title: Internet and computer-based cognitive behavioral therapy for anxiety and depression in youth: a meta-analysis of randomized controlled outcome trials.
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.
  
  
  RESULTS
  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.
authors.affiliation: 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.
authors.forename: David Daniel
authors.initials: DD
authors.lastname: Ebert
authors.affiliation: Leuphana University, Innovation Incubator, Division Health Trainings Online, Lueneburg, Germany.
authors.forename: Anna-Carlotta
authors.initials: AC
authors.lastname: Zarski
authors.affiliation: Black Dog Institute, Sydney, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Christensen
authors.affiliation: Center for Child and Adolescent Studies, University of Utrecht, the Netherlands.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Stikkelbroek
authors.affiliation: 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.
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
authors.affiliation: Leuphana University, Innovation Incubator, Division Health Trainings Online, Lueneburg, Germany; Friedrich-Alexander University Nuremberg-Erlangen, Department of Psychology, Clinical Psychology and Psychotherapy, Erlangen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Berking
authors.affiliation: 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.
authors.forename: Heleen
authors.initials: H
authors.lastname: Riper
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000523:psychology / Q000628:therapy*; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods* / Q000639:trends; D003863:Depression / Q000523:psychology / Q000628:therapy*; D006801:Humans; D020407:Internet; D015233:Models, Statistical; D016032:Randomized Controlled Trials as Topic; D013813:Therapy, Computer-Assisted / Q000379:methods* / Q000639:trends; D055815:Young Adult