Relative Effectiveness of Online Cognitive Behavioural Therapy with Anxious or Depressed Young People: Rapid Review and Meta-analysis

Abstract

ABSTRACT Global estimates suggest that 25% and 20% of youth have reported elevated symptoms of depression and anxiety, respectively, since the beginning of the COVID-19 pandemic compared to baseline functioning (Racine et al., 2021). Cognitive behavioural therapy (CBT) has been found to significantly benefit young people experiencing anxiety and depression (Christ et al., 2020). Pandemic-related protocols have led many mental health services to shift to online platforms. We wondered about the comparative efficacy of online versus offline CBT for young people between the ages of 10–25. We responded with a rapid review and meta-analysis of eight randomised controlled trial (RCT) outcomes. The sample-weighted, between-group effect size, the standardised mean difference (d), was essentially zero at longest follow-up (nine months), indicating that online and offline CBT were equally effective for youth with depression and anxiety; both online and offline groups’ symptom alleviation rates were approximately 90%. Recognising a lack of diversity in the samples has led us to argue that comparative meta-analyses across the most potentially vulnerable minoritised groups should be a focus in future research. This would help social workers and allied mental health providers support diverse clients and decision makers navigate the troubled clinical and social policy waters of the pandemic and its aftermath. IMPLICATIONS Online CBT seems as effective as offline CBT in alleviating anxiety and depressive symptoms among young people, including young adults beginning to develop symptoms. A more socially, racially, and gender-inclusive RCT-based synthetic research agenda is needed to steer online versus offline decisions in social work and allied mental health. Social work’s emphasis on diversity, equity, and inclusion has, with the focus of rigorous research, the potential to play an important role in addressing gendered, cultural, and socioeconomic knowledge gaps.