Effects of digital psychotherapy for depression and anxiety: A systematic review and bayesian network meta-analysis
Abstract
Objective To evaluate the effectiveness of digital psychotherapies for depression and anxiety. We conducted a systematic review and network meta-analyses (NMA) to make comparisons of digital psychotherapies.Methods A bayesian NMA was conducted in this study. The databases including PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials and CINAL were searched for all eligible randomized controlled trials (RCTs) published from Jan 1, 2012 to Oct 1, 2022. We used the Cochrane Collaboration's Risk of bias tool for quality assessment. The primary outcomes were set as a standardized mean difference model in efficacy to describe continuous outcomes. We used STATA and WinBUGS to conduct a bayesian network meta-analysis of all interventions based on a random-effects model. This study was registered with PROSPERO, number CRD42022374558.Results From the retrieved 16,750 publications, we included 72 RCTs (13,096 participants) with the overall medium quality and above. In terms of depression scale, cognitive behavioral therapy (CBT) was more effective than TAU (SMDs 0.53) and NT (SMDs 0.98). In terms of anxiety scale, CBT (SMDs 0.68; SMDs 0.72) and exercise therapy (ERT) (SMDs 1.01; SMDs 1.05) were more effective than TAU and NT.Limitations Uneven quality of literature, simple network, and subjective judgment.Conclusion Based on NMA results, we suggest that CBT, which is the most commonly used digital technology, should be preferred among digital psychotherapy for relieving depression and anxiety symptoms. Digital exercise therapy is an effective strategy to relieve some anxiety problems in the context of COVID-19.
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Most prior reviews relied on traditional pairwise meta-analysis, limiting comparisons to directly contrasted interventions and precluding simultaneous evaluation of multiple approaches.
“In addition, most prior reviews have relied on traditional pairwise meta-analysis, limiting comparisons to interventions directly contrasted in primary studies and precluding simultaneous evaluation of multiple approaches [33].”
From The Effect of Different Psychological Interventions on Athletes' Competitive Anxiety: A Systematic Review and Bayesian Network Meta-Analysis. (2026) · cites this paper as [33]
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Whiteside, S. P. H., Biggs, B. K., Ollendick, T. H., Dammann, J. E., Tiede, M. S., Hofschulte, D. R., Reneson-Feeder, S. T., Cunningham, M. L., Sawchuk, N. R., Geske, J. R., et al. (2022) · Behavior Therapy · doi:10.1016/j.beth.2022.01.010 · Cited by 14 · see citing works
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Addressing depression and behavioral health needs through a digital program at scale
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Biskupiak, Z., Ha, V. V., Rohaj, A., & Bulaj, G. W. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13020403 · Cited by 42 · see citing works
Zainal, N. H., Soh, C. P., Doren, N. V., & Benjet, C. L. (2024) · Clinical Psychology Review · doi:10.1016/j.cpr.2024.102518 · Cited by 32 · see citing works
Chen, J., Liu, L., Wang, Y., Qin, H., & Liu, C. (2024) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2024.111609 · Cited by 23 · see citing works
Effectiveness of telemedicine on common mental disorders: An umbrella review and meta-meta-analysis
Chen, J., Li, C., An, K., Dong, X., Liu, J., & Wu, H. Y. (2024) · Computers in Human Behavior · doi:10.1016/j.chb.2024.108325 · Cited by 16 · see citing works
Liu, S., Li, M., Ding, J., Ji, Q., Niu, Y., Yang, X. Y., Ai, S., & Li, S. (2025) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2025.07.004 · Cited by 13 · see citing works
Wolitzky-Taylor, K. B., Wen, A., Freimer, N. B., & Craske, M. G. (2025) · Neuropsychopharmacology · doi:10.1038/s41386-025-02174-4 · Cited by 17 · see citing works
Coumoundouros, C., Arab, R. A. E., Farrand, P. A., Hamilton, A., Sanderman, R., von Essén, L., & Woodford, J. (2023) · JMIR Human Factors · doi:10.2196/51461 · Cited by 8 · see citing works
“A CBT-based intervention was proposed given that internet-administered CBT is effective for depression and anxiety [7,28] and that CBT is the predominant therapeutic method adopted by the NHS Talking Therapies for Anxiety and Depression service [29].”
Langhammer, T., Hilbert, K., Wasenmueller, R., Praxl, B., Ertle, A., Asbrand, J., & Lueken, U. (2024) · Depression and Anxiety · doi:10.1155/2024/8950388 · Cited by 7 · see citing works
“Interestingly, two meta-analyses report large effect sizes for both depression and anxiety when examining internet-based full-blown CBT therapy for clinically diagnosed patients [33, 34].”
Wu, J., Tsai, Y.-Y., Chen, Y.-J., Hsiao, F., Hsu, C., Lin, K., & Liao, L. (2024) · Medical & Biological Engineering & Computing · doi:10.1007/s11517-024-03209-6 · Cited by 9 · see citing works
“Many studies have shown that remote psychotherapy conducted by therapists has a more substantial effect size and involves a lower number of treatments than face-to-face therapy for treating depressive disorder, panic disorder, anxiety disorder [63–65], insomnia [66], and PTSD.”
Wakabayashi, H., Mori, T., Nishioka, S., Maeda, K., Yoshimura, Y., Iida, Y., Shiraishi, A., & Fujiwara, D. (2023) · Journal of General and Family Medicine · doi:10.1002/jgf2.668 · Cited by 5 · see citing works
Li, L., Wang, J., Li, Q., & Fu, Q. (2026) · Sports Medicine - Open · doi:10.1186/s40798-026-01007-y · Cited by 5 · see citing works
“In addition, most prior reviews have relied on traditional pairwise meta-analysis, limiting comparisons to interventions directly contrasted in primary studies and precluding simultaneous evaluation of multiple approaches [33].”
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Li, L., Li, Q., Wang, J., Fu, Q., & Chi, M. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07227-y · Cited by 3 · see citing works
“Most previous reviews focus on only one or two treatment types and often rely on traditional meta-analysis that limit comparisons to treatments tested directly against one another [22, 24, 56].”
The effectiveness of virtual reality to improve depression: A systematic evidence map
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Effects of green exercise on mental health: a systematic review and meta-analysis
Liu, X., Sun, Z., Wang, X. Y., Dong, D., & Samsudin, S. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1802759 · Cited by 4 · see citing works
“Current strategies, including pharmacological treatments, psychotherapy, and community-based interventions, have proven effective (Heinz and Liu, 2022; Wang et al., 2023; Zhang et al., 2025).”
Goh, R., Ng, S. X., Tan, J., Pikkarainen, M. A., & He, H. G. (2025) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2025.103007 · Cited by 2 · see citing works
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“In recent years, a variety of DMHIs have been introduced to improve the dissemination of interventions for the treatment of common mental disorders on a large scale (19).”
Adu, P., Grigoryev, D. S., Rita, H. A., Mbinta, J. F., Jarvis, G. E., & Jurcik, T. (2025) · Mental Health & Prevention · doi:10.1016/j.mhp.2025.200406 · Cited by 1 · see citing works
Boltivets, S. I., Gonchar, T., Uralova, L., Honchar, O., & Chelyadyn, Y. (2025) · Eastern Ukrainian Medical Journal · doi:10.21272/eumj.2025;13(1):93-102 · Cited by 1 · see citing works
Preiß, M., Stamenkovich, K., Schimmerl, B., Ronay, F. C., Thiemel, C. M., Zarifzadeh, J. A., Wuketich, E., Varga, R. L., Schmidt, C., Schwarzenberg, J., et al. (2025) · SSRN Electronic Journal · doi:10.2139/ssrn.5213394 · Cited by 1 · see citing works
Kein Grund zur Panik, kein Grund zur Euphorie
Boeck, M. (2024) · Philosophie, Naturwissenschaft und Technik · doi:10.57088/978-3-7329-8889-1_13
Cao, Y., Xin, R., Wang, M., Song, D., & Dong, X. (2026) · Acta Psychologica · doi:10.1016/j.actpsy.2026.106649
Self-citationYu, W., Huang, L., Lv, D., Li, M. T., Huang, Y., Li, Y., & Wang, X. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1811907
“Studies were classified as high risk if two or more domains were rated high; as low risk if five or more domains were rated low and none were rated high; and as moderate risk if they did not meet either threshold (12).”
Zainal, N. H. (2024) · OSF Preprints (OSF Preprints)
- Authors
- Wang, M., Chen, H., Yang, F., Xu, X., & Li, J.
- Affiliations
- Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
- Corresponding author
- Li, Jiao
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2023-10
- Volume
- 338
- Pages
- 569-580
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W4382542510
- Cited by
- 25
- References
- 97
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 8 · 2023: 2
- FWCI
- 0.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Hunan Provincial Science and Technology Department
- Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences
- 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 › Psychotherapy Techniques and Applications
- Keywords
- digital psychotherapy, depression, anxiety, cognitive behavioral therapy, exercise therapy, usual care, online intervention, COVID-19 pandemic, treatment efficacy comparison
- MeSH terms
- COVID-19, Anxiety, Depression, Humans, Psychotherapy
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