2020) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2020.05.009 · Cited by 2,906 · see citing works
“Furthermore, computerized CBT, such as MoodGym, SPARX, and “Think, Feel, Do” generally have small but positive effects on mental health.(96,97) Although mobile applications for mental health have been found to be generally acceptable to children and adolescents, there is a lack of convincing evidence of effectiveness…”
BackgroundMethod
Mental Health Smartphone Apps: Review and Evidence-Based Recommendations for Future Developments
Bakker, D., Kazantzis, N., Rickwood, D., & Rickard, N. (2016) · JMIR Mental Health · doi:10.2196/mental.4984 · Cited by 886 · see citing works
“Similar findings for CCBT’s efficacy have emerged from meta-analyses that have focused on anxiety [47], depression [48], and its use with young people [49].”
Annual research review: Digital health interventions for children and young people with mental health problems—A systematic and meta-review
Hollis, C., Falconer, C. J., Martin, J. L., Whittington, C., Stockton, S., Glazebrook, C., & Davies, E. B. (2017) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12663 · Cited by 846 · see citing works
“The effects of DHIs on anxiety and depression outcomes were greater in adolescents and young adults than in children (Ebert et al., 2015; Pennant et al., 2015; Podina et al., 2016).”
BackgroundMethodInfluentialSelf-citation
Cognitive behavioural therapy for anxiety disorders in children and adolescents
James, A. C., James, G., Cowdrey, F. A., Soler, A., & Choke, A. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004690.pub4 · Cited by 876 · see citing works
Mental Health Mobile Apps for Preadolescents and Adolescents: A Systematic Review.
Grist, R., Porter, J., & Stallard, P. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.7332 · Cited by 518 · see citing works
“The Mayo Clinic Anxiety Coach was the only app describing an active “treatment” component (ie, exposure and response prevention) although a further eight provided “coping strategies” and skills practice (eg, meditation, dialectical behavioral therapy [DBT] skills, and CBT techniques).”
BackgroundInfluential
Anxiety disorders
Craske, M. G., Stein, M. B., Eley, T. C., Milad, M. R., Holmes, A., Rapee, R. M., & Wittchen, H.-U. (2017) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2017.24 · Cited by 652 · see citing works
Evidence on Digital Mental Health Interventions for Adolescents and Young People: Systematic Overview
Lehtimaki, S., Martic, J., Wahl, B., Foster, K. T., & Schwalbe, N. (2021) · JMIR Mental Health · doi:10.2196/25847 · Cited by 488 · see citing works
“On the basis of 2 RCTsb included in this review, no difference in anxiety outcomes is found between the intervention and control groups (alternative nontherapeutic videogame).”
BackgroundInfluential
Engaging children and young people in digital mental health interventions: systematic review of modes of delivery, facilitators, and barriers
Liverpool, S., Mota, C. P., Sales, C. M. D., Čuš, A., Carletto, S., Hancheva, C., Sousa, S., Cerón, S. C., Moreno-Peral, P., Pietrabissa, G., et al. (2020) · Journal of Medical Internet Research · doi:10.2196/16317 · Cited by 408 · see citing works
“Therefore, considering the increased digital literacy and internet use among youth [16], DHIs may serve as a new way to increase accessibility to MH interventions in this population [17,18].”
Cognitive behavioural therapy for anxiety disorders in children and adolescents
James, A. C., Reardon, T., Soler, A., James, G., & Creswell, C. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013162.pub2 · Cited by 344 · see citing works
Self-citation
Technology delivered interventions for depression and anxiety in children and adolescents: a systematic review and meta-analysis
Grist, R., Croker, A., Denne, M., & Stallard, P. (2019) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-018-0271-8 · Cited by 287 · see citing works
Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder
Andrews, G., Bell, C., Boyce, P., Gale, C., Lampe, L., Marwat, O., Rapee, R., & Wilkins, G. (2018) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867418799453 · Cited by 243 · see citing works
Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder
MacQUEEN, G. M., Frey, B. N., Ismail, Z., Jaworska, N., Steiner, M. S., Lieshout, R. J. V., Kennedy, S. H., Lam, R. W. M., Milev, R. V., Parikh, S. V., et al. (2016) · The Canadian Journal of Psychiatry · doi:10.1177/0706743716659276 · Cited by 251 · see citing works
“, waitlist, no treatment) in alleviating depression symptoms, particularly in adolescents.(18,19) As such, these interventions may be a promising treatment alternative when in-person/face-to-face treatment is not feasible or available.”
Background
Internet-Based Cognitive-Behavioral Therapy for Depression: Current Progress and Future Directions
Webb, C. A., Rosso, I. M., & Rauch, S. L. (2017) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000139 · Cited by 217 · see citing works
“Finally, iCBT programs adapted for children and adolescents have been shown to significantly reduce depressive symptoms.(47)”
Background
Evidence synthesis of digital interventions to mitigate the negative impact of the COVID-19 pandemic on public mental health: Rapid meta-review
Rauschenberg, C., Schick, A., Hirjak, D., Seidler, A., Paetzold, I., Apfelbacher, C., Riedel-Heller, S. G., & Reininghaus, U. (2021) · Journal of Medical Internet Research · doi:10.2196/23365 · Cited by 205 · see citing works
“Importantly, effectiveness has been demonstrated across differing age groups, including adults [24,54,59] and adolescents from the general population [34,52,56,61-63], and effect sizes mostly ranged from small to medium.”
Background
Practitioner review: Unguided and guided self-help interventions for common mental health disorders in children and adolescents: a systematic review and meta-analysis
Bennett, S. D., Cuijpers, P., Ebert, D. D., McKenzie Smith, M., Coughtrey, A. E., Heyman, I., Manzotti, G., & Shafran, R. (2019) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13010 · Cited by 162 · see citing works
“…and/or depression in youth, of which the majority were self-help or guided self-help, demonstrated medium to large effect sizes (Ebert et al., 2015; Pennant et al., 2015; Rooksby, Elouafkaoui, Humphris, Clarkson, & Freeman, 2015; Stasiak et al., 2016); although ﬁndings were inconclusive for…”
Background
Anxiety disorders in children and adolescents: A summary and overview of the literature
Rapee, R. M., Creswell, C., Kendall, P. C., Pine, D. S., & Waters, A. M. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104376 · Cited by 202 · see citing works
Self-citation
Preventive digital mental health interventions for children and young people: A review of the design and reporting of research
Bergin, A. D., Vallejos, E. P., Davies, E. B., Daley, D., Ford, T., Harold, G., Hetrick, S., Kidner, M., Long, Y., Merry, S., et al. (2020) · npj Digital Medicine · doi:10.1038/s41746-020-00339-7 · Cited by 157 · see citing works
Anxiety in youth with asthma: a meta-analysis
Dudeney, J., Sharpe, L., Jaffe, A., Jones, E. B., & Hunt, C. (2017) · Pediatric Pulmonology · doi:10.1002/ppul.23689 · Cited by 169 · see citing works
“For example, appropriate treatment options include cognitive behavior interventions, which have been shown to be effective in reducing anxiety in youth when delivered both inperson(42,43) and remotely through online or smartphonemediums.(44,45) A strength of the meta-analytic procedure is being able to pool results fr…”
Background
Impact of guidance on intervention adherence in computerised interventions for mental health problems: a meta-analysis
Musiat, P., Johnson, C., Atkinson, M., Wilksch, S., & Wade, T. (2022) · Psychological Medicine · doi:10.1017/s0033291721004621 · Cited by 166 · see citing works
“…online interventions are increasingly available for a wide range of mental health conditions, such as depression (Andersson & Cuijpers, 2009), anxiety (Andrews, Cuijpers, Craske, McEvoy, & Titov, 2010; Pennant et al., 2015), and eating disorders (Aardoom, Dingemans, Spinhoven, & Van Furth, 2013).”
Background
Loneliness and mental health in children and adolescents with pre‐existing mental health problems: A rapid systematic review
Hards, E., Loades, M. E., Higson‐Sweeney, N., Shafran, R., Serafimova, T., Brigden, A., Reynolds, S., Crawley, E., Chatburn, E., Linney, C., et al. (2022) · British Journal of Clinical Psychology · doi:10.1111/bjc.12331 · Cited by 162 · see citing works
Internet and computer-based cognitive behavioral therapy for anxiety and depression in adolescents and young adults: systematic review and meta-analysis.
Christ, C., Schouten, M. J., Blankers, M., van Schaik, D. J., Beekman, A. T., Wisman, M. A., Stikkelbroek, Y. A., & Dekker, J. J. (2020) · Journal of Medical Internet Research · doi:10.2196/17831 · Cited by 148 · see citing works
“Our results are largely in line with those of previous studies on cCBT in children and young people aged up to 25 years [36], adolescents and young adults aged 12 to 25 years [37] and 10 to 25 years [43], and children and adolescents aged up to 18 years [44].”
BackgroundResultInfluential
Practitioner Review: Anxiety disorders in children and young people – assessment and treatment
Creswell, C., Waite, P., & Hudson, J. (2020) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13186 · Cited by 140 · see citing works
“a useful approach (Pennant et al., 2015; Spence et al., 2011) although positive benefits are less”
Self-citation
Use of the Principles of Design Thinking to Address Limitations of Digital Mental Health Interventions for Youth: Viewpoint
Scholten, H., & Granic, I. (2019) · Journal of Medical Internet Research · doi:10.2196/11528 · Cited by 138 · see citing works
“Furthermore, problems such as insufficient search processes of the literature, small sample sizes, differences at baseline in study samples, and publication bias play important roles in the quality of these studies [32,39].”
Influential
Internet-delivered cognitive behavioural therapy for children with anxiety disorders: A randomised controlled trial
Vigerland, S., Ljótsson, B., Thulin, U., Öst, L.-G., Andersson, G., & Serlachius, E. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.11.006 · Cited by 136 · see citing works
“To date, there are several trials evaluating computerised or internet delivered CBT-interventions for children and adolescents with anxious or depressive symptoms (Pennant et al., 2015; ReyesPortillo et al., 2014; Richardson, Stallard, & Velleman, 2010).”
Background
Using Peer Support to Strengthen Mental Health During the COVID-19 Pandemic: A Review
Suresh, R., Alam, A., & Karkossa, Z. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.714181 · Cited by 146 · see citing works
COVID-19 and telemental health: Benefits, challenges, and future directions.
Madigan, S. L., Racine, N. M., Cooke, J. E., & Korczak, D. J. (2020) · Canadian Psychology/Psychologie canadienne · doi:10.1037/cap0000259 · Cited by 128 · see citing works
Web-Based Interventions Supporting Adolescents and Young People With Depressive Symptoms: Systematic Review and Meta-Analysis
Välimäki, M., Anttila, K., Anttila, M., & Lahti, M. (2017) · JMIR mHealth and uHealth · doi:10.2196/mhealth.8624 · Cited by 110 · see citing works
“On the basis of previous reviews, cognitive behavioral therapy (CBT)–based Web-based interventions have been found to impact the appearance of depressive and anxiety symptoms among young people [9-11], whereas online and mobile psychosocial suicide prevention intervention has reduced suicidal ideation, depression, and…”
Background
The impact of COVID-19 on child and adolescent mental health and treatment considerations
Chavira, D. A., Ponting, C., & Ramos, G. (2022) · Behaviour Research and Therapy · doi:10.1016/j.brat.2022.104169 · Cited by 110 · see citing works
Internet- and Mobile-Based Interventions for Mental and Somatic Conditions in Children and Adolescents: A Systematic Review of Meta-analyses
Domhardt, M., Steubl, L., & Baumeister, H. (2020) · Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie · doi:10.1024/1422-4917/a000625 · Cited by 101 · see citing works
“Pennant et al. (2015) incorporated any form of computerized therapies which varied between conventional CBT approaches and dynamic gaming-type interventions.”
Influential
How do eHealth Programs for Adolescents With Depression Work? A Realist Review of Persuasive System Design Components in Internet-Based Psychological Therapies
Wozney, L., Huguet, A., Bennett, K., Radomski, A. D., Hartling, L., Dyson, M., McGrath, P. J., & Newton, A. S. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.7573 · Cited by 93 · see citing works
“…CBT and IPT therapies for clinical (adolescents diagnosed with MDD) and general (adolescents with subthreshold symptoms, adolescents considered at high risk for MDD) populations result in improvements in depressive symptoms and moderate to high satisfaction with the therapies [11-13].”
A Meta-Analysis on the Efficacy of Technology Mediated CBT for Anxious Children and Adolescents
Podina, I. R., Mogoase, C., David, D., Szentagotai, A., & Dobrean, A. (2016) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-015-0228-5 · Cited by 83 · see citing works
Computerised CBT for depressed adolescents: randomised controlled trial
Smith, P., Scott, R., Eshkevari, E., Jatta, F., Leigh, E., Harris, V., Robinson, A., Abeles, P., Proudfoot, J., Verduyn, C., et al. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.07.009 · Cited by 93 · see citing works
“A recent systematic review and meta-analysis (Pennant et al., 2015) concluded that CCBT has potential for treating depression in young people.”
Background
Eficacia de la terapia cognitivo conductual transdiagnóstica en el tratamiento de la ansiedad y la depresión en adultos, niños y adolescentes: Un meta-análisis
García-Escalera, J., Chorot, P., Valiente, R. M., Reales, J. M., & Sandín, B. (2017) · Revista de Psicopatología y Psicología Clínica · doi:10.5944/rppc.vol.21.num.3.2016.17811 · Cited by 94 · see citing works
Evaluating the Efficacy of Internet-Delivered Cognitive Behavioral Therapy Blended With Synchronous Chat Sessions to Treat Adolescent Depression: Randomized Controlled Trial
Topooco, N., Byléhn, S., Nysäter, E. D., Holmlund, J., Lindegaard, J., Johansson, S., Åberg, L., Nordgren, L. B., Zetterqvist, M., & Andersson, G. (2019) · Journal of Medical Internet Research · doi:10.2196/13393 · Cited by 93 · see citing works
“The depression reduction observed in this study is moreover in line with meta-analyses suggesting that computer and Web-based ICBT for youth depression produces effect [11,32], and more broadly, that coached Web-based interventions fare better than self-guided [33].”
BackgroundResult
eHealth to redress psychotherapy access barriers both new and old: A review of reviews and meta-analyses
Bennett, C. B., Ruggero, C. J., Sever, A. C., & Yanouri, L. (2020) · Journal of Psychotherapy Integration · doi:10.1037/int0000217 · Cited by 87 · see citing works
Gamifying CBT to deliver emotional health treatment to young people on smartphones
Christie, G. I., Shepherd, M., Merry, S. N., Hopkins, S., Knightly, S., & Stasiak, K. (2019) · Internet Interventions · doi:10.1016/j.invent.2019.100286 · Cited by 81 · see citing works
Therapist-supported online remote behavioural intervention for tics in children and adolescents in England (ORBIT): a multicentre, parallel group, single-blind, randomised controlled trial
Hollis, C. P., Hall, C. L., Jones, R., Marston, L., Novere, M. L., Hunter, R. M., Brown, B. J., Sanderson, C., Andrén, P., Bennett, S. D., et al. (2021) · The Lancet Psychiatry · doi:10.1016/s2215-0366(21)00235-2 · Cited by 78 · see citing works
Benefits of Individualized Feedback in Internet-Based Interventions for Depression: A Randomized Controlled Trial
Zagorscak, P., Heinrich, M., Sommer, D., Wagner, B., & Knaevelsrud, C. (2018) · Psychotherapy and Psychosomatics · doi:10.1159/000481515 · Cited by 77 · see citing works
Prevention of depression in childhood and adolescence
Mendelson, T., & Tandon, S. D. (2016) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2015.11.005 · Cited by 77 · see citing works
Design and Development of the “POD Adventures” Smartphone Game: A Blended Problem-Solving Intervention for Adolescent Mental Health in India
Gonsalves, P. P., Hodgson, E. S., Kumar, A., Aurora, T., Chandak, Y., Sharma, R., Michelson, D., & Patel, V. (2019) · Frontiers in Public Health · doi:10.3389/fpubh.2019.00238 · Cited by 68 · see citing works
Implementation of internet-delivered CBT for children with anxiety disorders in a rural area: A feasibility trial
Jolstedt, M., Ljótsson, B., Fredlander, S., Tedgård, T., Hallberg, A., Ekeljung, A., Högström, J., Mataix-Cols, D., Serlachius, E., & Vigerland, S. (2018) · Internet Interventions · doi:10.1016/j.invent.2017.11.003 · Cited by 75 · see citing works
The Effectiveness of Web-Based Interventions Delivered to Children and Young People With Neurodevelopmental Disorders: Systematic Review and Meta-Analysis
Khan, K., Hall, C. L., Davies, E. B., Hollis, C. P., & Glazebrook, C. (2019) · Journal of Medical Internet Research · doi:10.2196/13478 · Cited by 74 · see citing works
A randomized controlled trial examining the efficacy of an internet-based cognitive behavioral therapy program for adolescents with anxiety disorders
Stjerneklar, S., Hougaard, E., McLellan, L. F., & Thastum, M. (2019) · PLOS ONE · doi:10.1371/journal.pone.0222485 · Cited by 71 · see citing works
Practitioner Review: Effectiveness of indicated school‐based interventions for adolescent depression and anxiety – a meta‐analytic review
Gee, B., Reynolds, S. A., Carroll, B., Orchard, F., Clarke, T., Martin, D., Wilson, J., & Pass, L. (2020) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13209 · Cited by 71 · see citing works
“There are a growing range of evidence-based treatments for depression and anxiety disorders in young people (Pennant et al., 2015; Reynolds, Wilson, Austin, & Hooper, 2012; Tindall et al., 2017; Weersing, Jeffreys, Do, Schwartz, & Bolano, 2017).”
Background
Therapist-Guided Internet-Delivered Cognitive Behavioral Therapy vs Internet-Delivered Supportive Therapy for Children and Adolescents With Social Anxiety Disorder
Nordh, M., Wahlund, T., Jolstedt, M., Sahlin, H., Bjureberg, J., Åhlén, J., Lalouni, M., Salomonsson, S., Vigerland, S., Lavner, M., et al. (2021) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2021.0469 · Cited by 75 · see citing works
Web-Based and Mobile Suicide Prevention Interventions for Young People: A Systematic Review.
Perry, Y., Werner‐Seidler, A., Calear, A. L., & Christensen, H. M. (2016) · PubMed Central · Cited by 69 · see citing works
Treating child and adolescent anxiety effectively: Overview of systematic reviews
BENNETT, K. J., Manassis, K., Duda, S. J., Bagnell, A. L., Bernstein, G. A., Garland, E., Miller, L. D., Newton, A. S., Thabane, L., & Wilansky, P. (2016) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.09.006 · Cited by 65 · see citing works
“Similarly, Pennant et al (2015) pooled 2 RCTs of ABM and reported no statistically significant difference in anxiety symptoms compared to active controls (SMD = -0.19, 95% CI = -0.69 to 0.32).”
BackgroundInfluential
Business as usual? Psychological support at a distance.
Payne, L., Flannery, H., Kambakara Gedara, C., Daniilidi, X., Hitchcock, M., Lambert, D., Taylor, C., & Christie, D. (2020) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104520937378 · Cited by 65 · see citing works
“The relative minority of studies evaluating non-CBT interventions, such as computerised problem-solving therapy (Hoek et al., 2012) and attention/cognitive bias modification (Hollis et al., 2017; Pennant et al., 2015) are inconclusive due to low quality evidence.”
Background
Where to go from here? An exploratory meta-analysis of the most promising approaches to depression prevention programs for children and adolescents
Hetrick, S., Cox, G., & Merry, S. (2015) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph120504758 · Cited by 62 · see citing works
“This field is in its infancy currently, but results of trials of computerized CBT indicate potential benefits for treating depression in adolescents [26,70].”
Background
Digital Behavior Change Interventions for Younger Children With Chronic Health Conditions: Systematic Review
Brigden, A., Anderson, E., Linney, C., Morris, R., Parslow, R., Serafimova, T., Smith, L., Briggs, E., Loades, M., & Crawley, E. (2020) · Journal of Medical Internet Research · doi:10.2196/16924 · Cited by 63 · see citing works
“Furthermore, reviews investigating digital interventions for young people with chronic health conditions typically do not include children aged below 10 years [35], or, if they do, only a minority of the interventions included in the reviews include children aged below 13 years [15,36-38], recognizing that there are “…”
Background
A pilot evaluation of the SPARX-R gaming intervention for preventing depression and improving wellbeing among adolescents in alternative education
Kuosmanen, T., Fleming, T. M., Newell, J., & Barry, M. M. (2017) · Internet Interventions · doi:10.1016/j.invent.2017.03.004 · Cited by 56 · see citing works
“There is increasing evidence supporting the delivery of computerized mental health programs to promote youth mental health and wellbeing (Clarke et al., 2015; Pennant et al., 2015).”
Background
Attentional bias modification (ABM) training induces spontaneous brain activity changes in young women with subthreshold depression: a randomized controlled trial
Li, H., Wei, D., Browning, M., Du, X., Zhang, Q., & Qiu, J. (2016) · Psychological Medicine · doi:10.1017/s003329171500238x · Cited by 59 · see citing works
“…inconsistent findings concerning the effects of ABM intervention on depression have been reported (e.g. Hallion & Ruscio, 2011; Mogoaşe et al. 2014; Pennant et al. 2015), a number of studies have found that ABM is an effective tool in reducing depressive symptoms (Baert et al. 2010; Browning et…”
BackgroundMethod
Digital Mental Health Interventions for Child and Adolescent Anxiety
Khanna, M. S., & Carper, M. M. (2021) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2021.05.003 · Cited by 59 · see citing works
Computerized Cognitive Behavioral Therapy for Treatment of Depression and Anxiety in Adolescents: Systematic Review and Meta-analysis
Wickersham, A., Barack, T., Cross, L., & Downs, J. (2022) · Journal of Medical Internet Research · doi:10.2196/29842 · Cited by 49 · see citing works
“Previous systematic reviews and meta-analyses of the efficacy of digitally delivered CBT for anxiety or depression in children and young people have yielded promising results [14,17-23].”
Background
Cognitive–behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis
Fordham, B., Sugavanam, T., Edwards, K., Hemming, K., Howick, J., Copsey, B. J., Lee, H., Kaidesoja, M., Kirtley, S., Hopewell, S., et al. (2021) · Health Technology Assessment · doi:10.3310/hta25090 · Cited by 59 · see citing works
Design and Delivery Features That May Improve the Use of Internet-Based Cognitive Behavioral Therapy for Children and Adolescents With Anxiety: A Realist Literature Synthesis With a Persuasive Systems Design Perspective
Radomski, A. D., Wozney, L., McGrath, P., Huguet, A., Hartling, L., Dyson, M. P., Bennett, K., & Newton, A. S. (2019) · Journal of Medical Internet Research · doi:10.2196/11128 · Cited by 40 · see citing works
“Recent systematic reviews and meta-analyses have found a range of iCBT programs to be effective at reducing anxiety in children and adolescents [9,10,20,21]; however, poor and highly variable rates of completion can be found across programs (up to 50% of participants not reaching the end of a…”
Background
eMental Healthcare Technologies for Anxiety and Depression in Childhood and Adolescence: Systematic Review of Studies Reporting Implementation Outcomes
Wozney, L., McGrath, P. J., Gehring, N. D., Bennett, K., Huguet, A., Hartling, L., Dyson, M. P., Soleimani, A., & Newton, A. S. (2018) · JMIR Mental Health · doi:10.2196/mental.9655 · Cited by 50 · see citing works
“In the past 5 years, a number of literature reviews have highlighted the increase in research and development activities for eMental healthcare technologies for children and adolescents [18-22].”
Background
Mobile-based interventions for common mental disorders in youth: a systematic evaluation of pediatric health apps
Domhardt, M., Messner, E.-M., Eder, A.-S., Engler, S., Sander, L. B., Baumeister, H., & Terhorst, Y. (2021) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-021-00401-6 · Cited by 43 · see citing works
“Furthermore, the efficacy of internet-based interventions for depression in youth is documented by four meta-analyses [23, 24, 27, 28], with effect sizes in the range from 0.”
Background
Strategies not accompanied by a mental health professional to address anxiety and depression in children and young people: a scoping review of range and a systematic review of effectiveness
Wolpert, M., Dalzell, K., Ullman, R., Garland, L., Cortina, M. A., Hayes, D., Patalay, P., & Law, D. (2018) · The Lancet Psychiatry · doi:10.1016/s2215-0366(18)30465-6 · Cited by 49 · see citing works
Therapist-guided internet-based psychodynamic therapy versus cognitive behavioural therapy for adolescent depression in Sweden: a randomised, clinical, non-inferiority trial
Mechler, J., Lindqvist, K., Carlbring, P., Topooco, N., Falkenström, F., Lilliengren, P., Andersson, G., Johansson, R., Midgley, N., Edbrooke-Childs, J. H., et al. (2022) · The Lancet Digital Health · doi:10.1016/s2589-7500(22)00095-4 · Cited by 48 · see citing works
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Computerised cognitive behavioural therapy has the potential to prevent and treat anxiety and depression in young people
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RESEARCH ARTICLE Internet and Computer-Based Cognitive Behavioral Therapy for Anxiety and Depression in Youth: A Meta-Analysis of Randomized Controlled Outcome Trials
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Internet and computer-based cognitive behavioral therapy for anxiety and depression in adolescents and young adults: systematic review and meta-analysis.
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Authors: Pennant, M. E., Loucas, C. E., Whittington, C., Creswell, C., Fonagy, P., Fuggle, P., Kelvin, R., Naqvi, S., Stockton, S., & Kendall, T.
Affiliations: Royal College of Psychiatrists (GB)
University College London (GB)
University of Reading (GB)
Anna Freud Centre (GB)
University of Cambridge (GB)
Corresponding author: Pennant, Mary E.
ORCID: Loucas, Christina E.
Whittington, Craig
Creswell, Cathy
Fonagy, Peter
Fuggle, Peter
Kendall, Tim
Venue: Behaviour Research and Therapy
Publisher: Elsevier BV
Published: 2015-04
Volume: 67
Pages: 1-18
ISSN: 0005-7967 (ISSN-L)
DOI: 10.1016/j.brat.2015.01.009
OpenAlex: W1985615249
Cited by: 269
References: 68
Citations by year: 2026: 16 · 2025: 19 · 2024: 22 · 2023: 18 · 2022: 29 · 2021: 35 · 2020: 30 · 2019: 34 · 2018: 19 · 2017: 24 · 2016: 16 · 2015: 7
FWCI: 3.03
Type: journal article
Language: en
Open access: green
discovery.ucl.ac.uk
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Behaviour Research and Therapy (publishedVersion)
PubMed (publishedVersion)
UCL Discovery (University College London) (submittedVersion)
Funders: Department of Health and Social Care
National Institute for Health and Care Excellence
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 › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords: computerized cognitive behavioral therapy, childhood anxiety, adolescent depression, children and young people, self-help intervention, anxiety symptoms, depressive symptoms, prevention of mental disorders
MeSH terms: Adolescent, Adult, Anxiety Disorders, Child, Child, Preschool, Computers, Depressive Disorder, Female, Humans, Male, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome, Internet, Young Adult, Mobile Applications

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Computerised therapies for anxiety and depression in children and young people: A systematic review and meta-analysis

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