The efficacy of internet interventions for depression and anxiety disorders: a review of randomised controlled trials
Abstract
OBJECTIVE: To review the outcomes, nature and quality of published randomised controlled trials of preventive and treatment internet interventions for depression and anxiety disorders, and to document the availability of effective interventions. DATA SOURCES: Previous reviews of internet interventions for mental health and related conditions were updated using an extension of the original methodology. All studies included in the original reviews and more recent eligible trials (published before June 2009) were included, together with any trials identified from a search of the health intervention web portal Beacon and the Journal of Medical Internet Research. STUDY SELECTION: A total of 29 reports describing 26 trials satisfied the inclusion criteria. DATA SYNTHESIS: All trials employed a cognitive behaviour therapy intervention program. Of the 26 trials, 23 demonstrated some evidence of effectiveness relative to controls. Effect size differences ranged from 0.42 to 0.65 for depression interventions involving participants with clinically significant symptoms of depression, and 0.29 to 1.74 for anxiety interventions involving participants with a diagnosed anxiety disorder. Of the five effective English-language programs, three are available to the public without charge and two can be accessed at a small cost through health practitioner referral. CONCLUSION: Internet interventions for depression and anxiety disorders offer promise for use as self-help applications for consumers or as an adjunct to usual care.
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Online interventions addressing anxiety and depression in the general population have demonstrated similar levels of efficacy to face-to-face interventions in both the general population and cancer patients.
“Online interventions addressing anxiety and depression in the general population have demonstrated similar levels of efficacy to face-to-face interventions in both the general population and cancer patients (Griffiths, Farrer, & Christensen, 2010;Jacobsen & Jim, 2008).”
From e-TC: Development and pilot testing of a web-based intervention to reduce anxiety and depression in survivors of testicular cancer (2017) · cites this paper as Griffiths, Farrer, & Christensen, 2010
Internet-based and computer-aided treatments are effective in treating a wide range of psychological problems, with effect sizes comparable to traditional psychological treatments.
“Internet-based and computer-aided treatments have been shown to be effective in treating a wide range of psychological problems, and have effect sizes (ES) comparable to those found for more traditional types of psychological treatments [21-32].”
From Feasibility of a personal health technology-based psychological intervention for men with stress and mood problems: Randomized controlled pilot trial (2013) · cites this paper as [27]
The acceptability, effectiveness and uptake of iCBT treatment for mental disorders has not been established in older populations.
“However, the acceptability, effectiveness and uptake of iCBT treatment for mental disorders has not been established in older populations [5], [6].”
Older individuals are generally under-represented in the samples that provide efficacy data for iCBT programs.
“Reviews of iCBT for mental illness have indicated that older individuals are generally under-represented in the samples that provide efficacy data for these programs [5], [6].”
Reviews of randomised controlled trials of internet interventions with therapist assistance for depressive and anxiety disorders have found reductions in symptoms, relevant cognitions, and improvement in patients' mental health literacy.
“Reviews of randomised controlled trials (RCTs) of internet interventions with therapist assistance for depressive and anxiety disorders have found reductions in symptoms, relevant cognitions and improvement in patients’ mental health literacy [37–39].”
From Study protocol for a randomised controlled trial of internet-based cognitive-behavioural therapy for obsessive-compulsive disorder (2014) · cites this paper as [37]
The effect sizes for CBT in the Cochrane meta-analysis were somewhat smaller than those reported in other recent reviews.
“These effects were somewhat smaller than those reported in other recent reviews [17, 19–22] and also smaller than the large effect sizes for Internet-based ACT (0.80 and 0.87) in the study of Fledderus et al. [40] and for Internet-based CBT for anxiety complaints in older adults (1.43) in the study of Dear et al. [26].”
Current psychotherapies for anxiety can be delivered online using a website.
“Current psychotherapies for anxiety can be delivered online using a website, 47,48”
From Effectiveness of mobile technologies delivering Ecological Momentary Interventions for stress and anxiety: A systematic review (2016) · cites this paper as [48]
Four other reviews had a wider scope than cCBT for depression.
“Four other reviews [15-18] had a wider scope than cCBT for depression.”
From Meta-review of the effectiveness of computerised CBT in treating depression (2011) · cites this paper as [15]
Four reviews did not name the packages they examined.
“Four reviews did not name the packages they examined [12,15-17].”
From Meta-review of the effectiveness of computerised CBT in treating depression (2011) · cites this paper as [15]
Few studies have compared supported and unsupported interventions in the same trial.
“However, few studies have compared supported and unsupported interventions in the same trial [11] and so the issue of whether support adds unequivocal benefit has not yet been resolved.”
From Internet-Based CBT for Depression with and without Telephone Tracking in a National Helpline: Randomised Controlled Trial (2011) · cites this paper as [11]
Web-based CBT applications have been effective either with or without support from mental health professionals, paraprofessionals or teachers.
“A range of software applications available on the web have also delivered effective CBT to depressed samples [11], reduced depression in school settings [12] and in general practice environments [13], [14], either with or without support from mental health professionals, paraprofessionals or teachers [11].”
From Internet-Based CBT for Depression with and without Telephone Tracking in a National Helpline: Randomised Controlled Trial (2011) · cites this paper as [11]
A range of software applications available on the web have delivered effective CBT to depressed samples.
“A range of software applications available on the web have also delivered effective CBT to depressed samples [11], reduced depression in school settings [12] and in general practice environments [13], [14], either with or without support from mental health professionals, paraprofessionals or teachers [11].”
From Internet-Based CBT for Depression with and without Telephone Tracking in a National Helpline: Randomised Controlled Trial (2011) · cites this paper as [11]
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“There is evidence that computerized cognitive behavioral therapy (cCBT) is effective in the treatment of various mental disorders, including depression [6-10].”
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- Authors
- Griffiths, K. M., Farrer, L., & Christensen, H.
- Affiliations
- Australian National University (AU)
- Corresponding author
- Griffiths, Kathleen M
- Venue
- Medical Journal of Australia
- Publisher
- Wiley
- Published
- 2010-06
- Volume
- 192
- Issue
- S11
- Pages
- S4-11
- ISSN
- 0025-729X (ISSN-L)
- 1326-5377
- OpenAlex
- W2181769958
- Cited by
- 303
- References
- 55
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 2 · 2023: 3 · 2022: 14 · 2021: 15 · 2020: 12 · 2019: 17 · 2018: 22 · 2017: 24 · 2016: 29 · 2015: 36 · 2014: 51 · 2013: 33 · 2012: 18
- FWCI
- 2.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- The Medical Journal of Australia (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Health and Medical Research Council
- 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 › Social Psychology › Mental Health Treatment and Access
- Keywords
- online intervention, depression, anxiety disorders, cognitive behavioral therapy, self-help, treatment efficacy, preventive interventions
- MeSH terms
- Anxiety Disorders, Depressive Disorder, Humans, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Telemedicine, Internet
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