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Internet- and Mobile-Based Psychological Interventions: Applications, Efficacy, and Potential for Improving Mental Health: A Report of the EFPA E-Health Taskforce
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Abstract. The majority of mental health disorders remain untreated. Many limitations of traditional psychological interventions such as limited availability of evidence-based interventions and clinicians could potentially be overcome by providing Internet- and mobile-based psychological interventions (IMIs). This paper is a report of the Taskforce E-Health of the European Federation of Psychologists’ Association and will provide an introduction to the subject, discusses areas of application, and reviews the current evidence regarding the efficacy of IMIs for the prevention and treatment of mental disorders. Meta-analyses based on randomized trials clearly indicate that therapist-guided stand-alone IMIs can result in meaningful benefits for a range of indications including, for example, depression, anxiety, insomnia, or posttraumatic stress disorders. The clinical significance of results of purely self-guided interventions is for many disorders less clear, especially with regard to effects under routine care conditions. Studies on the prevention of mental health disorders (MHD) are promising. Blended concepts, combining traditional face-to-face approaches with Internet- and mobile-based elements might have the potential of increasing the effects of psychological interventions on the one hand or to reduce costs of mental health treatments on the other hand. We also discuss mechanisms of change and the role of the therapist in such approaches, contraindications, potential limitations, and risk involved with IMIs, briefly review the status of the implementation into routine health care across Europe, and discuss confidentiality as well as ethical aspects that need to be taken into account, when implementing IMIs. Internet- and mobile-based psychological interventions have high potential for improving mental health and should be implemented more widely in routine care.
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“Most online interventions are grounded in Cognitive Behavioral Therapy (CBT), with the majority of these using traditional CBT techniques (e.g. cognitive restructuring, progressive muscle relaxation, etc.; Ebert et al., 2018; Fleming et al., 2018).”
From A systematic review and meta-analysis of self-guided online acceptance and commitment therapy as a transdiagnostic self-help intervention (2023) · cites this paper as Ebert et al., 2018
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“They are effective in treating and preventing a broad range of disorders (19, 20), yet uptake remains low as students lack knowledge and experience with IMI but show positive attitudes towards apps (i.e., future expectations and less fear of risks) (21).”
From Mental health services for German university students: acceptance of intervention targets and preference for delivery modes (2024) · cites this paper as [19]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“A promising approach to address the challenge of low uptake of mental health services could be telehealth interventions which can be used flexibly in time and location and thus, facilitate health care access (Ebert et al., 2018; Snoswell et al., 2021).”
From How to promote usage of telehealth interventions for farmers' mental health? A qualitative study on supporting and hindering aspects for acceptance and satisfaction with a personalized telephone coaching for depression prevention (2023) · cites this paper as Ebert et al., 2018
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“While there is already substantial evidence in the area of digital interventions in the field of mental health, there is still much to learn about the needs and best way of providing digital interventions for people with medical conditions (Ebert et al., 2018).”
From Special issue on digital health interventions in chronic medical conditions: Editorial (2022) · cites this paper as Ebert et al., 2018
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The research on IMIs has so far almost exclusively focused on stand-alone IMIs, i.e., online interventions that are used as an alternative to on-site treatment (8, 9).”
From Clinical and Cost-Effectiveness of PSYCHOnlineTHERAPY: Study Protocol of a Multicenter Blended Outpatient Psychotherapy Cluster Randomized Controlled Trial for Patients With Depressive and Anxiety Disorders (2021) · cites this paper as [8]
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“IMIs have the potential to overcome barriers to help-seeking by offering anonymous, flexible, and easily accessible support whenever and wherever needed, thereby reducing feelings of shame and stigmatization (Ebert et al., 2018).”
From PandaMom – Feasibility and acceptability of an internet- and mobile-based intervention to enhance peripartum mental well-being and to prevent postpartum depression (2024) · cites this paper as Ebert et al., 2018
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“several trials suggesting near equivalent effects as compared to face-to-face therapy”
From A systematic review and meta-analysis of self-guided online acceptance and commitment therapy as a transdiagnostic self-help intervention (2023) · cites this paper as Ebert et al., 2018
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“Researchers on telehealth interventions have argued that remotely delivered health service might offer low-threshold access to (mental) health care (Ebert et al., 2018; Snoswell et al., 2021) and improves health care in underserved areas (Myers, 2019; Salize et al., 2007), which is supported for farming communities by our interviewees.”
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“Other studies revealed that digital health interventions, including smartphone apps, showed significant clinical improvements in depression and anxiety (19), and psychosis (20).”
From Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review (2022) · cites this paper as [19]
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“Internet and mobile-based interventions (IMIs) can help overcome barriers of face-to-face treatments.30–32”
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“Numerous clinical trials summarized in several meta-analyses have now shown the effectiveness of IMIs in the treatment of mental disorders (8), particularly well-studied in depressive disorders and anxiety disorders (10, 11).”
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“Internet- and mobile-based interventions (IMIs) can provide a means of making evidence-based psychotherapeutic interventions available in a timely manner, thereby contributing to reducing the shortage of care (8, 9).”
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“a recent narrative review of digital interventions reported large effect sizes for participants with major depressive disorder, anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder and small effect sizes for eating disorders or problematic alcohol use [23].”
From The therapeutic alliance in digital mental health interventions for serious mental illnesses: narrative review (2020) · cites this paper as [23]
In the citing paper
“In addition, supported digital interventions have comparably smaller attrition rates and greater engagement, as demonstrated in systematic reviews [23,85].”
From The therapeutic alliance in digital mental health interventions for serious mental illnesses: narrative review (2020) · cites this paper as [23]
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“Using the internet to provide psychotherapeutic interventions may increase the coverage of usual care services [8,9] by providing highly accessible and scalable interventions reaching people who cannot be reached otherwise.”
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Special issue on digital health interventions in chronic medical conditions: Editorial
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Self-citationOláh, B., Rádi, B. M., & Kósa, K. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19137662 · Cited by 15
Grant, J. B., Gulliver, A., Calear, A. L., Farrer, L. M., & Batterham, P. J. (2023) · Journal of Mental Health · doi:10.1080/09638237.2023.2210663 · Cited by 16
Empower Psychotherapy with mHealth Apps: The Design of “Safer”, an Emotion Regulation Application
Diano, F., Sica, L. S., & Ponticorvo, M. (2023) · Information · doi:10.3390/info14060308 · Cited by 18
Undergraduate Students' Attitudes towards Online Counseling since the COVID-19 Pandemic
Yurayat, P., & Seechaliao, T. (2022) · Higher Education Studies · doi:10.5539/hes.v12n1p72 · Cited by 17
Dropping the E: The potential for integrating e-mental health in psychotherapy
Daele, T. V., Best, P., Bernaerts, S., Assche, E. V., & Witte, N. A. J. D. (2021) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2021.02.007 · Cited by 14
Persuasive e-Health Design for Behavior Change
Baumeister, H., Kraft, R., Baumel, A., Pryss, R. C., & Meßner, E.-M. (2022) · Studies in neuroscience, psychology and behavioral economics · doi:10.1007/978-3-030-98546-2_20 · Cited by 16
Self-citationAngerer, F., Mennel, V., Grund, S., Mayer, A., Büscher, R., Sander, L., Cuijpers, P. J., Terhorst, Y., Baumeister, H., & Domhardt, M. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.09.055 · Cited by 17
Self-citationApps in der Sekundärprävention nach Schlaganfall
Fruhwirth, V., Enzinger, C., Weiss, E. M., Schwerdtfeger, A. R., Gattringer, T., & Pinter, D. (2019) · Wiener Medizinische Wochenschrift · doi:10.1007/s10354-019-00707-3 · Cited by 14
Pabst, A., Löbner, M., Stein, J., Luppa, M., Kersting, A., König, H., & Riedel-Heller, S. G. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00735 · Cited by 14
Bielinski, L. L., & Berger, T. (2020) · Counseling Psychology and Psychotherapy · doi:10.17759/cpp.2020280305 · Cited by 17
Goldkind, L., & Wolf, L. (2021) · Families in Society The Journal of Contemporary Social Services · doi:10.1177/1044389421997796 · Cited by 15
Küchler, A.-M., Schultchen, D., Pollatos, O., Moshagen, M., Ebert, D. D., & Baumeister, H. (2020) · Trials · doi:10.1186/s13063-020-04868-0 · Cited by 12
Self-citationSchaeuffele, C., Heinrich, M., Behr, S., Fenski, F., Hammelrath, L., Zagorscak, P., Jansen, A., Pohl, S., Boettcher, J., & Knaevelsrud, C. (2022) · Trials · doi:10.1186/s13063-022-06757-0 · Cited by 15
Backend Concept of the eSano eHealth Platform for Internet- and Mobile-based Interventions
Idrees, A. R., Kraft, R., Pryss, R. C., Reichert, M., Nguyen, T. B. D., Stenzel, L., & Baumeister, H. (2022) · IEEE International Conference on Wireless and Mobile Computing, Networking and Communications (WiMob) · doi:10.1109/wimob55322.2022.9941520 · Cited by 13
Self-citationDrews‐Windeck, E., Greenwood, K., & Cavanagh, K. (2023) · Journal of Clinical Psychology · doi:10.1002/jclp.23523 · Cited by 19
Braun, P., Schwientek, A.-K., Angerer, P., Guthardt, L., Icks, A., Loerbroks, A., & Apolinário-Hagen, J. (2023) · Digital Health · doi:10.1177/20552076231173568 · Cited by 14
Aboye, G. T., Walle, M. V., Simegn, G. L., & Aerts, J. (2023) · Digital Health · doi:10.1177/20552076231178420 · Cited by 13
Costanzo, F., Fucà, E., Caciolo, C., Ruà, D., Smolley, S., Weissberg, D., & Vicari, S. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1176683 · Cited by 13
Harrer, M., Apolinário-Hagen, J., Fritsche, L., Drüge, M., Krings, L., Beck, K., Salewski, C., Zarski, A., Lehr, D., Baumeister, H., et al. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00361 · Cited by 17
Self-citationMoshe, I., Terhorst, Y., Cuijpers, P. J., Cristea, I. A., Pulkki-Råbäck, L., & Sander, L. (2020) · JMIR Research Protocols · doi:10.2196/14860 · Cited by 14
Online psychotherapy practice by psychodynamic therapists
Machado, L. F., Feijó, L. P., & Serralta, F. B. (2020) · Psico · doi:10.15448/1980-8623.2020.3.36529 · Cited by 15
Köhnen, M., Kriston, L., Härter, M., Dirmaier, J., & Liebherz, S. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-028042 · Cited by 10
Saruhanjan, K., Zarski, A., Schaub, M. P., & Ebert, D. D. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00190 · Cited by 14
Self-citationNaor, N., Frenkel, A., & Winsberg, M. E. (2022) · JMIR Formative Research · doi:10.2196/36018 · Cited by 15
Amanvermez, Y., Karyotaki, E., Cuijpers, P. J., Čihařová, M., Donker, M. H., Hurks, P. P. M., Salemink, E., Spinhoven, P., Struijs, S. Y., & de Wit, L. M. (2023) · JMIR Formative Research · doi:10.2196/45725 · Cited by 15
Hennemann, S., Böhme, K., Baumeister, H., Bendig, E., Kleinstäuber, M., Ebert, D. D., & Witthöft, M. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-024929 · Cited by 16
Self-citationTomaino, S. C. M., Viganó, G., & Cipolletta, S. (2022) · International Journal of Human-Computer Interaction · doi:10.1080/10447318.2022.2111047 · Cited by 13
Thielecke, J., Buntrock, C., Freund, J., Braun, L., Ebert, D. D., Berking, M., Baumeister, H., & Titzler, I. (2023) · Internet Interventions · doi:10.1016/j.invent.2023.100671 · Cited by 10
“Researchers on telehealth interventions have argued that remotely delivered health service might offer low-threshold access to (mental) health care (Ebert et al., 2018; Snoswell et al., 2021) and improves health care in underserved areas (Myers, 2019; Salize et al., 2007), which is supported for…”
BackgroundSelf-citationA Blended Cognitive–Behavioral Intervention for the Treatment of Postpartum Depression: A Case Study
Branquinho, M., Canavarro, M. C., & Fonseca, A. (2022) · Clinical Case Studies · doi:10.1177/15346501221082616 · Cited by 11
“…also contributes to increasing women’s autonomy, by allowing them to advance in their own time and at their own pace, to access contents and exercises between sessions with a psychologist (Titzler et al., 2018), and reducing the shame and stigma associated with help-seeking (Ebert et al., 2018).”
BackgroundFreund, J., Buntrock, C., Braun, L., Thielecke, J., Baumeister, H., Berking, M., Ebert, D. D., & Titzler, I. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100566 · Cited by 11
Self-citationBarber, C. C., & Masters‐Awatere, B. (2021) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.12333 · Cited by 14
Digital competency of Psychologists in Aotearoa New Zealand: A cross-sectional survey
Dobson, R., Variava, R., Douglas, M., & Reynolds, L. (2022) · Frontiers in Digital Health · doi:10.3389/fdgth.2022.951366 · Cited by 14
Kasinopoulos, O., Vasiliou, V. S., & Karekla, M. (2023) · Internet Interventions · doi:10.1016/j.invent.2023.100611 · Cited by 14
Self-citationLanghammer, T., Hilbert, K., Praxl, B., Kirschbaum, C., Ertle, A., Asbrand, J., & Lueken, U. (2021) · Mental Health & Prevention · doi:10.1016/j.mhp.2021.200221 · Cited by 12
Baumeister, H., & Montag, C. (2022) · Studies in neuroscience, psychology and behavioral economics · doi:10.1007/978-3-030-98546-2_1 · Cited by 12
Self-citationVogel, L., Färber, T., Hölzl, I., Deliens, T., Henning, C., Liel, C., Löchner, J., Lux, U., Opitz, A., Seiferth, C., et al. (2023) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-023-05735-x · Cited by 11
Buntrock, C., Kählke, F., Smit, F., & Ebert, D. D. (2019) · European Journal of Public Health · doi:10.1093/eurpub/ckz022 · Cited by 11
Self-citationBüscher, R., Beisemann, M., Doebler, P., Steubl, L., Domhardt, M., Cuijpers, P. J., Kerkhof, A. J. F. M., & Sander, L. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17145179 · Cited by 11
Hensel, D. J., von Hippel, C. D., Sandidge, R., Lapage, C. C., Zelin, N. S., & Perkins, R. H. (2021) · The Journal of Sex Research · doi:10.1080/00224499.2021.1912277 · Cited by 12
Metadata
- Authors
- Ebert, D. D., Van Daele, T., Nordgreen, T., Karekla, M., Compare, A., Zarbo, C., Brugnera, A., Øverland, S., Trebbi, G., Jensen, K. L., Kaehlke, F., & Baumeister, H.
- Affiliations
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- Department of Applied Psychology, Thomas More University of Applied Sciences, Antwerp, Belgium
- Haukeland University Hospital (NO)
- University of Cyprus (CY)
- University of Bergamo (IT)
- SuperEgo AS, Trondheim, Norway
- Trebbipsicologie, Luxembourg & Societé Luxembourgeoise de Psychologie SLP, Luxembourg
- Private Practice, Skagen, Denmark
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
- Universität Ulm (DE)
- ORCID
- Venue
- European Psychologist
- Publisher
- Hogrefe Publishing Group
- Published
- 2018-05
- Volume
- 23
- Issue
- 2
- Pages
- 167-187
- ISSN
- 1016-9040 (ISSN-L)
- 1878-531X
- OpenAlex
- W2803511537
- Cited by
- 437
- References
- 179
- Citations by year
- 2026: 34 · 2025: 56 · 2024: 64 · 2023: 54 · 2022: 65 · 2021: 58 · 2020: 55 · 2019: 38 · 2018: 12
- FWCI
- 51.39
- Type
- journal article
- Language
- en
- Open access
- Locations
- European Psychologist (publishedVersion)
- Bournemouth University Research Online (Bournemouth University) (acceptedVersion)
- Bournemouth University Research Online (Bournemouth University) (submittedVersion)
- Aisberg (University of Bergamo) (submittedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- online psychological intervention, e-mental health, depression, anxiety, insomnia, post-traumatic stress disorder, mental disorder prevention, blended intervention, therapist-guided intervention, self-guided intervention, mechanisms of change, confidentiality, implementation in routine care, treatment costs
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