title: The Benefit of Web- and Computer-Based Interventions for Stress: A Systematic Review and Meta-Analysis.
abstract: Stress has been identified as one of the major public health issues in this century. New technologies offer opportunities to provide effective psychological interventions on a large scale.
  
  
  
  The aim of this study is to investigate the efficacy of Web- and computer-based stress-management interventions in adults relative to a control group.
  
  
  
  A meta-analysis was performed, including 26 comparisons (n=4226). Cohen d was calculated for the primary outcome level of stress to determine the difference between the intervention and control groups at posttest. Analyses of the effect on depression, anxiety, and stress in the following subgroups were also conducted: risk of bias, theoretical basis, guidance, and length of the intervention. Available follow-up data (1-3 months, 4-6 months) were assessed for the primary outcome stress.
  
  
  
  The overall mean effect size for stress at posttest was Cohen d=0.43 (95% CI 0.31-0.54). Significant, small effects were found for depression (Cohen d=0.34, 95% CI 0.21-0.48) and anxiety (Cohen d=0.32, 95% CI 0.17-0.47). Subgroup analyses revealed that guided interventions (Cohen d=0.64, 95% CI 0.50-0.79) were more effective than unguided interventions (Cohen d=0.33, 95% CI 0.20-0.46; P=.002). With regard to the length of the intervention, short interventions (≤4 weeks) showed a small effect size (Cohen d=0.33, 95% CI 0.22-0.44) and medium-long interventions (5-8 weeks) were moderately effective (Cohen d=0.59; 95% CI 0.45-0.74), whereas long interventions (≥9 weeks) produced a nonsignificant effect (Cohen d=0.21, 95% CI -0.05 to 0.47; P=.006). In terms of treatment type, interventions based on cognitive behavioral therapy (CBT) and third-wave CBT (TWC) showed small-to-moderate effect sizes (CBT: Cohen d=0.40, 95% CI 0.19-0.61; TWC: Cohen d=0.53, 95% CI 0.35-0.71), and alternative interventions produced a small effect size (Cohen d=0.24, 95% CI 0.12-0.36; P=.03). Early evidence on follow-up data indicates that Web- and computer-based stress-management interventions can sustain their effects in terms of stress reduction in a small-to-moderate range up to 6 months.
  
  
  
  These results provide evidence that Web- and computer-based stress-management interventions can be effective and have the potential to reduce stress-related mental health problems on a large scale.
authors.affiliation: Department of Health Psychology and Applied Biological Psychology, Institute of Psychology, Leuphana University Lueneburg, Lueneburg, Germany.|Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany.|Faculty of Social and Human Sciences, University of Southampton, Southampton, United Kingdom.
authors.forename: Elena
authors.identifier: 0000-0002-3438-0756
authors.initials: E
authors.lastname: Heber
authors.affiliation: Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany.|Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen Nuremberg, Erlangen, Germany.
authors.forename: David Daniel
authors.identifier: 0000-0001-6820-0146
authors.initials: DD
authors.lastname: Ebert
authors.affiliation: Department of Health Psychology and Applied Biological Psychology, Institute of Psychology, Leuphana University Lueneburg, Lueneburg, Germany.|Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany.
authors.forename: Dirk
authors.identifier: 0000-0002-5560-3605
authors.initials: D
authors.lastname: Lehr
authors.affiliation: Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany.|Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
authors.forename: Pim
authors.identifier: 0000-0001-5497-2743
authors.initials: P
authors.lastname: Cuijpers
authors.affiliation: Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany.|Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen Nuremberg, Erlangen, Germany.
authors.forename: Matthias
authors.identifier: 0000-0001-5903-4748
authors.initials: M
authors.lastname: Berking
authors.affiliation: Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany.
authors.forename: Stephanie
authors.identifier: 0000-0001-8074-1412
authors.initials: S
authors.lastname: Nobis
authors.affiliation: Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany.|Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.|Telepsychiatric Centre, University of Southern Denmark, Odense, Denmark.
authors.forename: Heleen
authors.identifier: 0000-0002-8144-8901
authors.initials: H
authors.lastname: Riper
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000628:therapy; D006801:Humans; D020407:Internet; D008297:Male; D013315:Stress, Psychological / Q000628:therapy*
keywords: internet-based interventions; mental health; meta-analysis; randomized controlled trial; review; stress