A systematic review of digital and face-to-face cognitive behavioral therapy for depression

Abstract

Cognitive behavioral therapy (CBT) represents one of the major treatment options for depressive disorders besides pharmacological interventions. While newly developed digital CBT approaches hold important advantages due to higher accessibility, their relative effectiveness compared to traditional CBT remains unclear. We conducted a systematic literature search to identify all studies that conducted a CBT-based intervention (face-to-face or digital) in patients with major depression. Random-effects meta-analytic models of the standardized mean change using raw score standardization (SMCR) were computed. In 106 studies including n = 11854 patients face-to-face CBT shows superior clinical effectiveness compared to digital CBT when investigating depressive symptoms (p < 0.001, face-to-face CBT: SMCR = 1.97, 95%-CI: 1.74–2.13, digital CBT: SMCR = 1.20, 95%-CI: 1.08–1.32) and adherence (p = 0.014, face-to-face CBT: 82.4%, digital CBT: 72.9%). However, after accounting for differences between face-to-face and digital CBT studies, both approaches indicate similar effectiveness. Important variables with significant moderation effects include duration of the intervention, baseline severity, adherence and the level of human guidance in digital CBT interventions. After accounting for potential confounders our analysis indicates comparable effectiveness of face-to-face and digital CBT approaches. These findings underline the importance of moderators of clinical effects and provide a basis for the future personalization of CBT treatment in depression.

A Multilingual Digital Mental Health and Well-Being Chatbot (ChatPal): Pre-Post Multicenter Intervention Study

“…This paper further supports the need for blended service offerings, given that mental well-being scores did not significantly increase. This result is in line with findings from recent reviews [7,35], which found that blended service offerings were more effective in treating those living with depression, and several studies have shown that guided interventions resulted in better adherence and lower dropouts compared with unguided interventions [36][37][38].…”

Long-term effectiveness and cost-effectiveness of guided internet-based cognitive behavioral therapy for obsessive-compulsive disorder: 24-month follow-up

“…In contrast, 5 (25 %) of 20 adults received voluntarily for additional CBT. Improving adherence to treatment is crucial in ICBT compared to face-to-face CBT ( Kambeitz-Ilankovic et al, 2022 ). Factors such as literacy skills, concentration, and individual capabilities are considered to be lower in adolescents compared to adults, potentially influencing treatment adherence in ICBT ( Johansson et al, 2015 ).…”

A CBT-based mobile intervention as an adjunct treatment for adolescents with symptoms of depression: a virtual randomized controlled feasibility trial

“…This possibility was supported by a post hoc analysis of only participants with at least moderate baseline symptom severity that showed a clinically meaningful reduction in symptom severity at post-intervention. In fact, recent evidence suggests that digital interventions may be most effective for more severe forms of depression ( 98 ).…”