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Two decades of digital interventions for anxiety disorders: a systematic review and meta-analysis of treatment effectiveness
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Abstract Background Digital interventions for anxiety disorders are a promising solution to address barriers to evidence-based treatment access. Precise and powerful estimates of digital intervention effectiveness for anxiety disorders are necessary for further adoption in practice. The present systematic review and meta-analysis examined the effectiveness of digital interventions across all anxiety disorders and specific to each disorder v. wait-list and care-as-usual controls. Methods A systematic search of bibliographic databases identified 15 030 abstracts from inception to 1 January 2020. Forty-seven randomized controlled trials (53 comparisons; 4958 participants) contributed to the meta-analysis. Subgroup analyses were conducted by an anxiety disorder, risk of bias, treatment support, recruitment, location and treatment adherence. Results A large, pooled effect size of g = 0.80 [95% Confidence Interval: 0.68–0.93] was found in favor of digital interventions. Moderate to large pooled effect sizes favoring digital interventions were found for generalized anxiety disorder ( g = 0.62), mixed anxiety samples ( g = 0.68), panic disorder with or without agoraphobia ( g = 1.08) and social anxiety disorder ( g = 0.76) subgroups. No subgroups were significantly different or related to the pooled effect size. Notably, the effects of guided interventions ( g = 0.84) and unguided interventions ( g = 0.64) were not significantly different. Supplemental analysis comparing digital and face-to-face interventions (9 comparisons; 683 participants) found no significant difference in effect [ g = 0.14 favoring digital interventions; Confidence Interval: −0.01 to 0.30]. Conclusion The precise and powerful estimates found further justify the application of digital interventions for anxiety disorders in place of wait-list or usual care.
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“Evidence suggests that internet-based treatments are effective for the treatment of anxiety disorders and depression [35,36].”
From Evaluation and Future Challenges in a Self-Guided Web-Based Intervention With and Without Chat Support for Depression and Anxiety Symptoms During the COVID-19 Pandemic: Randomized Controlled Trial (2024) · cites this paper as [36]
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“Several meta-analyses [16] show that self-guided and guided DMHIs, particularly internet CBT-based programs, significantly improve symptoms of depression (83 studies; Hedge g=0.52, 95% CI 0.43‐0.60 [15]) and anxiety (47 studies, Hedge g=0.80, 95% CI 0.68‐0.93) [18].”
In the citing paper
“For anxiety, a recent meta-analysis [16] reported that compared to inactive controls, guided and self-guided DMHIs significantly reduced anxiety symptoms across 47 studies, with a large pooled effect size (Hedges g=0.80; 95% CI 0.68-0.93).”
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“Digital mental health interventions (DMHIs) are effective in reducing symptoms of depression and anxiety.”
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Metadata
- Authors
- Pauley, D., Cuijpers, P., Papola, D., Miguel, C., & Karyotaki, E.
- Affiliations
- Amsterdam Public Health (NL)
- University of Verona (IT)
- Harvard University (US)
- Corresponding author
- Pauley, Darin
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2021-05-28
- Volume
- 53
- Issue
- 2
- Pages
- 1-13
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC9899576
- OpenAlex
- W3165857807
- Cited by
- 170
- References
- 101
- Citations by year
- 2026: 29 · 2025: 46 · 2024: 45 · 2023: 33 · 2022: 9 · 2021: 8
- FWCI
- 3.82
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Psychological Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- 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 › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- digital interventions, anxiety disorders, treatment effectiveness, generalized anxiety disorder, panic disorder, social anxiety disorder, agoraphobia, medication adherence, access to mental health care
- MeSH terms
- Phobia, Social, Anxiety, Anxiety Disorders, Humans, Panic Disorder, Treatment Outcome
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