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PLoS One. 2015 Mar 18;10(3):e0119895. doi: 10.1371/journal.pone.0119895. eCollection 2015.

Internet and computer-based cognitive behavioral therapy for anxiety and depression in youth: a meta-analysis of randomized controlled outcome trials.

Author information

1
Leuphana University, Innovation Incubator, Division Health Trainings Online, Lueneburg, Germany; Friedrich-Alexander University Nuremberg-Erlangen, Department of Psychology, Clinical Psychology and Psychotherapy, Erlangen, Germany; Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University, Amsterdam, the Netherlands.
2
Leuphana University, Innovation Incubator, Division Health Trainings Online, Lueneburg, Germany.
3
Black Dog Institute, Sydney, Australia.
4
Center for Child and Adolescent Studies, University of Utrecht, the Netherlands.
5
Leuphana University, Innovation Incubator, Division Health Trainings Online, Lueneburg, Germany; GGZ inGeest, Regional Mental Health Service Centre, VU University Medical Centre, Amsterdam, the Netherlands; Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University, Amsterdam, the Netherlands.
6
Leuphana University, Innovation Incubator, Division Health Trainings Online, Lueneburg, Germany; Friedrich-Alexander University Nuremberg-Erlangen, Department of Psychology, Clinical Psychology and Psychotherapy, Erlangen, Germany.

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.

PMID:
25786025
PMCID:
PMC4364968
DOI:
10.1371/journal.pone.0119895
[Indexed for MEDLINE]
Free PMC Article

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