Practitioner review: Unguided and guided self-help interventions for common mental health disorders in children and adolescents: a systematic review and meta-analysis
Open accessAbstract
Mental health problems are common in children and adolescents, yet evidence-based treatments are hard to access. Self-help interventions can increase such access. The aim of this paper was to conduct a systematic review and meta-analysis of the use of guided and unguided self-help for children and young people with symptoms of common mental health disorders. In contrast to previous reviews of self-help in children, all types of self-help and multiple mental health disorders were investigated in order to increase power to investigate potential moderators of efficacy. Importantly, studies with control arms as well as those comparing against traditional face-to-face treatments were included. Fifty studies (n = 3396 participants in self-help/guided self-help conditions) met the inclusion criteria. Results demonstrated a moderate positive effect size for guided and unguided self-help interventions when compared against a control group (n = 44; g = 0.49; 95% CI: 0.37 to 0.61, p < .01) and a small but significant negative effect size when compared to other therapies (n = 15; g = -0.17; 95% CI: -0.27 to -0.07, p < .01). Few potential moderators had a significant effect on outcome. Most comparisons resulted in significant heterogeneity and therefore results are interpreted with caution.
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According to a meta-analysis, for self-guided digital interventions to be efficient for youths, at least minimal support from a human therapist is needed.
“Second, according to a meta-analysis, for self-guided digital interventions to be efficient for youths, at least minimal support from a human therapist is needed55.”
From Use of automated conversational agents in improving young population mental health: a scoping review (2024) · cites this paper as [55]
The Meta-analysis section reports that all self-help subgroups, including unguided interventions, were more effective than controls; guidance was associated with larger effects, not shown to be necessary. The Discussion describes superiority of guided interventions as only potential, and the paper does not establish a minimum therapist-support requirement specifically for digital interventions. No page numbers are available in our copy. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredReviews 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 [101]
The Meta-analysis section reports larger effects for guided than unguided self-help, although the difference was not significant when restricted to low-risk-of-bias studies. The Discussion suggests parental involvement may matter, particularly for younger children, but says the review could not test whether it was associated with effect size. No page numbers are available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSmartphone-delivered interventions can be unguided (offering treatment without personal contact or individualized feedback) or guided (offering varying amounts of personal support).
“Beyond this, interventions can be unguided, offering treatment without personal contact or individualized feedback, or guided, offering varying amounts of personal support (Andersson, 2018; Bennett et al., 2019).”
From Smartphone-delivered mental health care interventions for refugees: A systematic review of the literature (2023) · cites this paper as Bennett et al., 2019
The Introduction describes guided self-help as involving varying degrees of therapist input. The Discussion distinguishes guidance from other personal contact, such as emails encouraging adherence, so the paper does not establish that unguided interventions involve no personal contact; it also does not specifically address smartphone-delivered interventions. Page numbers were not available in our copy. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThese findings support the notion that therapist-guided online therapy and self-help materials are functionally distinct from one another.
“These findings support the notion that therapist-guided online therapy and self-help materials are functionally distinct from one another [22].”
From Efficacy of a six-week-long therapist-guided online therapy versus self-help internet-based therapy for COVID-19–induced anxiety and depression: Open-label, pragmatic, randomized controlled trial (2021) · cites this paper as [22]
The Discussion reports better outcomes with support in some comparisons and some evidence of greater effect sizes for computerised interventions than for bibliotherapy or other self-help. These findings support distinctions by guidance and format, but the review does not directly establish that therapist-guided online therapy and self-help materials are functionally distinct. Page numbers were not available in our copy. (LLM, conf=0.79)
Experimental — accuracy not yet measuredSelf-help interventions including bibliotherapy and computerized therapy have shown a moderate positive effect size compared to control groups, although they are generally less effective than face-to-face therapies.
“Self-help interventions including bibliotherapy99 and computerized therapy100 have shown a moderate positive effect size when compared to control groups although they are generally less effective than face to face therapies.101”
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 [101]
Recent controlled studies found that self-help interventions can be effective in reducing depression and anxiety.
“Recent controlled studies found that self-help interventions can be effective in reducing depression and anxiety (Andrews et al., 2018; Bennett et al., 2019; Cuijpers et al., 2019; Karyotaki et al., 2021).”
From Effects of self-guided stress management interventions in college students: A systematic review and meta-analysis (2022) · cites this paper as Bennett et al., 2019
Participants in the control group showed improvement as a result of the efficacy of the self-help materials, presumably due to regression of the mean and natural progression of these conditions with time.
“Nevertheless, participants in the control group did show an improvement as a result of the efficacy of the self-help materials, presumably due to the regression of the mean and the natural progression of these conditions with time [22].”
From Efficacy of a six-week-long therapist-guided online therapy versus self-help internet-based therapy for COVID-19–induced anxiety and depression: Open-label, pragmatic, randomized controlled trial (2021) · cites this paper as [22]
The Meta-analysis section reports that self-help improved outcomes relative to control conditions, including waiting lists and nonactive treatment as usual. It does not report whether control participants improved, attribute any such improvement to self-help materials, or discuss regression to the mean or natural progression; searches for those terms found no supporting passage. (LLM, conf=0.76)
Experimental — accuracy not yet measuredDetection bias regarding OCD self-report measures was considered to be based on a low risk of bias.
“In line with Bennet et al. (2019) [39], detection bias regarding OCD self-report measures were considered to be based on a low risk of bias.”
From Low intensity technology-delivered cognitive behavioral therapy for obsessive-compulsive disorder: a meta-analysis (2021) · cites this paper as [39]
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Self-citationWuthrich, V. M., Rapee, R. M., McLellan, L. F., Wignall, A., Jagiello, T., Norberg, M. M., & Belcher, J. (2021) · Child Psychiatry & Human Development · doi:10.1007/s10578-021-01291-7 · Cited by 3 · see citing works
Sung, J. Y., Kacmarek, C. N., & Schleider, J. L. (2020) · doi:10.31234/osf.io/mhe4w · Cited by 3 · see citing works
Mikhaylova, O. R., Gulina, E., Fomicheva, E. V., Ivashkina, E., Nagoryanskaya, A., Jyrgalbek, J., Shelkanova, D., Valiahmetova, D., Цыганова, Е. М., & Kudinova, V. (2025) · International Journal of Adolescence and Youth · doi:10.1080/02673843.2025.2474039 · Cited by 2 · see citing works
Bucher, K. A., Moriarty, C. M., Lazarchak, A., & McIntire, R. K. (2025) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph22071135 · Cited by 2 · see citing works
Translation to the clinic and other modalities
Taylor, J. E., Jalon, I., Chiba, T., Motegi, T., Kawato, M., & Hendler, T. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-822421-2.00002-8 · Cited by 2 · see citing works
The Toolbox Approach: Towards a Novel Flexible Way of Implementing and Testing Positive Education
Lucciarini, E., & Boniwell, I. (2023) · Springer eBooks · doi:10.1007/978-981-99-5609-8_8 · Cited by 2 · see citing works
Skaarnes, H., Sørensen, N. M., Wisnewski, A. H., Lomholt, J. J., Thastum, M., McLellan, L. F., & Mathiasen, K. (2024) · Trials · doi:10.1186/s13063-024-08511-0 · Cited by 3 · see citing works
Davey, E., Bryant‐Waugh, R., Bennett, S. D., Micali, N., Baudinet, J., Konstantellou, A., Clark-Stone, S., Green, A., & Shafran, R. (2025) · European Eating Disorders Review · doi:10.1002/erv.3171 · Cited by 2 · see citing works
Self-citationTreier, A., Hautmann, C., Dose, C., Nordmann, L., Katzmann, J., Pinior, J., Scholz, K., & Döpfner, M. (2022) · Child Psychiatry & Human Development · doi:10.1007/s10578-022-01400-0 · Cited by 2 · see citing works
Frick, U., Sipar, D., Bücheler, L., Haug, F., Haug, J., Almeqbaali, K. M., Pryss, R. C., Rosner, R., & Comteße, H. (2023) · JMIR Formative Research · doi:10.2196/44551 · Cited by 2 · see citing works
- Authors
- Bennett, S. D., Cuijpers, P., Ebert, D. D., McKenzie Smith, M., Coughtrey, A. E., Heyman, I., Manzotti, G., & Shafran, R.
- Affiliations
- University College London (GB)
- Amsterdam Public Health (NL)
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- UCL Great Ormond Street Institute of Child Health London UK
- Great Ormond Street Hospital (GB)
- Corresponding author
- Bennett, Sophie D.
- Venue
- Journal of Child Psychology and Psychiatry
- Publisher
- Wiley
- Published
- 2019-02-18
- Volume
- 60
- Issue
- 8
- Pages
- 828-847
- ISSN
- 0021-9630 (ISSN-L)
- 1469-7610
- OpenAlex
- W2915432956
- Cited by
- 162
- References
- 92
- Citations by year
- 2026: 12 · 2025: 17 · 2024: 24 · 2023: 27 · 2022: 40 · 2021: 26 · 2020: 13 · 2019: 3
- FWCI
- 2.87
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Child Psychology and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- VU Research Portal (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust/Institute of Cancer Research
- National Institute for Health and Care Research
- University College London
- Great Ormond Street Hospital for Children
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- self-help intervention, guided self-help, children and adolescents, common mental disorders, treatment efficacy, access to mental health care, treatment moderators
- MeSH terms
- Self-Management, Adolescent, Mental Disorders, Child, Preschool, Humans, Self Care, Outcome Assessment, Health Care
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