Two decades of digital interventions for anxiety disorders: a systematic review and meta-analysis of treatment effectiveness

Darin Pauley, Pim Cuijpers, Davide Papola, Clara Miguel, Eirini Karyotaki, Darin Pauley, Pim Cuijpers, Davide Papola, Clara Miguel, Eirini Karyotaki

Abstract

Background: Digital interventions for anxiety disorders are a promising solution to address barriers to evidence-based treatment access. Precise and powerful estimates of digital intervention effectiveness for anxiety disorders are necessary for further adoption in practice. The present systematic review and meta-analysis examined the effectiveness of digital interventions across all anxiety disorders and specific to each disorder v. wait-list and care-as-usual controls.

Methods: A systematic search of bibliographic databases identified 15 030 abstracts from inception to 1 January 2020. Forty-seven randomized controlled trials (53 comparisons; 4958 participants) contributed to the meta-analysis. Subgroup analyses were conducted by an anxiety disorder, risk of bias, treatment support, recruitment, location and treatment adherence.

Results: A large, pooled effect size of g = 0.80 [95% Confidence Interval: 0.68-0.93] was found in favor of digital interventions. Moderate to large pooled effect sizes favoring digital interventions were found for generalized anxiety disorder (g = 0.62), mixed anxiety samples (g = 0.68), panic disorder with or without agoraphobia (g = 1.08) and social anxiety disorder (g = 0.76) subgroups. No subgroups were significantly different or related to the pooled effect size. Notably, the effects of guided interventions (g = 0.84) and unguided interventions (g = 0.64) were not significantly different. Supplemental analysis comparing digital and face-to-face interventions (9 comparisons; 683 participants) found no significant difference in effect [g = 0.14 favoring digital interventions; Confidence Interval: -0.01 to 0.30].

Conclusion: The precise and powerful estimates found further justify the application of digital interventions for anxiety disorders in place of wait-list or usual care.

Keywords: Anxiety disorders; digital interventions; effect size; effectiveness; meta-analysis.

Figures

Fig. 1.
Fig. 1.
Flowchart of the selection of studies.
Fig. 2.
Fig. 2.
Forest plot of effect sizes per comparison and overall pooled effect size organized by GAD, mixed anxiety samples, PD/A and SAD.

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Source: PubMed

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