Guided internet-based transdiagnostic individually tailored Cognitive Behavioral Therapy for symptoms of depression and/or anxiety in college students: A randomized controlled trial
Open accessAbstract
Common mental disorders, such as depression and anxiety, often emerge in college students during the transition into early adulthood. Mental health problems can seriously impact students' functioning, interpersonal relationships, and academic achievement. Actively reaching out to college students with mental health problems and offering them internet-based interventions may be a promising way of providing low-threshold access to evidence-based treatment in colleges. This randomized controlled trial aimed to assess the effectiveness of a guided web-based transdiagnostic individually tailored Cognitive Behavioral Therapy (iCBT) in treating college students with depression and/or anxiety symptoms. Through an online survey that screened college students' mental health, we recruited 100 college students aged ≥18 years who reported mild to moderate depression and/or anxiety symptoms and were attending colleges in the Netherlands. Participants were randomly allocated to guided iCBT (n = 48) or treatment as usual (TAU) control (n = 52). Primary outcomes were symptoms of depression and anxiety measured at post-treatment (7 weeks post-randomization). We also measured all outcomes at 6- and 12-months post-randomization. All analyses were based on the intention-to-treat principle and were repeated using the complete-case sample. We found no evidence of a difference between the effects of guided iCBT and TAU in any of the examined outcomes (i.e., symptoms of depression and anxiety, quality of life, educational achievement, and college dropout) across all time points (p > .05). There was no evidence that effects of iCBT were associated with treatment satisfaction and adherence. More research into transdiagnostic individually tailored iCBT is necessary. Further, future studies should recruit larger samples to investigate possible smaller but clinically relevant effects of internet-based interventions for college students with depression and/or anxiety.
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The consistent improvements in the intervention group on both anxiety measures and wellbeing are in concurrence with preceding literature on internet-delivered ACT and mindfulness programs.
“The consistent improvements in the intervention group on both measures of anxiety, the generalized and social anxiety variants, as well as wellbeing are in concurrence with the preceding literature”
From An internet-delivered acceptance and commitment therapy program for anxious affect, depression, and wellbeing: A randomized, parallel, two-group, waitlist-controlled trial in a Middle Eastern sample of college students (2024) · cites this paper as [26]
The Discussion reports that prior findings did not show significant improvements in quality of life from internet-based interventions, contrary to the claimed agreement with improvements in wellbeing. The Main and Secondary Outcomes sections also report no significant advantage of this iCBT intervention over treatment as usual for anxiety or quality of life. The paper does not discuss internet-delivered ACT or mindfulness programs as the claimed preceding literature. (LLM, conf=0.87)
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Experimental — accuracy not yet measuredInternet-delivered CBT has demonstrated effectiveness in addressing anxiety disorders and depression in college samples.
“Internet-delivered CBT has demonstrated effectiveness in addressing anxiety disorders and depression in both the general population [23–25] and in college samples [26, 27].”
From An internet-delivered acceptance and commitment therapy program for anxious affect, depression, and wellbeing: A randomized, parallel, two-group, waitlist-controlled trial in a Middle Eastern sample of college students (2024) · cites this paper as [26]
The Introduction reports earlier college-student trials with reductions in anxiety and, in one trial, depression symptoms. But the Discussion reports that this paper’s own trial found no advantage over treatment as usual for either outcome, and the cited findings concern symptoms rather than diagnosed anxiety disorders. The broad effectiveness claim omits these qualifications; page numbers are unavailable in our copy. (LLM, conf=0.85)
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“PSS has shown to be a valid and reliable measure in college students (Matsushita et al., 2011).”
BackgroundBolinski, F., Kleiboer, A., Karyotaki, E., Bosmans, J. E., Zarski, A.-C., Weisel, K. K., Ebert, D. D., Jacobi, C., Cuijpers, P., & Riper, H. (2018) · Trials · doi:10.1186/s13063-018-2477-y · Cited by 31 · cited 2× · see citing works
“Previous research has shown that iCBT has moderate effects in reducing symptoms of adult depression and anxiety when delivered with some form of therapeutic support (Karyotaki et al., 2018; Karyotaki et al., 2021; Pauley, Cuijpers, Papola, Miguel, & Karyotaki, 2021).”
Self-citationKaryotaki, E., Klein, A. M., Riper, H., Wit, L. D., Krijnen, L., Bol, E., Bolinski, F., Burger, S., Ebert, D. D., Auerbach, R. P., et al. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-028739 · Cited by 28 · cited 3× · see citing works
“The reader is referred to our protocol for a more detailed description of our intervention (Karyotaki et al., 2019).”
BackgroundMethodSelf-citationWeisel, K. K., Zarski, A., Berger, T., Krieger, T., Moser, C. T., Schaub, M. P., Görlich, D., Berking, M., & Ebert, D. D. (2020) · Journal of Medical Internet Research · doi:10.2196/16450 · Cited by 26 · see citing works
Self-citationWeisel, K. K., Zarski, A., Berger, T., Schaub, M. P., Krieger, T., Moser, C. T., Berking, M., & Ebert, D. D. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00274 · Cited by 21 · cited 1× · see citing works
“The guided iCBT used in this study is a transdiagnostic individually tailored intervention called ‘ICare Prevent ’ (Weisel et al., 2019; Weisel et al., 2018).”
Self-citationIs psychotherapy effective? Pretending everything is fine will not help the field forward
Cuijpers, P. J., Karyotaki, E., Reijnders, M., & Ebert, D. D. (2019) · Epidemiology and Psychiatric Sciences · doi:10.1017/s204579601800080x · Cited by 16 · cited 4× · see citing works
“The recruitment was conducted through the epidemiological e-survey of the WHO WMH-ICS (More information on the e-survey can be found in our study protocol, Karyotaki, et al., 2019).”
InfluentialSelf-citationReducing Stigma Barriers to Help-Seeking Behaviors among College Students
Reichert, E. C. (2012) · Psychology · doi:10.4236/psych.2012.310134 · Cited by 15 · cited 1× · see citing works
“Next to the limited availability of counseling services, many students are reluctant to seek help from counsellors due to the stigma associated with depression and anxiety (Czyz, Horwitz, Eisenberg, Kramer, & King, 2013; Farrer, Christensen, Griffiths, & Mackinnon, 2011; Reichert, 2012).”
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InfluentialOpie, J. E., Vuong, A. T., Welsh, E. T., Gray, R. J., Pearce, N., Marchionda, S., Mutch, R., & Khalil, H. (2024) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-024-00469-4 · Cited by 35 · see citing works
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“Although one study reported positive within-group effects immediately after the intervention (depression: d =0.42; anxiety: d =1.19) [84], another study found no difference between the ICare Prevent intervention and CAU in an RCT among students [70].”
InfluentialSelf-citationCiharova, M., Cuijpers, P., Amanvermez, Y., Riper, H., Klein, A. M., Bolinski, F., de Wit, L. D., der Heijde, C. M. V., Bruffaerts, R., Struijs, S., et al. (2023) · Internet Interventions · doi:10.1016/j.invent.2023.100646 · Cited by 17 · see citing works
Self-citationThe relationship between life events, life satisfaction, and coping style of college students
Ding, S., Shi, W., Ding, L., Chen, Y., Dai, J., Yuan, H., & Zhou, G. (2022) · Psychology Health & Medicine · doi:10.1080/13548506.2022.2115181 · Cited by 19 · see citing works
“…(Bruffaerts et al., 2018; Lattie et al., 2019) have found that mental health problems, such as depression and anxiety, are a common phenomenon among college students and can seriously impact students’ functioning, interpersonal relationships, and academic achievement (Karyotaki et al., 2022).”
BackgroundYan, K., Yusufi, M. H., & Nazari, N. (2022) · World Journal of Clinical Cases · doi:10.12998/wjcc.v10.i24.8599 · Cited by 16 · see citing works
Dehghan-Bonari, M., Alipour‐Vaezi, M., Nasiri, M. M., & Aghsami, A. (2023) · Healthcare Analytics · doi:10.1016/j.health.2023.100238 · Cited by 16 · see citing works
A systematic review on eHealth technology personalization approaches
ten Klooster, I., Kip, H., van Gemert‐Pijnen, J. E. W. C., Crutzen, R., & Kelders, S. M. (2024) · iScience · doi:10.1016/j.isci.2024.110771 · Cited by 18 · see citing works
Husky, M. M., Léon, C., du Roscoät, E., & Vasiliadis, H. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.09.019 · Cited by 14 · see citing works
Martínez-Líbano, J., & Yeomans‐Cabrera, M. (2023) · Frontiers in Education · doi:10.3389/feduc.2023.1293259 · Cited by 14 · see citing works
Koelen, J. A., Klein, A. M., Wolters, N. E., Bol, E., de Koning, L., Roetink, S., Blom, J. V., boutin, B., Schaaf, J. V., Grasman, R. P. P. P., et al. (2024) · JMIR Mental Health · doi:10.2196/50503 · Cited by 14 · see citing works
“For a full description of the intervention, see the study by Karyotaki et al [10].”
BackgroundMethodResultInfluentialSelf-citationChanging Landscape of Mental Health from Early Career Psychiatrists’ Perspective in Indonesia
Cipta, D. A., & Saputra, A. (2022) · Journal of Global Health Neurology and Psychiatry · doi:10.52872/001c.37413 · Cited by 13 · see citing works
Brennenstuhl, S., Agard, C., Ho, R., & Cleverley, K. (2025) · PLoS ONE · doi:10.1371/journal.pone.0319473 · Cited by 20 · see citing works
Pan, J., Carlbring, P., & Lu, L. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100600 · Cited by 12 · see citing works
Expanding, improving, and understanding behaviour research and therapy through digital mental health
Cohen, Z. D., & Schueller, S. M. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104358 · Cited by 10 · see citing works
Berman, A. H., Topooco, N., Lindfors, P., Bendtsen, M., Lindner, P., Molander, O., Kraepelien, M., Sundström, C., Talebizadeh, N., Engström, K., et al. (2024) · Trials · doi:10.1186/s13063-024-07986-1 · Cited by 9 · see citing works
“Further, studies are needed to explore the possibility that internet-deliv-ered CBT (ICBT) for students with symptoms of mild to moderate depression or anxiety might benefit from small improvements that could be clinically relevant [21].”
BackgroundGuided Internet-Delivered Treatment for Depression: Scoping Review
Børtveit, L., Dechsling, A., Sütterlin, S., Nordgreen, T., & Nordahl‐Hansen, A. (2022) · JMIR Mental Health · doi:10.2196/37342 · Cited by 11 · see citing works
“In Multimedia Appendix 5 [17,73-182], the data charted from and the characteristics of the different sources of evidence are presented.”
BackgroundInfluentialFarrer, L. M., Jackson, H. M., Gulliver, A., Calear, A. L., Leach, L., Hasking, P. A., Katruss, N., & Batterham, P. J. (2024) · Journal of Medical Internet Research · doi:10.2196/53598 · Cited by 9 · see citing works
“In addition, this group faces numerous stressors such as transition to independent living, instability in relationships, financial stress, and academic pressure [3-6]; these stressors increase their risk of developing mental health problems [7].”
InfluentialTransdiagnostic psychological interventions for emotional disorders: A comprehensive meta-analysis
Jiménez-Orenga, N., Miguel, C., González-Robles, A., Fernández‐Álvarez, J., Grimaldos, J., Bretón-López, J. M., Botella, C., Cuijpers, P. J., García‐Palacios, A., Papola, D., et al. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119537 · Cited by 9 · see citing works
Self-citationLiu, J., Li, C., Qiu, Y.-F., Yu, Y.-Q., Zeng, L., Wu, M., Han, Y., & Yang, F. (2024) · Psychiatry Research · doi:10.1016/j.psychres.2024.116324 · Cited by 9 · see citing works
Xiang, X., Turner, S., Ruiz-Sierra, S., Zheng, C., Ash, S., Kodkany, N., Dimoji, A., Gosdzinski, C., & Kubicek, G. (2024) · Clinical Gerontologist · doi:10.1080/07317115.2024.2395890 · Cited by 8 · see citing works
“This strategy – combining intuitive design with on-demand technical support – could serve as a model for future implementation of DMHIs targeting older adults.”
InfluentialHuang, H., Wu, H., Luo, L., Jiao, B., Wu, Y., Zou, G., Lin, J., Wang, W., & Ma, L. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1538390 · Cited by 7 · see citing works
Dietvorst, E., de Vries, L. P., van Eijl, S., Mesman, E., Legerstee, J. S., Keijsers, L., Hillegers, M. H. J., & Vreeker, A. (2024) · Digital Health · doi:10.1177/20552076241294105 · Cited by 9 · see citing works
Kim, M., Moon, Y.-K., & Chung, K.-M. (2024) · JMIR mHealth and uHealth · doi:10.2196/50006 · Cited by 5 · see citing works
“…(1) providing content that reflects the characteristics and experiences of the target population [17-20], (2) developing personalized treatment plans according to individuals’ diagnoses or symptoms [21,22], and (3) enabling users to customize features such as menus, tools, and notifications [23].”
Özer, Ö., & Köksal, B. (2023) · OSMANGAZİ JOURNAL OF MEDICINE · doi:10.20515/otd.1309551 · Cited by 5 · see citing works
Vally, Z., Shah, H., Varga, S.-I., Hassan, W., Kashakesh, M., Albreiki, W., & Helmy, M. (2024) · PLoS ONE · doi:10.1371/journal.pone.0313243 · Cited by 3 · see citing works
Atik, E., Hornstein, S., Reinking, E., & Schückes, M. (2025) · Internet Interventions · doi:10.1016/j.invent.2025.100815 · Cited by 2 · see citing works
Celleri, M., Klajner, F., Cremades, F. C., Garay, C. J., Etchevers, M. J., & Osma, J. (2025) · Journal of Clinical Psychology · doi:10.1002/jclp.70037 · Cited by 2 · see citing works
“Previous qualitative studies with patients reported the lack of contact with the therapist as the main reason for dropout (Karyotaki et al. 2022; Titzler et al. 2018), and in general, therapist ‐ guided interventions showed better effectiveness (Zhang et al. 2024).”
Ohashi, S., Urao, Y., Fujiwara, K., Koshiba, T., Ishikawa, S., & Shimizu, E. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-06264-3 · Cited by 2 · see citing works
Eylem, Ö., Poulter, S., Ashcroft, K., Robinson, T., Mane, P., Islam, M., Condell, J. V., & Leavey, G. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-083554 · Cited by 2 · see citing works
“31 However, other RCTs investigating the same intervention reported promising results in terms of the feasibility, acceptability and potential effectiveness of ICare Prevent among students with anxiety and/or depression in Germany 32 33 South Africa 34 and Indonesia.”
BackgroundEylem-van Bergeijk, O., Robinson, T., Manktelow, M., Olympios, M., Poulter, S., Mane, P., Panagioti, M., Condell, J., & Leavey, G. (2025) · JMIR mHealth and uHealth · doi:10.2196/70691 · Cited by 2 · see citing works
“Despite the assumed benefits of digital CBT, such as reduced costs, anonymity, and accessibility [25], the existing randomized controlled trials (RCTs) point to mixed results about the effectiveness of these interventions in reducing GAD symptoms among student populations [26-31].”
InfluentialJackson, H. M., Batterham, P. J., Calear, A. L., Ohan, J. L., & Farrer, L. M. (2024) · JMIR Mental Health · doi:10.2196/53794 · Cited by 1 · see citing works
“Strengths of the study include the large sample relative to other trials testing web-based interventions in tertiary student populations [79-81], recruitment of participants from universities across Australia rather than a single institution, and a focus on maximizing ecological validity.”
Alzilfi, Y. A., Almalki, R. H., Almuntashiri, A. H., & Almathami, J. (2024) · Cureus · doi:10.7759/cureus.73905 · Cited by 1 · see citing works
“Three studies were conducted in the USA [20,23,30], two studies were conducted in Sweden [25,29], and one study each was conducted in Germany [28], the UK [26], Brazil [22], Canada [27], China [21], and the Netherlands [24].”
Designing compassionate experiences for mental health and wellbeing: a scoping review
Lusi, B., Karahanoğlu, A., van Lotringen, C. M., Klaassen, R., Noordzij, M. L., & Ludden, G. (2025) · Behaviour and Information Technology · doi:10.1080/0144929x.2025.2559290 · Cited by 3 · see citing works
“Consequently, online modules based on Cognitive Behavioral Therapy (CBT) (Fadipe et al. 2023; Karyotaki et al. 2022) are increasingly integrated into therapeutic paths or are offered without any human guidance whatsoever (Kemp et al. 2020).”
Liang, H., Xiang, Y., Long, Y., LIWen-jian, & Zhang, L. (2025) · Behaviour Research and Therapy · doi:10.1016/j.brat.2025.104947 · Cited by 1 · see citing works
Liu, J., Guo, Y., Wu, Y., Jin, N., Dong, Y., Zhao, X., & Chen, X. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1745837 · Cited by 1 · see citing works
Preferences, tailoring, and self-tailoring in internet-delivered treatments: lessons learned
Andersson, G., & Carlbring, P. (2026) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2026.2652294 · Cited by 1 · see citing works
“Other studies sometimes state that a treatment has been tailored for certain target groups [24], but here we focus on actual tailoring of treatment modules which means that participants receive different modules.”
The impact of social media use on college students’ mental health: a narrative review
Li, C. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1811098 · Cited by 1 · see citing works
Syafii, M. H., & Mulya, A. (2024) · Journal of Islamic Communication and Counseling · doi:10.18196/jicc.v3i1.72 · Cited by 1 · see citing works
Rodrigues, M. C. J., Rocha, A. C. R., Kawczyński, A., Clemente, F. M., Noll, M., Freire, A. B., de Lira, C. A. B., Corrêa, J. F., Aprigliano, V., Weiss, K., et al. (2026) · Research Square · doi:10.21203/rs.3.rs-8652432/v1 · Cited by 1 · see citing works
Telehealth interventions in Mental Health: a Systematic Review (Preprint)Preprint
Torres-Silva, E. A., Pereira-Montiel, E., Arenas, D. A. M., Uribe, A., Montoya, M. A. A., & Florez-Arango, J. F. (2023) · doi:10.2196/preprints.52249
An App-based CBT Program tailored for College Students: A Randomized Controlled Trial (Preprint)Preprint
Kim, M. H., & Chung, K. (2024) · doi:10.2196/preprints.50006
Özer, Ö., Öztemür, G., Altınöz, A. E., Köksal, B., Doğan, U., Batmaz, S., Gür, R., & Altınok, A. (2025) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2025.101443
“…people with anxiety and depression [56 – 58], sleep-related problems for adults and adolescents [59], and studies with college samples found that TA-based internet-based interventions were effective in treating underlying personality risk factors [60], depression [34], anxiety and depression [61].”
Topooco, N., Lindner, P., Andersson, C. R., Lindfors, P., Molander, O., Kraepelien, M., Sundström, C., Vlaescu, G., Andersson, G., Bendtsen, M., et al. (2026) · JMIR Formative Research · doi:10.2196/68698
“…studies: one study demonstrated moderate to large effects relative to a waitlist control [28], another found no significant benefit over treatment as usual [29], and a third reported higher remission rates for ICBT with therapist support compared to unsupported ICBT and treatment as usual [30].”
Effectiveness and uptake of ROOM to grow: Results of a Randomized Controlled Trial
Laure, T., Boffo, M., Konigorski, S., Dulloo, D., Engels, R. C. M. E., & Remmerswaal, D. (2026) · Internet Interventions · doi:10.1016/j.invent.2026.100962
Longitudinal Associations Among Hope, Self-Compassion, Anxiety, and Depression in College Students.
Li, J., Li, X., Liu, G.-R., Hou, X.-Y., & Ding, Y.-D. (2026) · The Journal of psychology · doi:10.1080/00223980.2026.2705512
Arif, K., McGloin, H., McGuigan, K., Condell, J. V., Dhunnoo, P., & McCann, M. (2026) · doi:10.2196/preprints.112304
Hirsig, A., Walder, N., Häfeli, X. A., & Schmidt, S. J. (2026) · Journal of Medical Internet Research · doi:10.2196/76494
Changing Landscape of Mental Health from Early Career Psychiatrists’ Perspective in Indonesia
Cipta, D. A., & Saputra, A. (2022) · Journal of Global Health Neurology and Psychiatry · doi:10.7189/001c.37413
- Authors
- Karyotaki, E., Klein, A. M., Ciharova, M., Bolinski, F., Krijnen, L., de Koning, L., de Wit, L., van der Heijde, C. M., Ebert, D. D., Riper, H., Batelaan, N., Vonk, P., Auerbach, R. P., Kessler, R. C., Bruffaerts, R., Struijs, S., Wiers, R. W., & Cuijpers, P.
- Affiliations
- Amsterdam Public Health (NL)
- Leiden University (NL)
- Trimbos Institute (NL)
- Utrecht University (NL)
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- University of Amsterdam (NL)
- Columbia University (US)
- Harvard University (US)
- KU Leuven (BE)
- Corresponding author
- Karyotaki, Eirini
- ORCID
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2022-03
- Volume
- 150
- Pages
- 104028
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W4205824839
- Cited by
- 60
- References
- 63
- Citations by year
- 2026: 8 · 2025: 17 · 2024: 17 · 2023: 10 · 2022: 8
- FWCI
- 11.45
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Behaviour Research and Therapy (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- VU Research Portal (publishedVersion, other-oa)
- UvA-DARE (University of Amsterdam) (submittedVersion, cc-by)
- Lirias (submittedVersion, cc-by)
- Leiden Repository (Leiden University) (submittedVersion, cc-by)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion, cc-by-nc-nd)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion, other-oa)
- Pure Amsterdam UMC (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Netherlands Organisation for Health Research and Development (636110005)
- 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
- internet-based cognitive behavioral therapy, transdiagnostic treatment, depressive symptoms, anxiety symptoms, university students, quality of life, academic performance, university dropout, medication adherence, treatment satisfaction
- MeSH terms
- Internet-Based Intervention, Adolescent, Adult, Anxiety, Depression, Humans, Quality of Life, Students, Cognitive Behavioral Therapy, Treatment Outcome, Internet
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