Response and Remission Rates in Internet-Based Cognitive Behavior Therapy: An Individual Patient Data Meta-Analysis
Open accessAbstract
Background: Internet-delivered cognitive behavior therapy (ICBT) was developed over 20 years ago and has since undergone a number of controlled trials, as well as several systematic reviews and meta-analyses. However, the crucial question of response rates remains to be systematically investigated. The aim of this individual patient meta-analysis (IPDMA) was to use a large dataset of trials conducted in Sweden to determine reliable change and recovery rates across trials for a range of conditions. Methods: We used previously collected and aggregated data from 2866 patients in 29 Swedish clinical trials of ICBT for three categories of conditions: anxiety disorders, depression, and other. Raw scores at pre-treatment and post-treatment were used in an IPDMA to determine the rate of reliable change and recovery. Jacobson and Truax’s (1991) reliable change index (RCI) was calculated for each primary outcome measure in the trials as well as the recovery rates for each patient, with the additional requirement of having improved substantially. We subsequently explored potential predictors using binomial logistic regression. Results: Applying an RCI of z = 1.96, 1162 (65.6%) of the patients receiving treatment were classified as achieving recovery, and 620 (35.0%) were classified as reaching remission. In terms of predictors, patients with higher symptom severity on the primary outcome measure at baseline (odds ratio [OR] = 1.36) and being female (OR = 2.22) increased the odds of responding to treatment. Having an anxiety disorder was found to decrease the response to treatment (OR = 0.51). Remission was predicted by diagnosis in the same direction (OR = 0.28), whereas symptom severity was inversely predictive of worse outcome (OR = 0.81). Conclusions: Response seems to occur among approximately half of all clients administered ICBT, whereas about a third reach remission. This indicates that the efficacy of ICBT is in line with that of CBT based on prior trials, with a possible caveat being the lower remission rates. Having more symptoms and being female might increase the chances of improvement, and a small negative effect of having anxiety disorder versus depression and other conditions may also exist.
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Guided ICBT is likely as effective as face-to-face CBT.
“According to 2 systematic reviews with meta-analyses, guided ICBT is likely as effective as face-to-face CBT [9,10].”
From Feasibility of Guided Internet-Based Cognitive Behavioral Therapy for Panic Disorder and Social Anxiety Disorder in Japan: Pilot Single-Arm Trial (2024) · cites this paper as [9]
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“8) 279 (10) Social anxiety disorder 541 (30.”
BackgroundInternet-based cognitive—behavior therapy for procrastination: A randomized controlled trial.
Rozental, A., Forsell, E., Svensson, A., Andersson, G., & Carlbring, P. (2015) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000023 · Cited by 103 · see citing works
Self-citationIvarsson, D., Blom, M., Hesser, H., Carlbring, P., Enderby, P., Nordberg, R., & Andersson, G. (2014) · Internet Interventions · doi:10.1016/j.invent.2014.03.002 · Cited by 102 · see citing works
Self-citationAndersson, G., Waara, J., Jonsson, U., Malmaeus, F., Carlbring, P., & Öst, L. (2009) · Cognitive Behaviour Therapy · doi:10.1080/16506070902931326 · Cited by 101 · cited 1× · see citing works
“population SCID-I Relationship problems Guided CBT (80) Wait-list with”
BackgroundSelf-citationDahlin, M., Andersson, G., Magnusson, K., Johansson, T., Sjögren, J., Håkansson, A., Pettersson, M., Kadowaki, Å., Cuijpers, P., & Carlbring, P. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.12.007 · Cited by 86 · cited 3× · see citing works
“Oroshjälpen (18) General population SCID-I Generalized anxiety disorder Guided ACT (52) Wait-list (51) 7 modules/9 weeks GAD-7 PSWQ, GADQ-IV, BAI, MADRS-S, PHQ9, QOLI 27 (64.”
BackgroundSelf-citationInternet-based treatment of pathological gambling with a three-year follow-up
Carlbring, P., Degerman, N., Jonsson, J., & Andersson, G. (2012) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2012.689323 · Cited by 78 · see citing works
Self-citationMukaka, M., White, S. A., Terlouw, D. J., Mwapasa, V., Kalilani‐Phiri, L., & Faragher, E. B. (2016) · Trials · doi:10.1186/s13063-016-1473-3 · Cited by 75 · cited 1× · see citing works
“Given the complexity of modeling reasons for missing data in such a heterogeneous group of research participants and the fact that we were focused on binary outcomes in this review, we decided to use a complete case approach instead of multiple imputation, as we were convinced that data were not missing completely at…”
MethodRozental, A., Andersson, G., & Carlbring, P. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00589 · Cited by 74 · cited 6× · see citing works
“Individual Patient Data Meta-Analysis As described in our two previous IPDMAs (26, 27), we used the scores for individual client and outcome variable across studies female might increase the chances of improvement, and a small negative effect of having”
BackgroundMethodResultInfluentialAndersson, E., Walén, C., Hallberg, J., Paxling, B., Dahlin, M., Almlöv, J., Källström, R., Wijma, K., Carlbring, P., & Andersson, G. (2011) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2011.02391.x · Cited by 73 · cited 4× · see citing works
“*Based on complete case analysis, i.e., only complete data. aSeparate analyses of deterioration were conducted for the two primary outcome measures depending on the diagnosis of the patient. bFour treatment conditions were included in the study, with/without treatment rationale, respectively, but are pooled in the cur…”
MethodInfluentialSelf-citationBoettcher, J., Hasselrot, J., Sund, E., Andersson, G., & Carlbring, P. (2014) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2013.809141 · Cited by 68 · cited 1× · see citing works
“Sofie 13 (72) General population SCID-I Social anxiety disorder Guided CBT with CBM (61), Guided CBT without CBM (65), n.”
MethodSelf-citationAkl, E. A., Kahale, L. A., Agoritsas, T., Brignardello-Petersen, R., Busse, J. W., Carrasco-Labra, A., Ebrahim, S., Johnston, B. C., Neumann, I., Sola, I., et al. (2015) · Systematic Reviews · doi:10.1186/s13643-015-0083-6 · Cited by 66 · cited 2× · see citing works
“Stella (63) General population SCID-I and II Depression Guided CBT (33), group therapy (36), guided CBT as preferred choice (16) n.”
MethodSilfvernagel, K., Westlinder, A., Andersson, S., Bergman, K., Diaz Hernandez, R., Fallhagen, L., Lundqvist, I., Masri, N., Viberg, L., Forsberg, M.-L., et al. (2018) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2017.1388276 · Cited by 65 · see citing works
Self-citationStröm, M., Uckelstam, C.-J., Andersson, G., Hassmén, P., Umefjord, G., & Carlbring, P. (2013) · PeerJ · doi:10.7717/peerj.178 · Cited by 64 · cited 1× · see citing works
“Finally, there are also programs based on physical exercise (20), mindfulness (21), and relaxation (22), even if the latter two are often incorporated into ICBT protocols (23).”
BackgroundSelf-citationThe Internet and CBT: A Clinical Guide
Andersson, G. (2014) · doi:10.1201/b13645 · Cited by 63 · cited 4× · see citing works
“One way to describe ICBT is to pinpoint the similarities with online education, even if the treatment is largely based on self-help texts and cognitive behavioral therapy (CBT) manuals (3).”
BackgroundMethodInfluentialSelf-citationHeeren, A., Maurage, P., Rossignol, M., Vanhaelen, M., Peschard, V., Eeckhout, C., & Philippot, P. (2012) · Canadian Journal of Behavioural Science / Revue canadienne des sciences du comportement · doi:10.1037/a0026249 · Cited by 61 · cited 3× · see citing works
“Depressionshjälpen (64) General population SCID-I Depression Guided CBT (40) Wait-list (40) 7 modules/8 weeks BDI MADRS-S, BAI, QOLI, WAI 26 (66.”
BackgroundMethodAndersson, G., Waara, J., Jonsson, U., Malmaeus, F., Carlbring, P., & Öst, L.-G. (2013) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2013.844202 · Cited by 59 · see citing works
Reliability and validity of the self-report version of the Panic Disorder Severity Scale in Korea
Lee, E.-H., Kim, J.-H., & Yu, B.-H. (2009) · Depression and Anxiety · doi:10.1002/da.20461 · Cited by 55 · see citing works
Johansson, R., Hesslow, T., Ljótsson, B., Jansson, A., Jonsson, L., Färdig, S., Karlsson, J., Hesser, H., Frederick, R. J., Lilliengren, P., et al. (2017) · Psychotherapy · doi:10.1037/pst0000147 · Cited by 55 · cited 1× · see citing works
“Stella (63) General population SCID-I and II Depression Guided CBT (33), group therapy (36), guided CBT as preferred choice (16) n.”
MethodSelf-citationPallesen, S., Nordhus, I. H., Carlstedt, B., Thayer, J. F., & Johnsen, T. B. (2006) · Scandinavian Journal of Psychology · doi:10.1111/j.1467-9450.2006.00518.x · Cited by 52 · see citing works
The fear of fear concept: Stability, retest artefact and predictive power
Arrindell, W. A. (1993) · Behaviour Research and Therapy · doi:10.1016/0005-7967(93)90065-3 · Cited by 50 · see citing works
Boettcher, J., Magnusson, K., Marklund, A., Berglund, E., Blomdahl, R., Braun, U., Delin, L., Lundén, C., Sjöblom, K., Sommer, D., et al. (2018) · Computers in Human Behavior · doi:10.1016/j.chb.2018.04.052 · Cited by 47 · see citing works
Self-citationMediators in Internet-Based Cognitive Behavior Therapy for Severe Health Anxiety
Hedman, E., Andersson, E., Andersson, G., Lindefors, N., Lekander, M., Rück, C., & Ljótsson, B. (2013) · PLoS ONE · doi:10.1371/journal.pone.0077752 · Cited by 43 · cited 19× · see citing works
“Challenger (62) General population MINI Social anxiety disorder Unguided CBT with smartphone application (68), unguided bibliotherapy (70) Wait-list (69) 9 modules/6 weeks LSAS-SR GAD-7, PHQ-9, QOLI, BBQ, Mini-SPIN 40 (62.5”
BackgroundInfluentialSelf-citationBehavioral activation versus physical activity via the internet: A randomized controlled trial
Nyström, M. B. T., Stenling, A., Sjöström, E., Neely, G., Lindner, P., Hassmén, P., Andersson, G., Martell, C. R., & Carlbring, P. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.03.018 · Cited by 43 · see citing works
Self-citationLindegaard, T., Brohede, D., Koshnaw, K., Osman, S. S., Johansson, R., & Andersson, G. (2019) · Journal of Clinical Psychology · doi:10.1002/jclp.22753 · Cited by 34 · see citing works
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Effectiveness of digital mental health interventions for university students: An umbrella review
Harith, S., Backhaus, I., Mohbin, N., Ngo, H. T., & Khoo, S. (2022) · PeerJ · doi:10.7717/peerj.13111 · Cited by 105 · see citing works
Wallert, J., Boberg, J., Kaldo, V., Mataix-Cols, D., Flygare, O., Crowley, J. J., Halvorsen, M., Ben Abdesslem, F., Boman, M., Andersson, E., et al. (2022) · Translational Psychiatry · doi:10.1038/s41398-022-02133-3 · Cited by 48 · see citing works
“As there is room for improvement, researchers have begun to investigate what variables predict symptom reduction [3, 8, 10], remission status [11], and other outcomes proximal to ICBT response such as adherence [12], and dropout [13].”
BackgroundResultEsfandiari, N., Mazaheri, M. A., Akbari-Zardkhaneh, S., Sadeghi-Firoozabadi, V., & Cheraghi, M. (2021) · International Journal of Preventive Medicine · doi:10.4103/ijpvm.ijpvm_208_21 · Cited by 45 · see citing works
“International Journal of Preventive Medicine 2021, 12: 153 6 In a recent study that investigated the remission rates in ICBT, symptom severity seems to be predictive of outcome inversely, while having more symptoms and being a female increase the chance of improvement.[24]”
BackgroundNiles, A. N., Axelsson, E., Andersson, E., Hedman‐Lagerlöf, E., Carlbring, P., Andersson, G., Johansson, R., Widén, S., Driessen, J., Santoft, F., et al. (2020) · Behaviour Research and Therapy · doi:10.1016/j.brat.2020.103767 · Cited by 35 · see citing works
Self-citationDigitalising mental health care: Practical recommendations from the European Psychiatric Association
Kalman, J. L., Burkhardt, G., Samochowiec, J., Gebhard, C., Dom, G., John, M., Kılıç, Ö., Kurimay, T., Lien, L., Schouler‐Ocak, M., et al. (2023) · European Psychiatry · doi:10.1192/j.eurpsy.2023.2466 · Cited by 34 · see citing works
“As of 2022, over 300.000 DMHIs offering psychoeducation and treatment for patients with mental health problems have been developed [5, 6].”
BackgroundInfluentialAn observational treatment study of metacognition in anxious-depression
Fox, C. A., Lee, C. T., Hanlon, A. K., Seow, T. X., Lynch, K., Harty, S., Richards, D., Palacios, J., O'Keane, V., Stephan, K. E., et al. (2023) · eLife · doi:10.7554/elife.87193 · Cited by 34 · see citing works
Benjet, C. L., Albor, Y., Alvis–Barranco, L., Contreras‐Ibáñez, C. C., Montoya, G. P. C., Cudris–Torres, L., González, N., Morelos, J. C., Gutiérrez–García, R. A., Medina‐Mora, M. E., et al. (2023) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000846 · Cited by 30 · see citing works
Scholten, W., Seldenrijk, A., Hoogendoorn, A. W., Bosman, R. C., Muntingh, A., Karyotaki, E., Andersson, G., Berger, T., Carlbring, P., Furmark, T., et al. (2023) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2023.1291 · Cited by 28 · see citing works
Self-citationDigital technological interventions in mental health care
Srivastava, K., Chaudhury, S., Dhamija, S., Prakash, J., & Chatterjee, K. (2020) · Industrial Psychiatry Journal · doi:10.4103/ipj.ipj_32_21 · Cited by 22 · see citing works
“[3] As digital approaches to mental health increase, there is also space for artificial intelligence (AI) to be used to predict or detect or treat mental health issues.”
BackgroundRemote cognitive behaviour therapy for social anxiety disorder: A meta-analysis
Winter, H. R., Norton, A. R., Burley, J., & Wootton, B. M. (2023) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2023.102787 · Cited by 22 · see citing works
Bantjes, J. R., Hunt, X., Cuijpers, P. J., Kazdin, A. E., Kennedy, C. J., Luedtke, A. R., Malenica, I., Petukhova, M. V., Sampson, N. A., Zainal, N. H., et al. (2024) · Behaviour Research and Therapy · doi:10.1016/j.brat.2024.104554 · Cited by 21 · see citing works
Persson Asplund, R., Asplund, S., von Buxhoeveden, H., Delby, H., Eriksson, K., Svenning Gerhardsson, M., Palm, J., Skyttberg, T., Torstensson, J., Ljótsson, B., et al. (2023) · Journal of Medical Internet Research · doi:10.2196/34446 · Cited by 18 · see citing works
“There are indications that greater initial symptom severity results in higher response and remission rates [77,78].”
Zantvoort, K., Scharfenberger, J., Boß, L., Lehr, D., & Funk, B. (2023) · Journal of Healthcare Informatics Research · doi:10.1007/s41666-023-00148-z · Cited by 19 · see citing works
“DMHIs can be unguided self-help interventions or can include guidance by e-coaches, for example, via calls or messages [6].”
BackgroundSchubert, K., Lohse, J., Kalder, M., Ziller, V., & Weise, C. (2022) · Trials · doi:10.1186/s13063-022-06204-0 · Cited by 17 · see citing works
Zainal, N. H., & Newman, M. G. (2024) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2024.102825 · Cited by 17 · see citing works
The latest developments with internet-based psychological treatments for depression
Andersson, G. (2024) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2024.2309237 · Cited by 17 · see citing works
“As with psychotherapy in general, not all clients respond to internet-based psychological treatments [6], and there are several challenges for researchers to consider when it comes to understanding mechanisms of change, predicting what works for whom and to target sub-groups such as ethnic…”
BackgroundSelf-citationInternet Interventions in Clinical Psychology
Andersson, G., & Carlbring, P. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00211-9 · Cited by 15 · see citing works
Self-citationDahlin, M., Johansson, A., Romare, H., Carlbring, P., & Andersson, G. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100531 · Cited by 15 · see citing works
Self-citationForsell, E., Jernelöv, S., Blom, K., & Kaldo, V. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100554 · Cited by 14 · see citing works
Mårtensson, E., Coumoundouros, C., Sörensdotter, R., von Essén, L., & Woodford, J. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.09.093 · Cited by 15 · see citing works
“Indeed, higher symptoms of depression at baseline are associated with better outcomes (Andersson et al., 2019; Buckman et al., 2021; Cuijpers et al., 2022).”
Lopes, R. D. C. T., Šipka, D., Krieger, T., Klein, J. P., & Berger, T. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100480 · Cited by 13 · see citing works
Guided Internet-Delivered Treatment for Depression: Scoping Review
Børtveit, L., Dechsling, A., Sütterlin, S., Nordgreen, T., & Nordahl‐Hansen, A. (2022) · JMIR Mental Health · doi:10.2196/37342 · Cited by 11 · see citing works
Innovating CBT and Answering New Questions: the Role of Internet-Delivered CBT
Andersson, G. (2023) · International Journal of Cognitive Therapy · doi:10.1007/s41811-023-00199-5 · Cited by 10 · see citing works
“One example was an umbrella review on 9 meta-analytic reviews out of a total of 618 meta-analytic reviews identified (Andersson et al., 2019b).”
Self-citationDahlin, M., Carlbring, P., Håkansson, A., & Andersson, G. (2020) · Digital Psychiatry · doi:10.1080/2575517x.2020.1822730 · Cited by 9 · see citing works
“Response and remission rates appear to be similar to face-to-face CBT as well [12].”
Self-citationHalbeisen, G., & Paslakis, G. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10204703 · Cited by 7 · see citing works
Spalding, D. M., Ejoor, T., Zhao, X., Bomarsi, D., Ciliberti, M., Ottaviani, C., Valášek, M., Hirsch, C. R., Critchley, H., & Meeten, F. (2025) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-025-09687-0 · Cited by 9 · see citing works
“While increased symptom severity is associated with increased likelihood of treatment response to cognitive interventions, having an anxiety disorder conversely decreases these odds (Andersson et al., 2019).”
Hegazi, O. E., Alalalmeh, S. O., Alfaresi, A., Dashtinezhad, S., Bahada, A., Shahwan, M. J., Jairoun, A. A., Babalola, T. K., & Yasin, H. K. A. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192316063 · Cited by 6 · see citing works
“At large, digital technological interventions have shown promise, with some illustrating the potential of digital interventions as a tool to break the barriers of conventional mental health services and the stigma that follows it [47], and others displaying its potential in furthering cognitive behavioral therapy [48].”
BackgroundHammerfald, K., Jahren, H. H., & Solbakken, O. A. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1494729 · Cited by 5 · see citing works
Shafierizi, S., Basirat, Z., Amiri, F. N., Kheirkhah, F., Geraili, Z., Pasha, H., & Faramarzi, M. (2024) · BMC Psychiatry · doi:10.1186/s12888-023-05484-3 · Cited by 7 · see citing works
“For example, previous studies suggested that high pre-treatment symptom severity [14, 17] and comorbidity [14] are associated with poorer response, while other studies showed that having more symptoms, higher education, and being female were predictors of treatment improvement [21, 22].”
ResultDahlin, M. (2020) · Linköping studies in behavioural science · doi:10.3384/diss.diva-170049 · Cited by 5 · see citing works
Chan, W. W. L., Wu, K. C., Li, S. X., Tsang, K. K. Y., Shum, K. K., Kwan, H. W., Su, M. R., & Lam, S. (2024) · Mindfulness · doi:10.1007/s12671-024-02430-6 · Cited by 5 · see citing works
“Despite the promising results, most evidence for online psychological interventions pertains to traditional cognitive behavioral therapy (Andersson et al., 2019).”
Jackson, H. M., Batterham, P. J., Ohan, J. L., Calear, A. L., & Farrer, L. M. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05953-3 · Cited by 4 · see citing works
“However, not all individuals who use these interventions will experience benefits [8].”
BackgroundZhang, D., Bi, H., & Zhao, W. (2024) · Journal of Cancer Survivorship · doi:10.1007/s11764-024-01712-1 · Cited by 4 · see citing works
Rozental, A., Shafran, R., Johansson, F., Forsström, D., Jovicic, F., Gelberg, O., Molin, K., Carlbring, P., Andersson, G., & Buhrman, M. (2024) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2024.2327339 · Cited by 4 · see citing works
“In terms of binary outcomes, approximately one-third of the participants in iCBT-P were classified as recovered and about 40% as improved, which is slightly higher than for iCBT overall (35.0%; Andersson, Carlbring, et al., 2019).”
ResultInfluentialSelf-citationBrog, N. A., Hegy, J. K., Berger, T., & Znoj, H. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.835356 · Cited by 3 · see citing works
Machine Learning Model for Response to Internet-Delivered CBT vs Antidepressant Medication
Lee, C. T., Richards, D., Heinzle, J., Hanlon, A. K., Lynch, K., Harty, S., Claus, N., O’Keane, V., Stephan, K. E., Whelan, R., et al. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.41639 · Cited by 3 · see citing works
The Relationship Between CBT-Mindedness and iCBT Outcomes Amongst a Large Adult Sample
McLellan, L. F., Hobbs, M. J., Peters, L., Millard, M., & Mahoney, A. (2022) · Cognitive Therapy and Research · doi:10.1007/s10608-022-10298-w · Cited by 3 · see citing works
“Despite strong efficacy, not all individuals who start treatment engage, complete it, or recover (Andersson et al., 2019; Springer et al., 2018).”
BackgroundBjurner, P., Isacsson, N. H., Abdesslem, F. B., Boman, M., Forsell, E., & Kaldo, V. (2025) · Internet Interventions · doi:10.1016/j.invent.2025.100816 · Cited by 3 · see citing works
“Despite the success of psychological interventions such as CBT and ICBT the fact remains that not all patients are helped and some even get worse after treatment (Andersson et al., 2019b; Rozental et al., 2017).”
Role and Value of the Corporate Medical Director
Stave, G. M., Burton, W. N., Heron, R. J. L., Hudson, T. W., Pawlecki, J. B., Roomes, D., Sepulveda, M., Rendel, M., & Hymel, P. A. (2023) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000002979 · Cited by 4 · see citing works
Gold, A. K., Rabideau, D. J., Nolte, D., Faria, C. M., Deng, S. Y., George, N., Boccagno, C. E., Temes, C. M., Kamali, M., Akpolat, N., et al. (2024) · Psychiatry Research Communications · doi:10.1016/j.psycom.2024.100182 · Cited by 3 · see citing works
Esfandiari, N., Mazaheri, M. A., Sadeghi‐Firoozabadi, V., & Cheraghi, M. (2020) · doi:10.2196/preprints.18275 · Cited by 3 · see citing works
Metacognition in anxious-depression is state-dependent: an observational treatment studyPreprint
Fox, C. A., Lee, C. T., Hanlon, A. K., Seow, T. X. F., Lynch, K., Harty, S., Richards, D., Palacios, J. E., O’Keane, V., Stephan, K. E., et al. (2023) · eLife · doi:10.7554/elife.87193.1 · Cited by 3 · see citing works
Shinno, S., Matsumoto, K., Hamatani, S., Inaba, Y., Ozawa, Y., Kawasaki, Y., Ikai, T., Sutoh, C., Hayashi, H., & Shimizu, E. (2024) · JMIR Formative Research · doi:10.2196/53659 · Cited by 2 · see citing works
Lai, L., Li, Y., Zhao, Z., & Ren, Z. (2025) · Internet Interventions · doi:10.1016/j.invent.2025.100805 · Cited by 2 · see citing works
“A systematic review indicated that the overall treatment response rate for ICBT across various psychological conditions is approximately 69.9 %, yet anxiety disorders exhibit significantly lower response rates compared to other mental health issues (Andersson et al., 2019).”
InfluentialKravchenko, O., Bäckman, J., Mataix‐Cols, D., Crowley, J. J., Halvorsen, M., Sullivan, P. F., Wallert, J., & Rück, C. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07012-x · Cited by 3 · see citing works
“However, CBT/ICBT is not universally efficacious, with up to 50% of patients not responding sufficiently to the treatment [13], [14], [15].”
Shin, Y., Kim, E., Kim, K., Kim, J. S., Kim, S., & Kim, B. (2025) · Psychiatry Investigation · doi:10.30773/pi.2025.0168 · Cited by 2 · see citing works
“63 Meta-analysis research suggests that a higher initial symptom intensity predicts better treatment response, 64 while other studies link it to reduced benefits.”
Frye, N., O’Neal, C. W., & Lucier‐Greer, M. (2025) · Family and Consumer Sciences Research Journal · doi:10.1002/fcsr.70031 · Cited by 2 · see citing works
Ustrup, M., Christensen, T. N., Curth, N. K., Heine, K., Bojesen, A. B., & Eplov, L. F. (2024) · Psychiatric Quarterly · doi:10.1007/s11126-024-10081-y · Cited by 2 · see citing works
“In addition, despite socioeconomic status being a commonly reported predictor in the literature [10–13, 15, 48], studies vary in which parameters are used for measuring socioeconomic status thus, other studies also find no association [6, 49, 50].”
InfluentialPotentials and Pitfalls of Self‐Help Tools: A Survey Study of Digital Psychiatry in Denmark
Dyrlev, E. K. (2025) · Social Inclusion · doi:10.17645/si.9990 · Cited by 2 · see citing works
Woodford, J., Karlsson, M., Hagström, J., Sylvén, Y. H., Norbäck, K., Grönqvist, H., & von Essén, L. (2021) · JMIR Formative Research · doi:10.2196/26266 · Cited by 2 · see citing works
An observational treatment study of metacognition in anxious-depression
Fox, C. A., Lee, C. T., Hanlon, A., Seow, T. X. F., Lynch, K., Harty, S., Richards, D., Palacios, J., O'Keane, V., Stephan, K. E., et al. (2023) · doi:10.31234/osf.io/uk7hr · Cited by 2 · see citing works
Bjarke, J., Gjestad, R., & Nordgreen, T. (2026) · Internet Interventions · doi:10.1016/j.invent.2026.100907 · Cited by 1 · see citing works
“This is consistent with prior research suggesting a small but statistically significant advantage for women in depression treatment outcomes (Andersson et al., 2019; Sextl-Pl ¨ otz et al., 2024).”
InfluentialYoung, D. K. W., Carlbring, P., Ng, S., Cheng, D., Petrus Yat-nam, N. G., Chen, Q.-R. J., Tam, H.-L., & Yeung, J. W. K. (2025) · Clinical Social Work Journal · doi:10.1007/s10615-025-00990-1 · Cited by 1 · see citing works
“…iCBT has been shown to be more effective than unguided/self-help iCBT, which only offers self-learning online modules without counselling support (Andersson et al., 2019 ; Etzelmueller et al., 2020; Koma-riah et al., 2022), and guided iCBT has been reported to be as effective as traditional…”
InfluentialSelf-citationLearning how to recover from stress-related disorders via internet-based interventions
Asplund, R. P. (2021) · Linköping studies in behavioural science · doi:10.3384/diss.diva-172685 · Cited by 1 · see citing works
Internet-based psychotherapies
Andersson, G. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-822201-0.00008-3 · Cited by 1 · see citing works
Self-citationAn observational treatment study of metacognition in anxious-depression
Fox, C. A., Lee, C. T., Hanlon, A. K., Seow, T. X., Lynch, K., Harty, S., Richards, D., Palacios, J., O'Keane, V., Stephan, K. E., et al. (2023) · eLife · doi:10.7554/elife.87193.3 · Cited by 1 · see citing works
Metacognition in anxious-depression is state-dependent: an observational treatment study
Fox, C. A., Lee, C. T., Hanlon, A. K., Seow, T. X., Lynch, K., Harty, S., Richards, D., Palacios, J., O’Keane, V., Stephan, K. E., et al. (2023) · doi:10.7554/elife.87193.2 · Cited by 1 · see citing works
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Kravchenko, O., Boberg, J., Mataix‐Cols, D., Crowley, J. J., Halvorsen, M., Sullivan, P. F., Wallert, J., & Rück, C. (2024) · Research Square · doi:10.21203/rs.3.rs-4075444/v1
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Zantvoort, K., Matthiesen, J., Bjurner, P., Bendix, M., Brefeld, U., Funk, B., & Kaldo, V. (2025) · Internet Interventions · doi:10.1016/j.invent.2025.100828
“Digital Mental Health Interventions (DMHIs) are pivotal in expanding much-needed psychological treatment (Andersson et al., 2019).”
Predictive Modelling of Depression Treatment Response using Individual Symptoms and Latent FactorsPreprint
Buehler, S. K., Heinzle, J., Eladawi, M. A., Lee, C. T., Hanlon, A. K., O’Keane, V., Harty, S., Lynch, K., Stephan, K. E., & Gillan, C. M. (2025) · medRxiv · doi:10.1101/2025.09.17.25335980
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Jackson, H. M., Batterham, P. J., Ohan, J. L., Calear, A. L., & Farrer, L. M. (2024) · Figshare · doi:10.6084/m9.figshare.26756740
Evidence of Internet- and Mobile-Based Interventions for Mental Disorders
Löchner, J., Schoenenberg, K., & Zarski, A. (2026) · Springer eBooks · doi:10.1007/978-3-032-08980-9_3
Evaluating Client Outcomes and Experiences in a Student-Led Clinic: A Pretest–Posttest Study
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“For the sample size calculation, we also assumed a prevalence of response to iCBT of 0.5 (42), setting the shrinkage parameter to 0.9 to avoid over fi tting 4 – 6 predictors (parameter estimates from our tasks and candidate predictors from the literature such as baseline severity (43) and gender…”
InfluentialParks, A. C., Woodward, A. L., Vlisides‐Henry, R. D., Arden, K. A., Vando, L., Swain, J., & Lamichhane, B. (2026) · Journal of Medical Internet Research · doi:10.2196/92647
“These results are made more clinically relevant by the speed at which they occurred—by 4 weeks, or approximately half the time required for standard treatments to take effect [19,39,40].”
Kravchenko, O., Halvorsen, M., Boberg, J., Kaldo, V., Crowley, J. J., Kuja‐Halkola, R., Rück, C., & Wallert, J. (2026) · Journal of Medical Internet Research · doi:10.2196/100162
Yonatan‐Leus, R., Freidlander, A., Sinai, D., Lichtenberg, P., Weiser, M., Caspi, A., Elberg, D., & Bitan, D. T. (2026) · Journal of Mental Health · doi:10.1080/09638237.2026.2695014
Internet CBT for panic disorder - a review
Praško, J., Vaněk, J., Bělohradová, K., Sollár, T., Šlepecký, M., Mikula, M., & Ocisková, M. (2026) · Psychiatrie pro praxi · doi:10.36290/psy.2026.021
- Authors
- Andersson, G., Carlbring, P., & Rozental, A.
- Affiliations
- Linköping University (SE)
- Stockholm University (SE)
- Karolinska Institutet (SE)
- Corresponding author
- Andersson, Gerhard
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2019-10-25
- Volume
- 10
- Pages
- 749-749
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC6823683
- OpenAlex
- W2981658599
- Cited by
- 71
- References
- 90
- Citations by year
- 2026: 8 · 2025: 12 · 2024: 16 · 2023: 13 · 2022: 10 · 2021: 7 · 2020: 5
- FWCI
- 0.78
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion, cc-by)
- DiVA (Linkoping University) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Linköpings Universitet
- 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
- internet-based cognitive behavioral therapy, treatment response rate, remission rate, reliable change index, recovery rate, predictors of treatment response, symptom severity, anxiety disorders, depression, sex differences in treatment response
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