Internet and Computer-Based Cognitive Behavioral Therapy for Anxiety and Depression in Youth: A Meta-Analysis of Randomized Controlled Outcome Trials

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Abstract

Background

Anxiety and depression in children and adolescents are undertreated. Computer- and Internet-based cognitive behavioral treatments (cCBT) may be an attractive treatment alternative to regular face-to-face treatment.This meta-analysis aims to evaluate whether cCBT is effective for treating symptoms of anxiety and depression in youth.

Methods and Findings

We conducted systematic searches in bibliographical databases (Pubmed, Cochrane controlled trial register, PsychInfo) up to December 4, 2013. Only randomized controlled trials in which a computer-, Internet- or mobile-based cognitive behavioral intervention targeting either depression, anxiety or both in children or adolescents up to the age of 25 were compared to a control condition were selected. We employed a random-effects pooling model in overall effect analyses and a mixed effect model for sub-group analyses. Searches resulted in identifying 13 randomized trials, including 796 children and adolescents that met inclusion criteria. Seven studies were directed at treating anxiety, four studies at depression, and two were of a transdiagnostic nature, targeting both anxiety and depression. The overall mean effect size (Hedges’ g) of cCBT on symptoms of anxiety or depression at post-test was g=0.72 (95% CI:0.55-0.90, numbers needed to be treated (NNT)=2.56). Heterogeneity was low (I²=20.14%, 95% CI: 0-58%). The superiority of cCBT over controls was evident for interventions targeting anxiety (g=0.68; 95% CI: 0.45-0.92; p < .001; NNT=2.70) and for interventions targeting depression (g=0.76; 95% CI: 0.41-0.12; p < .001; NNT=2.44) as well as for transdiagnostic interventions (g=0.94; 95% CI: 0.23-2.66; p < .001; NNT=2.60).

Conclusions

Results provide evidence for the efficacy of cCBT in the treatment of anxiety and depressive symptoms in youth. Hence, such interventions may be a promising treatment alternative when evidence based face-to-face treatment is not feasible. Future studies should examine long-term effects of treatments and should focus on obtaining patient-level data from existing studies, to perform an individual patient data meta-analysis.

Related collections

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Author and article information

Contributors

Jan L. Wallander: Role: Academic Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 18 March 2015

Publication date Collection: 2015

Volume: 10

Issue: 3

Electronic Location Identifier: e0119895

Affiliations

[1 ]Leuphana University, Innovation Incubator, Division Health Trainings Online, Lueneburg, Germany

[2 ]Friedrich-Alexander University Nuremberg-Erlangen, Department of Psychology, Clinical Psychology and Psychotherapy, Erlangen, Germany

[3 ]Black Dog Institute, Sydney, Australia

[4 ]Center for Child and Adolescent Studies, University of Utrecht, the Netherlands

[5 ]GGZ inGeest, Regional Mental Health Service Centre, VU University Medical Centre, Amsterdam, the Netherlands

[6 ]Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University, Amsterdam, the Netherlands

Merced, UNITED STATES

Author notes

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: DDE HR. Performed the experiments: DDE PC HR. Analyzed the data: DDE HR PC. Contributed reagents/materials/analysis tools: DDE MB. Wrote the paper: DDE AZ HC PC YS MB HR.

* E-mail: ebert@ 123456inkubator.leuphana.de

Article

Publisher ID: PONE-D-14-33759

DOI: 10.1371/journal.pone.0119895

PMC ID: 4364968

PubMed ID: 25786025

SO-VID: 41d521c0-d1e0-4016-93ea-620e9406c430

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

History

Date received : 29 July 2014

Date accepted : 5 January 2015

Page count

Figures: 2, Tables: 2, Pages: 15

Funding

This study is funded by the European Union (EFRE: ZW6-80119999, CCI 2007DE161PR001). The funders played no role in study design, collection, analysis, interpretation of data, writing of the report, or in the decision to submit the paper for publication.

Custom metadata

Data Availability All relevant data are within the manuscript.

ScienceOpen disciplines: Uncategorized

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