The effectiveness of supplemental and replacement blended cognitive behavioral therapy for internalizing disorders: a meta-analysis.
Sara L M Velthuizen, Miranda C Lutz, Esther van den Bos et al.
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In 30 seconds
This meta-analysis examined blended cognitive behavioral therapy (bCBT), which combines face-to-face and online therapy, for internalizing disorders including anxiety and depression. It synthesized comparisons with treatment as usual and pre-to-post treatment changes. Across 19 studies (N = 2749), supplementary bCBT had a significantly greater treatment effect than usual care (Cohen's d = 0.41, 95% CI [0.24, 0.59]); replacement bCBT was comparable to usual care (d = -0.01, 95% CI [-0.18, 0.17]). A second analysis of 32 studies (N = 1895) found significant improvement with bCBT overall.
Key findings
- Supplementary bCBT outperformed treatment as usual (Cohen's d = 0.41, 95% CI [0.24, 0.59]).
- Replacement bCBT was on par with treatment as usual (d = -0.01, 95% CI [-0.18, 0.17]).
- Across 32 studies (N = 1895), pre-to-post improvement with bCBT was significant (Morris's D = 1.12, 95% CI [0.92, 1.33]), irrespective of blended method or therapist contact.
Why it matters
The findings distinguish two ways of integrating online therapy with in-clinic care: adding online components was associated with better outcomes than usual care, whereas replacing some face-to-face sessions did not show an advantage over usual care. This distinction may help frame evaluation of blended treatment models for anxiety and depression, while the overall improvement finding supports continued consideration of bCBT.