A Systematic Review and Meta-Analysis of Third-Wave Online Interventions for Depression
Open accessAbstract
Online psychological interventions for the treatment of depression are increasing as an alternative to traditional face-to-face psychotherapy. Adaptations of cognitive behavioral therapy for the treatment of depression have been tested, with meta-analyses showing weighted effect sizes ranging from d = 0.40 to 0.56. However, there is less evidence on the effect of adaptations of third-wave behavioral therapies for depression. Accordingly, this study reviews the evidence of online applications of third-wave behavioral therapies for depression. Nine randomized clinical trials were found with a total of 1910 participants. Most of these trials implemented online versions of behavioral activation (BA) and acceptance and commitment therapy (ACT). All studies reported positive effects of third-wave therapies. A meta-analysis was conducted with the 6 studies (N = 1744) that compared an online intervention versus wait-list or treatment as usual conditions. Medium to large effect sizes were found with a weighted effect size of d = 0.61. In conclusion, online adaptations of third-wave therapies seem to be legitimate options for the treatment of depression.
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Existing meta-analyses on the effect of online psychological interventions have found small to medium effect sizes for the treatment of anxiety and depression.
“Existing meta-analyses on the effect of online psychological interventions (OPIs) have found small to medium effect sizes for the treatment of anxiety and depression.”
From Revisión sistemática y metaanálisis de intervenciones transdiagnósticas en línea de tercera generación (2023) · cites this paper as Sierra et al., 2018
The paper reports that earlier meta-analyses of online CBT interventions for depression found medium effects (d = 0.40–0.56), with small effects in interventions without support (section labelled Abstract; page unavailable). It does not report corresponding effect sizes for the treatment of anxiety, so the claim's extension to both conditions is unsupported. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThe current results are coherent with existing literature that reported small to medium effect sizes for the treatment of depression and anxiety using third-wave OPIs.
“The current results are also coherent with the findings of existing literature that reported small to medium effect sizes for the treatment of depression and anxiety using third-wave OPIs (Kelson et al., 2019; O'Connor et al., 2018; Sierra et al., 2018).”
From Revisión sistemática y metaanálisis de intervenciones transdiagnósticas en línea de tercera generación (2023) · cites this paper as Sierra et al., 2018
The Meta-analysis reports a medium pooled effect (d = 0.61) for third-wave online interventions for depression, supporting that part of the claim. The Discussion describes individual effects as medium to large, not small to medium, and the review does not establish a treatment effect for anxiety. Page numbers were not supplied in our copy. (LLM, conf=0.89)
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Cites
Yaşlı Kadınlarda Üreme Sağlığı
Kokanalı, D., & Engin Üstün, Y. (n.d.) · DergiPark (Istanbul University) · Cited by 170,090 · see citing works
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139 · see citing works
The CES-D Scale: A Self-Report Depression Scale for Research in the General Population
Radloff, L. S. (1977) · Applied Psychological Measurement · doi:10.1177/014662167700100306 · Cited by 53,267 · see citing works
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910 · see citing works
Diagnostic and Statistical Manual of Mental Disorders.
Widiger, T. A. (2000) · Oxford University Press eBooks · doi:10.1037/10518-009 · Cited by 19,767 · see citing works
(1998) · The Journal of Clinical Psychiatry · Cited by 19,139 · see citing works
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2009) · doi:10.1002/9780470743386 · Cited by 14,225 · see citing works
Detection of Postnatal Depression: Development of the 10-item Edinburgh Postnatal Depression Scale
Cox, J. L., Holden, J. M., & Sagovsky, R. (1987) · British Journal of Psychiatry · doi:10.1192/bjp.150.6.782 · Cited by 14,183 · see citing works
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2021) · doi:10.1002/9781119558378 · Cited by 9,799 · see citing works
Jacobson, N. S., & Truax, P. (1991) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.59.1.12 · Cited by 7,770 · see citing works
Beck, A. T., Steer, R. A., & Brown, G. (2011) · PsycTESTS Dataset · doi:10.1037/t00742-000 · Cited by 7,535 · see citing works
(1993) · Cited by 7,136 · see citing works
Cognitive-Behavioral Treatment of Borderline Personality Disorder
Cary, G. L. (1994) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.1994.48.1.155 · Cited by 6,300 · see citing works
(1999) · Cited by 5,934 · see citing works
Distribution Theory for Glass's Estimator of Effect Size and Related Estimators
Hedges, L. V. (1981) · Journal of Educational Statistics · doi:10.2307/1164588 · Cited by 5,695 · see citing works
The Handbook of Research Synthesis and Meta-Analysis
(2019) · doi:10.7758/9781610448864 · Cited by 4,553 · see citing works
Depression, chronic diseases, and decrements in health: results from the World Health Surveys
Moussavi, S., Chatterji, S., Verdes, E., Tandon, A., Patel, V., & Ustun, B. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61415-9 · Cited by 4,070 · see citing works
World health statistics 2016 : monitoring health for the SDGs, sustainable development goals
de la Salud, O. M. (2016) · Virtual Defense Library (Ministerio de Defensa) · Cited by 3,358 · see citing works
Writing About Emotional Experiences as a Therapeutic Process
Pennebaker, J. W. (1997) · Psychological Science · doi:10.1111/j.1467-9280.1997.tb00403.x · Cited by 2,486 · see citing works
Eysenbach, G. (2001) · Journal of Medical Internet Research · doi:10.2196/jmir.3.2.e20 · Cited by 2,449 · see citing works
Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: A meta-analysis
SPEK, V., CUIJPERS, P., NYKLÍČEK, I., RIPER, H., KEYZER, J., & POP, V. (2007) · Psychological Medicine · doi:10.1017/s0033291706008944 · Cited by 1,586 · see citing works
Computer-based psychological treatments for depression: A systematic review and meta-analysis
Richards, D., & Richardson, T. (2012) · Clinical Psychology Review · doi:10.1016/j.cpr.2012.02.004 · Cited by 1,442 · see citing works
Internet-Based and Other Computerized Psychological Treatments for Adult Depression: A Meta-Analysis
Andersson, G., & Cuijpers, P. (2009) · Cognitive Behaviour Therapy · doi:10.1080/16506070903318960 · Cited by 1,368 · see citing works
Barak, A., Hen, L., Boniel-Nissim, M., & Shapira, N. (2008) · Journal of Technology in Human Services · doi:10.1080/15228830802094429 · Cited by 1,283 · see citing works
Metacognitive therapy for anxiety and depression
Veeraraghavan, V. (2009) · Anxiety, Stress & Coping · doi:10.1080/10615800902833770 · Cited by 1,165 · see citing works
(2008) · Research Explorer (The University of Manchester) · Cited by 988 · see citing works
Spijkerman, M. P. J., Pots, W. T. M., & Bohlmeijer, E. T. (2016) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.03.009 · Cited by 975 · see citing works
(2001) · Medical Entomology and Zoology · Cited by 915 · see citing works
Hayes, S. C., Villatte, M., Levin, M., & Hildebrandt, M. (2011) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-032210-104449 · Cited by 800 · see citing works
Defining Internet-Supported Therapeutic Interventions
Barak, A., Klein, B., & Proudfoot, J. G. (2009) · Annals of Behavioral Medicine · doi:10.1007/s12160-009-9130-7 · Cited by 731 · see citing works
Harnessing context sensing to develop a mobile intervention for depression
Burns, M. N., Begale, M., Duffecy, J., Gergle, D., Karr, C. J., Giangrande, E., & Mohr, D. C. (2011) · Journal of Medical Internet Research · doi:10.2196/jmir.1838 · Cited by 646 · see citing works
Prigerson, H., & Jacobs, S. (2001) · American Psychological Association eBooks · doi:10.1037/10436-026 · Cited by 567 · see citing works
Boelen, P. A., de Keijser, J., van den Hout, M. A., & van den Bout, J. (2007) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.75.2.277 · Cited by 454 · see citing works
Functional Analytic Psychotherapy : Creating Intense and Curative Therapeutic Relationships
Kohlenberg, R. J., & Tsai, M. (2012) · Cited by 423 · see citing works
Individualism-Collectivism and Social Capital
Allïk, J., & Realo, A. (2004) · Journal of Cross-Cultural Psychology · doi:10.1177/0022022103260381 · Cited by 396 · see citing works
Meyer, B., Berger, T., Caspar, F., Beevers, C. G., Andersson, G., & Weiss, M. (2009) · Journal of Medical Internet Research · doi:10.2196/jmir.1151 · Cited by 363 · see citing works
Cavanagh, K., Strauss, C., Forder, L., & Jones, F. (2014) · Clinical Psychology Review · doi:10.1016/j.cpr.2014.01.001 · Cited by 340 · see citing works
Psychological treatment of depression: Results of a series of meta-analyses
Cuijpers, P., Andersson, G., Donker, T., & van Straten, A. (2011) · Nordic Journal of Psychiatry · doi:10.3109/08039488.2011.596570 · Cited by 335 · see citing works
Ly, K. H., Trüschel, A., Jarl, L., Magnusson, S., Windahl, T., Johansson, R., Carlbring, P., & Andersson, G. (2014) · BMJ Open · doi:10.1136/bmjopen-2013-003440 · Cited by 269 · see citing works
Ebert, D. D., Cuijpers, P., Muñoz, R. F., & Baumeister, H. (2017) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2017.00116 · Cited by 244 · see citing works
(2016) · Cited by 240 · see citing works
O'Mahen, H. A., Woodford, J., McGinley, J., Warren, F. C., Richards, D. A., Lynch, T. R., & Taylor, R. S. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.03.005 · Cited by 202 · see citing works
O'Mahen, H. A., Richards, D. A., Woodford, J., Wilkinson, E., McGinley, J., Taylor, R. S., & Warren, F. C. (2014) · Psychological Medicine · doi:10.1017/s0033291713002092 · Cited by 201 · see citing works
Brown, M., Glendenning, A., Hoon, A. E., & John, A. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.6200 · Cited by 198 · see citing works
Krusche, A., Cyhlarova, E., & Williams, J. M. G. (2013) · BMJ Open · doi:10.1136/bmjopen-2013-003498 · Cited by 192 · see citing works
Distance delivery of mindfulness-based cognitive therapy for depression: Project UPLIFT
Thompson, N. J., Walker, E. R., Obolensky, N., Winning, A., Barmon, C., DiIorio, C., & Compton, M. T. (2010) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2010.07.031 · Cited by 185 · see citing works
Eisma, M. C., Boelen, P. A., van den Bout, J., Stroebe, W., Schut, H. A. W., Lancee, J., & Stroebe, M. S. (2015) · Behavior Therapy · doi:10.1016/j.beth.2015.05.007 · Cited by 185 · see citing works
Carlbring, P., Hägglund, M., Luthström, A., Dahlin, M., Kadowaki, Å., Vernmark, K., & Andersson, G. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.12.020 · Cited by 177 · see citing works
Effectiveness of Online Self-Help for Suicidal Thoughts: Results of a Randomised Controlled Trial
van Spijker, B. A. J., van Straten, A., & Kerkhof, A. J. F. M. (2014) · PLoS ONE · doi:10.1371/journal.pone.0090118 · Cited by 142 · see citing works
Lappalainen, P., Granlund, A., Siltanen, S., Ahonen, S., Vitikainen, M., Tolvanen, A., & Lappalainen, R. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.07.006 · Cited by 138 · see citing works
Pots, W. T. M., Fledderus, M., Meulenbeek, P. A. M., ten Klooster, P. M., Schreurs, K. M. G., & Bohlmeijer, E. T. (2016) · British Journal of Psychiatry · doi:10.1192/bjp.bp.114.146068 · Cited by 133 · see citing works
Dimidjian, S., Arch, J. J., Schneider, R. L., Desormeau, P., Felder, J. N., & Segal, Z. V. (2016) · Behavior Therapy · doi:10.1016/j.beth.2016.07.002 · Cited by 130 · see citing works
Ethical issues in providing online psychotherapeutic interventions
Childress, C. A. (2000) · Journal of Medical Internet Research · doi:10.2196/jmir.2.1.e5 · Cited by 116 · see citing works
Lappalainen, P., Langrial, S., Oinas-Kukkonen, H., Tolvanen, A., & Lappalainen, R. (2015) · Behavior Modification · doi:10.1177/0145445515598142 · Cited by 115 · see citing works
Functional Analytic Psychotherapy: Creating Intense and Curative Therapeutic Relationships
Hoover, H. (1991) · Cited by 109 · see citing works
Dimidjian, S., Beck, A., Felder, J. N., Boggs, J. M., Gallop, R., & Segal, Z. V. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.09.004 · Cited by 87 · see citing works
Development of a web-based intervention for the indicated prevention of depression
Kelders, S. M., Pots, W. T., Oskam, M. J., Bohlmeijer, E. T., & van Gemert-Pijnen, J. E. (2013) · BMC Medical Informatics and Decision Making · doi:10.1186/1472-6947-13-26 · Cited by 80 · see citing works
Murray, G., Leitan, N., Berk, M., Thomas, N., Michalak, E. E., Berk, L., Johnson, S. L., Jones, S. H., Perich, T., Allen, N. B., et al. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.02.024 · Cited by 71 · see citing works
Felder, J. N., Segal, Z. V., Beck, A. L., Sherwood, N. E., Goodman, S. H., Boggs, J. M., Lemon, E. L., & Dimidjian, S. (2016) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2016.02.002 · Cited by 47 · see citing works
E-therapy: The Ethics Behind the Process
Kotsopoulou, A., Melis, A., Violetta-Irene, K., & Karasarlidou, C. (2015) · Procedia Computer Science · doi:10.1016/j.procs.2015.09.120 · Cited by 32 · see citing works
Initial Open Trial of a Computerized Behavioral Activation Treatment for Depression
Spates, C. R., Kalata, A. H., Ozeki, S., Stanton, C. E., & Peters, S. (2012) · Behavior Modification · doi:10.1177/0145445512455051 · Cited by 19 · see citing works
Online self-help for suicidal thoughts: 3-month follow-up results and participant evaluation
van Spijker, B. A. J., van Straten, A., & Kerkhof, A. J. F. M. (2015) · Internet Interventions · doi:10.1016/j.invent.2015.07.001 · Cited by 10 · see citing works
Flagged first, then by citations
4 of the 67 references couldn’t be matched to a known paper.
Research works printed but not linked: 3
- First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W. (1997). Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Washington, D.C.: American Psychiatric Press.
- Kohlenberg, R. J., & Tsai, M. (1991). Functional analytic psycho- therapy: Creating intense and curative therapeutic relation- ships. New York, NY: Springer.
- Segal, Z. V., Williams, M. G., & Teasdale, J. D. (2002). Mindful- ness-Based Cognitive Therapy: A new approach to preventing relapse. New York, NY: Guilford Press
Cited by
Sorted by citations
Rauschenberg, C., Schick, A., Hirjak, D., Seidler, A., Paetzold, I., Apfelbacher, C., Riedel-Heller, S. G., & Reininghaus, U. (2021) · Journal of Medical Internet Research · doi:10.2196/23365 · Cited by 205 · see citing works
Klimczak, K. S., San Miguel, G. G., Mukasa, M. N., Twohig, M. P., & Levin, M. E. (2023) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2023.2178498 · Cited by 88 · see citing works
Bennett, C. B., Ruggero, C. J., Sever, A. C., & Yanouri, L. (2020) · Journal of Psychotherapy Integration · doi:10.1037/int0000217 · Cited by 87 · see citing works
Digital mental health interventions for the treatment of depression: A multiverse meta-analysis
Plessen, C. Y., Panagiotopoulou, O. M., Tong, L., Cuijpers, P., & Karyotaki, E. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.10.018 · Cited by 53 · see citing works
Planas, R., & Yuguero, O. (2021) · Informatics for Health and Social Care · doi:10.1080/17538157.2021.1887196 · Cited by 17 · see citing works
Cunha, O., Pereira, B., Sousa, M., & Rodrigues, A. D. C. (2024) · Aggression and Violent Behavior · doi:10.1016/j.avb.2024.101923 · Cited by 17 · see citing works
Davis, C. H., Twohig, M. P., & Levin, M. E. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.12.097 · Cited by 12 · see citing works
Pearson, R., Carl, E., & Creech, S. K. (2021) · Journal of Medical Internet Research · doi:10.2196/30065 · Cited by 11 · see citing works
Apolinário-Hagen, J., Drüge, M., Hennemann, S., & Breil, B. (2021) · Advances in experimental medicine and biology · doi:10.1007/978-981-33-6044-0_17 · Cited by 10 · see citing works
Davis, C. H., Donahue, M. L., Gaudiano, B. A., Uebelacker, L. A., Twohig, M. P., & Levin, M. E. (2023) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2023.2265560 · Cited by 4 · see citing works
Sierra, M. A., & Ruiz, F. J. (2022) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2022.08.003 · Cited by 5 · see citing works
Self-citationSierra, M. A., & Ortíz, E. (2023) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2023.03.010 · Cited by 10 · see citing works
Self-citationCao, Q., Du, X., Ruiz, F. J., sierra, M. A., Yu, X., & Ren, Z. (2025) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2025.09.006 · Cited by 2 · see citing works
Self-citationSierra, M. A., & Ortiz, E. (2023) · Interdisciplinaria Revista de Psicología y Ciencias Afines · doi:10.16888/interd.2023.40.2.5 · Cited by 1 · see citing works
Self-citationThe Effectiveness of Intervention with Intimate Partner Violence Perpetrators: An Umbrella Review
Sousa, M., Silva, T. P. E., Almeida, T. C., Santirso, F. A., Caridade, S., & Cunha, O. S. (2026) · Journal of Family Violence · doi:10.1007/s10896-026-01115-z · Cited by 1 · see citing works
Self-Compassion Pada Ibu Dengan Postpartum Depression: Kajian Literatur
Amalia, S., Kurniawati, D., & Rahmawati, I. (2023) · Alauddin Scientific Journal of Nursing · doi:10.24252/asjn.v5i1.40174
- Authors
- Sierra, M. A., Ruiz, F. J., & Flórez, C. L.
- Affiliations
- Fundación Universitaria Konrad Lorenz (CO)
- Corresponding author
- Ruiz, Francisco J.
- Venue
- Revista Latinoamericana de Psicología
- Published
- 2018-09-30
- Volume
- 50
- Issue
- 2
- Pages
- 126
- ISSN
- 0120-0534 (ISSN-L)
- OpenAlex
- W2890336202
- Cited by
- 15
- References
- 67
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 5 · 2022: 1 · 2021: 4 · 2020: 1
- FWCI
- 0.17
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- Revista Latinoamericana de Psicología (publishedVersion, cc-by-nc-nd)
- Dialnet (Universidad de la Rioja) (submittedVersion)
- Redalyc (Universidad Autónoma del Estado de México) (submittedVersion)
- Funders
- Ministerio de Educación y Ciencia (SEJ 2004-07311/EDUC)
- 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 › Mindfulness and Compassion Interventions
- Keywords
- depression, online intervention, behavioral activation, acceptance and commitment therapy, digital mental health, internet-based psychotherapy, treatment effect size
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