Table 5.
Key socioemotional outcomes of included studies
| Study (year) Level of evidence | Outcome (measure) | Synchronous guided intervention delivery | ||||||
|---|---|---|---|---|---|---|---|---|
| Key findings | ||||||||
| Depression | Anxiety | Stress | Well-being | Mindfulness | Quality of life | Other | ||
|
Celia et al. (2022) Level 5 |
1. Anxiety (STAI-Y) 2. Stress (DT) 3. Global mental distress (YP-CORE) 4. Subjective well-being (SWLS) 5. Positive and Negative Affect Schedule (PANAS) |
State (p = 0.002, d = 0.59) and trait anxiety (p = 0.003, d = .57) significantly ↓ post intervention | Perceived stress (p < 0.001, d = 0.66) significantly ↓ post intervention | Subjective wellbeing significantly ↑ pre to post (d = − 0.58, p = 0.001) |
Global mental distress p < 0.001, d = 0.80 significantly ↓ post intervention Negative affect significantly ↓ post intervention p < 0.001, d = 0.66 |
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|
Cerutti et al. (2022) Level 5 |
1. Depression (BDI-II) 2. Anxiety (BAI) 3. General functioning (OQ-45) 4. Hopelessness (BHS) 5. Personal burnout (CBI) |
Significant pre-post ↓in depression. Mean change high (d = 1.11, p < 0.001) | Significant pre-post ↓in anxiety, with high mean change (d = 0.69, p < 0.001) | Significant pre-post improvement in general functioning, with high mean change (d = 0.70, p < 0.001). Significant pre-post ↓for hopelessness. Change low-moderate (d = 0.35, p < 0.01). Significant pre-post ↓for burnout. Change low-moderate (d = 0.46, p < 0.001) | ||||
|
Harra and Vargas (2023)* Level 1 |
1. Depression (PHQ-18) 2. Anxiety (MASQ) |
Significant ↓ post intervention depression symptoms (d = 0.48, p < 0.05), with larger ↓ in treatment vs. control | NS group differences on anxiety symptoms across all domains (general distressed anxious symptoms: d = 0.04, general distress mixed symptoms: d = 0.53; anxious arousal: d = 0.13; general distress depressive symptoms: d = 0.08). All p values NR. Significant group differences on anhedonic depression subscale; d = 0.79, p < 0.05) | |||||
|
Novella et al. (2022)* Level 1 |
1. Generalized anxiety (CCAPS) 2. Social anxiety (CCAPS) 3. Clinical anxiety (BAI) |
NS difference in pre to f/u change in generalized anxiety (in-person M = − 7.29, SD = 6.71; online delivery M = − 6.38, SD = 4.79; t(39) = − 0.222, p = 0.640). NS difference in pre to f/u change on social anxiety (in-person M = − 4.312, SD = 4.14; online delivery M = − 2.666, SD = 3.80; t(27) = − 1.161, p = 0.291). NS difference in clinical anxiety at pre, post and f/u between delivery systems (F(1, 33) = 0.313, p = .580, np1 = 0.009). BAI post and f/u score significantly ↓than pre (F(1, 33) = 13.556, p = 0.001, np2 = 0.001) | ||||||
| Study | Outcome (measure) | Asynchronous guided intervention delivery | ||||||
|---|---|---|---|---|---|---|---|---|
| Key findings | ||||||||
| Depression | Anxiety | Stress | Well-being | Mindfulness | Quality of life | Other | ||
|
Cook et al. (2019)* Level 1 |
1. Depression (PSWQ; PHQ-9) 2. Anxiety (SCID-I, GAD, PSWQ) 3. Stressful events (ELEI) 3. Rumination (RRS) 5. Worry (PSWQ) |
When controlling for past depression and baseline stress, 34% ↓ risk of depression in guided i-RFCBT vs. control, although NS (HR 0.66, p = 0.20). Guided i-RFCBT reduced depression risk by 34% vs. usual care (HR 0.66, p = 0.20). Significant improvements in depressive symptoms in short-to-medium term (statistics NR). Unguided i-RFCBT 36% ↓risk of future depression vs. control (HR 0.64, p NR). At 6-months, depression significantly ↓for guided i-RFCBT vs. control (p < .05). NS between-group differences at 3, 6, 15-month f/u (ps < 0.05) | NS between-group differences on anxiety symptoms at 3-, 6- and 15-month f/u (p > 0.05) |
Participants with higher baseline stress benefited most from intervention (HR 0.43, p = 0.02) Unguided i-RFCBT larger effect for undergraduates with moderate-severe baseline stress (HR 0.48, p NR) |
At 3-month f/u, rumination scores significantly lower for guided i-RFCBT vs. usual care (p < 0.05). NS group differences at 6 and 15-month f/u (ps > 0.05). At 6-month f/u, worry significantly lower for guided i-RFCBT vs. usual care (p < 0.05), and there was NS between-group differences at 3- and 15-month f/u (p < 0.05) for guided i-RFCBT and control | |||
| Hennemann et al. (2022a)* Level 1 |
1. Emotional reactivity (PERS) 2. Somatosensory amplification (SSAS) 3. Somatic symptom distress (PHQ-15) |
Stronger pre-post improvements favoring iSOMA in somatic symptom distress, with medium effects (d = 0.70, p < 0 .001). NS moderating effect of Emotional Reactivity and treatment effects on somatic symptom distress (positive reactivity: B = − 0.08, p = 0.144; negative reactivity: B = − 0.02, p = 0.686). Somatosensory amplification moderated the outcome favoring iSOMA, i.e., higher pre-test somatosensory amplification associated with better outcome in active vs. control (B = − 0.17, p = 0.031). Main effect of treatment NS when SSAS as moderator and controlling for PHQ-15 pre-test scores (B = 2.43, p = 0.287). In WL group, ↑pre SSAS scores associated with ↑post PHQ-15 scores, as indicated by significant main effect of SSAS scores (B = 0.15, p = 0.009). Depression NS moderate effect of intervention vs. control on somatic symptom distress at post-assessment (B = − 0.54, SE = 0.12, p = 0.654). Anxiety NS moderate effect of intervention vs. control on somatic symptom distress post-assessment (B = − 0.02, SE = 0.11, p = 0.878) | ||||||
|
Hennemann et al. (2022b)* Level 1 |
1. Depression (PHQ-9) 2. Anxiety (GAD-7) 3. Somatic symptom distress (SSD) 4. Therapeutic alliance (WAI-SR) |
Significant pre-post ↓ in negative affect (iSOMA-guided: (d = 0.92, p = 0.370), iSOMA-GoD: d = 0.55) with NS group differences (p = 0.393) NS between-group difference in frequency of reliable change in PHQ-15 (p = 1.00) |
NS (p = 0.335) effects of treatment conditions on anxiety iSOMA-guided: (d = 0.58), iSOMA-GoD: d = 0.48) | Significant pre-post ↓ in somatic symptom distress (iSOMA-guided: (d = 0.86), iSOMA-GoD: d = 0.63), with NS group differences (p = 0.467). iSOMA-guided group reached statistically significant change in somatic symptom distress compared to iSOMA-GoD (p = 0.011). Strong therapeutic alliance in both conditions, with NS difference between groups (iSOMA-guided: M = 3.38, SD = 0.83; iSOMA-GoD: M = 3.28, SD = 0.62, p > 0.05) | ||||
|
Juniar et al. (2022) Level 5 |
1. Depression (DASS-42) 2. Anxiety (DASS-42) 3. Stress (DASS-42) 4. Quality of life (WHOQOL-BREF) |
Significantly ↓ depression pre-post (M = − 6.85, d = 0.58, p = 0.02) | Significantly ↓ anxiety pre-post (M = − 6.45, d = 0.62, p = 0.01) | Significantly ↓stress pre-post (M = − 10.04, d = 0.93, p < 0.001) | Significant ↑ quality of life for physical health (d = 1.25, p < 0.001), psychological health (d = 0.78, p = 0.003), overall quality of life (d = 0.62, p = 0.01), overall health (d = 0.54, p = 0.03) pre-post. NS differences in social relationship (p = 0.45) and environmental health domains of QoL (p = 0.13) | |||
|
Karyotaki et al. (2022)* Level 1 |
1. Depression (PHQ-9) 2. Anxiety (GAD-7) 3. Quality of life (EQ-5D) 4. Diagnoses of mental health disorders (MINI) |
ITT analyses: NS differences between intervention and control depression symptoms post-test (β = − 0.50, p > 0.05), 6- (β = 0.30, p > 0.05) and 12-month f/u (β = − 0.19; p > 0.05) Complete-cases analyses: Similar results from ITT analyses were observed |
ITT analyses: NS differences between intervention and control in anxiety symptoms at post-test (β = − 0.46, p > 0.05) and at 6- (β = 0.13; p > 0.05) and 12-month f/u (β = − 0.61; p > 0.05). Complete-cases analyses: Similar results from ITT analyses were observed |
ITT analyses: NS differences between intervention and control QoL post-test (β = − 0.005, p > 0.05), 6-month (β = 0.01, p > 0.05) and 12-month f/u (β = 0.003; p > 0.05) Complete-cases analyses: Similar results from ITT analyses were observed. NS difference between guided iCBT and TAU in quality of life at post-treatment (β = − 0.005; p > 0.05) and f/u (6-months: β = 0.01; 12-months: β = 0.003; p > 0.05) |
At 12-months, NS difference in depression and anxiety diagnoses between intervention and control (MDD: β = 0.12, GAD: β = − 0.62, SE = 1.0.; panic disorder: β = − 0.41, agoraphobia: β = − 0.022, p > 0.05) | |||
|
Küchler et al. (2023)* Level 1 |
1. Depression (PHQ-9) 2. Anxiety (GAD-7) 3. Stress (PSS-4) 4. Well-being (WHO-5) 5. Mindfulness (FMI) |
ITT analysis: Comparisons between UG vs. WL yielded mostly significant results after 4 wks (B = − 0.23, p = 0.048), 8 wks (B = − 0.33, p = 0.020) and 6- months (B = − 0.31 p = 0.045). Comparisons between GoD vs. WL yielded significant results after 4 wks (B = − 0.28, p = 0.025), 8 wks (B = − 0.44, p < 0.001) and 6- months (B = − 0.40, p = 0.007). Comparisons between GoD and UG yielded NS results after 4 wks (B = − 0.05, p = 0.706), 8 wks (B = − 0.11, p = 0.465) and 6-months (B = − 0.09, p = 0.62) | ITT analysis: Comparisons between UG vs. WL yielded mostly significant results after 8 wks (B = − 0.36, p = 0.014) and 6- months (B = 0.− 0.37, p = 0.012), with exception of 4 wks (B = − 0.22, p = 0.077). Comparisons between GoD vs. WL yielded significant results after 4 wks (B = − 0.46, p < 0.001), 8 wks (B = − 0.58, p < 0.001) and 6-months (B = − 0.66, p < 0.001). Comparisons between GoD and UG yielded mostly NS results after 4 wks (B = − 0.23, p = 0.082), and 8 wks (B = − 0.20, p = 0.166), however significant difference after 6-months (B = − 0.28, p = 0.026), where improvement significantly higher in GoD vs. UG | ITT analysis: Comparisons between UG vs. WL yielded mostly significant results after 4 wks (B = − 0.35, p = 0.008), 8 wks (B = − 0.31, p = 0.030) except at 6-months (B = − 0.23, p = 0.102). Comparisons between GoD vs. WL yielded significant results after 4 wks (B = − 0.47, p < 0.001), 8 wks (B = − 0.60, p < 0.001) and 6-months (B = − 0.47, p = 0.004). Comparisons between GoD and UG yielded mostly NS after 4 wks (B = − 0.12, p = 0.390), and 6-months (B = − 0.24, p = 0.155), with exceptions of stress at 8 wks (B = − 0.29, p = 0.031), where improvement significantly higher in GoD vs. UG |
ITT analysis: Comparisons between UG vs. WL yielded mostly significant results after 8 wks (B = 0.40, p = 0.004) and 6-months (B = 0.42, p = 0.015), except for 4 wks (B = 0.20, p = 0.140). Comparisons between GoD vs. WL yielded significant results after 4 wks (B = 0.52, p < 0.001), 8 wks (B = 0.51, p < 0.001) and 6-months (B = 0.34, p = 0.016) Comparisons between GoD and UG yielded mostly NS results after 8 wks (B = 0.10, p = 0.508), and 6- months (B = − 0.08, p = 0.589), with exceptions of well-being at 4 wks (B = 0.32, p = 0.023), where improvement significantly higher in GoD vs. UG |
Large effects (d = .94–1.07) post intervention when comparing both UG and GoD against WL Mindfulness significantly improved after 4 wks, 8 wks and 6-months in both intervention groups (IGs) compared with WL ITT analysis: Comparisons between UG vs. WL yielded significant results after 4 wks (B = 0.65, p < 0.001), 8 wks (B = 0.88., p < 0.001) and 6-months (B = 0.73, p < 0.001). Comparisons between GoD vs. WL yielded significant results after 4 wks (B = 0.76, p < 0.001), 8 wks (B = 0.88, p < 0.001) and 6- months (B = 0.97, p < 0.001). Comparisons between GoD and UG yielded NS results after 4 wks (B = 0.07, p = 0.56), 8 wks (B = − 0.02, p = 0.90) and 6-months (B = 0.22, p = 0.80) |
||
|
Pescatello et al. (2021)* Level 3 |
1. Depression (PHQ-9) 2. Anxiety (GAD-7) 3. Treatment outcome (OQ-45) |
SC-ONLY vs. SC + TX NS difference for depression (b = 0.20, p = 0.39). High severity participants using SC-ONLY vs. SC + TX NS depression difference (b = 0.20, p = 0 .77)., no group differences for participants who experienced greater symptom change (b = 0.17, p = 0.65. NS differences in usage for participants who experienced a large amount of change on PHQ-9 (b = 0.14, p = 0.74 | SC-ONLY vs. SC + TX NS difference anxiety (b = 0.34, p = 0.15). High severity participants using SC-ONLY vs. SC + TX NS anxiety difference (b = 0.75, p = 0.11). no group differences for participants who experienced greater symptom change on anxiety (b = 0.46, p = 0 .42). NS differences in usage for participants who experienced a large amount of change on GAD-7 (b = 0.33, p = 0.52) | SC + TX better outcomes than TX-ONLY (b = 1.83, p = 0.04) when controlling for therapy type and presenting concern. Relationship held when controlling for race, gender, and treatment length. High severity participants in SC + TX NS different treatment outcomes than TX-ONLY (b = 3.87, p = 0.08) | ||||
|
Peynenburg et al. (2022)* Level 1 |
1. Depression (PHQ-9) 2. Anxiety (GAD-7) 3. Academic functioning (PAF) 4. Mental health disability (SDS) 5. Alcohol consumption (AUDIT) 6. Drug use (DUDIT) |
Large pre-post ↓for depression (d = 1.28–1.48), with improvements maintained 1-month (d = 1.27–1.37) and 3-month f/u (d = 1.22–1.31). Main effect for MI intervention with ↓in depression symptoms (between-group d = 0.23, 95% CI − 0.01–0.47; p = 0.06) from pre-post treatment. Between-group differences were NS at the 1-month or 3-month f/u (p = 0.25, − 0.52). Main effects in favor of accessing the booster on depression (p = 0.09). Those who accessed booster had larger improvements in depression (between-group d = 0.31) at 3-month f/u | Large pre-post ↓for anxiety (d = 1.46–1.72), with improvements maintained at 1-month (d = 1.29–1.51) and 3-month f/u (d = 1.19–1.31). main effect for MI intervention with ↓in anxiety symptoms (between-group d = 0.25, 95% CI 0.02–0.49; p = 0.04) post. Between-group differences NS at 1-month or 3-month f/u (p = 0.57, − 0.60). Between-group effects (those assigned to the booster versus those who were not assigned to any) were NS for anxiety (p = 0.21) or SDS (p = 0.61) at 3-month f/u | For MI, small between-group effect post treatment, such that clients who received MI had larger improvements on mental health disability (SDS) than clients who did not receive MI (between-group d = 0.35). At 1-month (d = − 0.24 to 0.23) and 3-month f/u (d = − 0.20 to 0.27), differences no longer present, and there were large within-group effect sizes for improvements on SDS, regardless of factor (MI vs. booster) (d = 1.02–1.25) and 3-month f/u (d = 0.97–1.18). Between-group effects for MI and those who accessed MI with booster NS for mental health disability (p = .61) at 3-month f/u. NS between-group differences found for academic functioning at any of 3 time points (p = 0.48–0.75). Main effects in favor of accessing booster on academic functioning (PAF) (p = .02). Clients who accessed booster had larger ↑ perceived academic functioning (between-group d = 0.42) at 3-month f/u.No main effect found for MI for AUDIT (p = .35) or DUDIT (p = .49) post -measures not administered during f/u | ||||
|
Radovic et al. (2021)* Level 1 |
1. Depressive symptoms (PHQ-9) 2. Anxiety symptoms (GAD-7) 3. Emotional support (MOS-SS) 4. Parent adolescent communication (PACS) 5. General functioning (MAFS) |
ITT analysis: From pre to 6 wks, ↓in depression in the EUC group compared with SOVA group (p = 0.09) Per-protocol analysis: NS differences between adolescents accessing the SOVA intervention and those who did not access it on depressive symptoms (p = 0.71) |
ITT analysis: ↓in anxiety in EUC group compared with SOVA group (p = 0.04) Per-protocol analysis: NS differences between adolescents accessing the SOVA intervention and those who did not access it on anxiety symptoms (p = 0.42) |
↑ social support in EUC group vs. SOVA from pre-6 wks post (p = .02). NS changes (pre-6 wks post) between SOVA and EUC for general functioning p = 0.95, family functioning p = 0.95, peer functioning p = 0.70, parent–child communication: (openness of communication p = .030; extent of communication p = 0.67). Per -protocol analysis comparing change scores between adolescents accessing SOVA vs. those who did not: NS differences on adolescent functioning subscales, except ↑in peer functioning in SOVA vs. EUC (p = 0.02). NS differences between the SOVA and those who did not access it on general functioning (p = 0.31), family functioning (p = 0.53), parent–child communication [openness of communication (p = 0.49), extent of communication (p = 40)], and social support (p = .99) | ||||
|
Ravaccia et al. (2022) Level 5 |
1. Welll-being (ORS) 2. Mental health empowerment (MHES) |
NS differences in well-being in group and gender subgroup analyses pre-post (pre M(SD) = 5.07(2.58); post M(SD) = 4.44(2.23), p NR). In subgroup analysis with young females, overall well-being increased by 0.83 points, from 3.34/10 at pre to 4.17/10 at post, although the difference was NS: t = 1.97, p = 0.05. NS differences in group and subgroup analysis for young males (effects NR) | Subgroup analysis examining females showed ↑ patient activation levels pre-post (t = 2.15, p = 0.04), meaning participants knew how to look after their health more after the intervention | |||||
|
Rice et al. (2020) Level 5 |
1. Depression (PHQ-9, MDRS-22) 2. Wellbeing (WVS LSS, SWEMWBS, ESS) 3. Social connectedness (DSSI, UCLA, SCS, INQ) 4. Social anxiety (LSAS, BFNE, ASI, SIAS) 5. Self-compassion (SCS short) 6. Self-esteem (RSES) 7. Emotional regulation (ERQ) 8. Guilt and shame (PFQ2-B) |
↓ depressive symptoms and suicidality pre-post (PHQ-9 full scale: d = 0.66, p < .001; suicidality item: d = 0.27, p = 0.026). NS pre-post change on the MDRS-22 (d = 0.30, p = 0.01) | Significant ↓ in social anxiety symptoms pre-post on the LSAS (d = 0.73, p < 0.001) and SIAS (d = 0.53; p < 0.001). 48.33% (n = 29) showing reliable improvement. NS improvements pre-post on social anxiety when measured with the BFNE (d = 0.37; p = 0.001) and ASI (d = 0.34; p = 001) | Significant ↑ wellbeing pre-post (SWEMWBS; d = 0.50, p < 0.001; WVS: d = 0.41, p < 0.001). NS change pre-post on the ESS (d = 0.07. p = 0.580) |
Loneliness ↓ pre-post across all scales: (UCLA: d = 0.63, p < 0.001; DSSI: d = 0.50, p < 0.001; SCS: d = 0.63, p < 0.001; INQ—perceived burdensomeness: d = 0.48, p < 0.001; INQ – thwarted belongingness: d = 0.58, p < 0.001) NS self-compassion change pre-post (p = 0.003, d = 0.35) ↑ in self-esteem pre-post (d = 0.47, p < .001) NS change in emotion regulation subscales: reappraisal (d = 0.05, p = 0.691) and suppression (d = 0.08, p = .509) NS pre-post change in guilt and shame (d = 0.17, p = .145) |
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|
Sun et al. (2022)* Level 1 |
1. Depression (PHQ-9) 2. Anxiety (GAD-7) 3. Mindfulness (MAAS) 4. Emotional Suppression (Chinese ERQ ESS subscale) |
Large depression ↓in both groups from baseline to f/u (p < 0.001, d = 1.46 and 1.10, for mindfulness and social support conditions, respectively). Size of depressive symptoms reduction over time NS different by condition (between group d = 0.36). Reductions in depressive symptoms in mindfulness mHealth group from baseline to f/u (73.7% to 17.3%) vs. social support mHealth group (71.9% to 34.0%) NS, p = 0.056. Condition × time effect NS for depression (p = 0.430) | Both groups ↓ anxiety symptoms from baseline to f/u (p < 0.001, ds = 1.40 and 0.68 for mindfulness and social support conditions, respectively). The mindfulness mHealth group experienced greater improvement [Condition × Time p = 0.024]. A stronger ↓ in mindfulness mHealth condition (↓ from 63.2% to 9.6%), compared to 57.9% to 27.7% for social support group (p = 0.020) | Both mindfulness-based and social support-based conditions improved in mindfulness and social support outcomes over time (time effect: p < 0.01). Mindfulness mHealth condition had large effect from baseline to f/u in improving mindfulness (d = 1.17) vs. control (d = 0.67). Condition × time effect NS, though there was a trend of improvement on mindfulness in the mindfulness mHealth condition (compared to social support condition), B = 1.97, p = 0.065 |
Both mindfulness-based and social support-based conditions improved in social support outcomes over time (time effect: p < 0.01). Small effects for improvements in social support for control (d = 0.33) and mindfulness conditions (d = 0.10). Condition × time effect was NS for social support (p = 0.084) NS between-group difference emotional suppression change during intervention, p = 0.091. Emotional suppression ↓ from baseline to post linked to ↓ of depression and anxiety symptoms from baseline to f/u in mindfulness condition, opposite direction found in control |
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|
Wahlund (2022) Level 5 |
1. Depression (NR) 2. Anxiety (NR) 3. Worry (PSWQ-C) 4. Impaired functioning (NR) |
Post-treatment significant medium to large ↓ in depressive symptoms (d = 0.69–1.38, p = 0.001). Post parent-reported depression significantly ↓ (d = 0.49–1.76; p = .001) with changes maintained at 1 and 3-month f/u | Post-treatment significant medium to large ↓ in anxiety symptoms (d = 0.69–1.38, p = 0.001). Post parent-reported significantly ↓anxiety (d = 0.49–1.76; p = 0.001) with changes maintained at 1 and 3-month f/u | Post-treatment medium to large significant↓ self-rated worry (d = 0.69–1.38, p = 0.001). Similar changes for depression reported by parents (d = 0.49–1.76; p = 0.001) and changes were maintained at 1 and 3-month f/u. Post-treatment results showed medium to large ↓ in impaired functioning (d = 0.69–1.38, p = 0.001) | ||||
| Study | Outcome (measure) | Mixed synchronous and asynchronous guided intervention delivery | ||||||
|---|---|---|---|---|---|---|---|---|
| Key findings | ||||||||
| Depression | Anxiety | Stress | Well-being | Mindfulness | Quality of life | Other | ||
|
Garnefski and Kraaij (2023) Level 5 |
1. Depression (PHQ-9) | Post-test, 17/23 (73.91%) showed categorical improvements, 6/23 (26.09%) remained in same ‘cut-off’ category & 0 deteriorated. Post-test, 19/23 (82.61%) scored in one of the categories of minimal or mild depression, vs. 5/23 (21.74%) at pre-test. Significant prepost improvements on depression for Completers = 5.52 (d = 1.31) and ITT (started but did not complete) = 4.10 (d = 0.94) | ||||||
|
Grudin et al. (2022)* Level 1 |
1. Assessor-rated child depressive symptoms (CDRS-R) 2. Self-rated depressive symptoms (SMFQ-A) 3. Parent-rated depressive symptoms (SMFQ-P) 4. Impaired functioning (WSAS-A) |
Significant ↓ in assessor-rated child depressive symptoms from pre to 3-month f/u for therapist-guided I-BA (B = − 11.3, p < 0.001) & self-guided I-BA (B = − 10.38, p < 0.001), but not TAU (B = − 4.40, p = 0.077, p > 0.05). Assessor-rated child depressive symptoms within-group d = 2.43 for therapist-guided I-BA, 2.23 for self-guided I-BA and 0.95 for TAU. Significant ↓ in self-rated depressive symptoms for all groups: therapist-guided I-BA (B = − 4.4, p < 0.001,), self-guided I-BA (B = − 3.39, p < 0.05) and TAU (B = − 4.04, p = 0.001,). Self-rated depression within-group effect d = 1.45 for therapist-guided I-BA, d = 1.12 for self-guided I-BA and d = 1.34 for TAU. Significant ↓ for parent-rated depressive symptoms for therapist-guided I-BA (B = − 2.83, p < 0.01), self-guided I-BA (B = − 3.75, p < 0.01), and TAU (B = − 3.29, p < 0.01). Parent-rated depression within-group d = 1.05 for therapist-guided I-BA, d = 1.40 for self-guided I-BA, d = 1.22 for TAU | Significant ↓for self-rated impaired functioning (WSAS-A) for therapist-guided I-BA (B = − 5.24, p < 0.001) and self-guided I-BA (B = − 3.58, p < 0.01), but not TAU (B = − 1.81, p = 0.163). For impaired functioning, within-group d = 1.47 for therapist-guided I-BA, 1.00 for self-guided I-BA and 0.51 for TAU | |||||
|
Keinonen et al. (2021) Level 5 |
1. Depression (DEPS) 2. Avoidance and cognitive fusion (AFQ-Y) 3. Perceived health (HBSC) |
Depression ↓during 5-wk intervention for high symptoms youth (B = 1.76, p < 0.001). NS effects on depression for youth with average or stable symptoms (p > 0.05). Heightened depression for those with low experiential avoidance and decreasing depressive symptoms post intervention (B = − 0.64, p < 0.001) | Experiential avoidance ↓ during 5-wk intervention among those with high symptomatology (B = 1.73, p < .001). NS effects on experiential avoidance for those with average and stable symptoms (p > .05). Heightened experiential avoidance for those with low experiential avoidance and decreasing depressive symptoms (B = − 0.63, p < 0.001). Those in high and decreasing experiential avoidance and depressive symptoms trajectory perceived their health significantly ↓ (p < 0.001) and sleep (p < 0.001), ↑substance abuse (p = 0.001) and ↓physical activity (p = 0.035) pre-intervention than those from other two trajectories (1: Average and stable experiential avoidance and depressive symptoms; 2: Low experiential avoidance and decreasing depressive symptoms) | |||||
|
Klimczak et al. (2023)* Level 1 |
1. Depression (DASS-21) 2. Anxiety (DASS-21) 3. Stress (DASS-21) 4. Total psychological distress (MHC-SF) 5. Positive mental health (DASS-21) 6. Psychological inflexibility (AAQ-II) and flexibility (CompACT) 8. Openness to experience (CompACT) 9. Behavioral awareness (CompACT) 10. Valued action (CompACT) |
Phone coaching experienced ↑ gains than control on depression (p = 0.035) pre-post. Text coaching NS effect on depression (p > 0.05). NS differences between phone and text coaching groups (p > 0.05). Assigned condition had significant effect on reliable improvement in depression (X2(2) = 15.6, p < 0.001). Phone condition significantly more likely to experience reliable improvement in depression (33%; p < 0.001) than control. NS differences between phone and text conditions, or text and control conditions (all p > 0.05) |
Phone coaching ↑ gains vs. control for anxiety (p = 0.025) pre-post. Text coaching NS effect on anxiety (p > 0.05). NS differences were found between phone and text coaching groups (p > 0.05) Assigned condition had NS effect on reliable improvement in anxiety (p NR; % Reliable improvement for phone = 17%, text = 10%) |
Phone coaching ↑ gains than control for stress (p = 0.045) pre-post. Text coaching NS effect on stress (p > 0.05). NS differences between phone and text coaching groups (p > 0.05). Assigned condition significant effect on reliable improvement in stress (X2(2) = 7.8, p = 0.021). Phone condition significantly more likely to experience reliable stress improvement (28%; p = 0.023) than control. NS differences between phone and text, or text and control groups (ps > 0.05) | Phone coaching ↑ gains vs. control pre-post for psychological distress (p = 0.007), positive mental health (p = .006), psychological inflexibility (p = 0.032), openness to experience (p < 0.001), behavioral awareness (p < 0.001), psychological flexibility (p < 0.001). NS difference between phone coaching and control for valued action (p = 0.134). Those receiving text message coaching experienced improved openness to experience (p = 0.025), behavioral awareness (p = 0.035), and psychological flexibility (p = 0.035) compared to control. Text coaching had no significant effect on psychological distress, positive mental health, psychological inflexibility, or valued action (all p > 0.05). NS differences between phone and text coaching groups (all p > 0.05). Assigned condition had significant effect on reliable improvement in psychological distress (X2(2) = 9.3, p = .009), positive mental health (X2(2) = 8, p = .018), psychological inflexibility (X2(2) = 7.6, p = .023). phone condition significantly more likely to experience reliable improvement in psychological distress (57%; p = .007), psychological inflexibility (20%; p = .018) compared to control. NS differences between phone and text conditions, or the text and control conditions (all p > 0.05) | |||
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Koltz (2022) Level 5 |
1. Perceived academic stress (PASS) | NS effects of online counseling on academic stress (P1: d = − 1.78; P2: d = − 0.44; P3: d = 0.12; P4: d = 0.66; (ps NR) | ||||||
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Lappalainen et al. (2021)* Level 1 |
1. Depressive symptoms (DEPS) 2. Life satisfaction (SWLS) 3. Avoidance & cognitive fusion (ATQ-Y) |
ITT analyses: change in interventions groups NS vs. control (p = 0.153). Changes for two iACT intervention groups significantly different vs. control (d = 0.16, p = 0.024). Depression symptoms ↓significantly more in both iACTface group (d = 0.15, p = 0.021) and iACT group (d = 0.16, p = 0.017) vs. control. Between-group effects small (d = 0.20, p < 0.05). Within-group pre-post change significant for both iACT groups, but not control (d = .05, p NR). Change in depressive symptoms equal in both intervention groups (p = 0.935). iACTface intervention, including two f2f meetings, ↓depression among girls but not boys (p = 0.006). NS gender differences for intervention including only support via WhatsApp (iACT) p > 0.05 | ITT analysis: NS differences in changes in two iACT interventions compared to control for life satisfaction (p = 0.195). Intervention effect significant for life satisfaction (d = 0.30, p = 0.030). Life satisfaction ↑significantly more in iACT without f2f meetings vs. control (d = 0.04, p = 0.013). iACTface positive impact on life satisfaction, but difference vs. control NS (p = 0.065). For life satisfaction, within-group effect pre-post significant for both intervention groups (p < 0.05), but not control (p > 0.05). For life satisfaction, vs. control, between-group effect small. NS difference in changes in life satisfaction between two iACT interventions (p = 0.456). NS gender differences on life satisfaction in either intervention groups (p = 0.397). NS effect for avoidance (psychological flexibility), but small ↓in avoidance in intervention groups (iACTface: d = 0.03, iACT: d = 0.15) vs. small ↑in control (d = 0.06). NS differences in changes for avoidance between groups (p > 0.05). iACTface intervention, including two f2f meetings, ↓ avoidance of unpleasant feelings in girls not boys (p = 0.033). NS gender differences for intervention incl. only support via WhatsApp (iACT) p = 0.555) | |||||
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Lappalainen et al. (2023)* Level 1 |
1. Depression (DEPS) 2. Anxiety (STAI) 3. Psychological flexibility (CompACT) 4. Self-compassion (SCS-SF) |
ITT analysis: Changes in both intervention groups (iACT student coach + virtual coach; iACT virtual coach) NS difference to control on depressive symptoms (p = 0.179). Per-protocol analysis: Depression showed ↑in iACT group, but NS (d = − 0.01, p = 0.224) | ITT analysis: Changes in both intervention groups (iACT student coach + virtual coach; iACT virtual coach) NS different to control on anxiety (p = 0.073). Anxiety slight ↑in iACT group (within ES, d = 0.05, p = 0.042), anxiety symptoms in control significantly greater ↑ (within ES, d = 0.34, p NR) | ITT analysis: Changes in both intervention groups (iACT student coach + virtual coach; iACT virtual coach) did not NS differ to control for psychological flexibility (p = 0.421) and self-compassion (p = 0.112). iACT group showed different change (slight ↑) compared to control group for self-compassion (d = 0.12, p = 0.030). Psychological flexibility, but not self-compassion, predicted depression symptom changes (F(1,69) = 5.911, p = 0.18) | ||||
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O'Connor et al. (2020)* Level 1 |
1. Anxiety (MASC-2) 2. Healthcare use (NR) |
Experimental group: M change in anxiety baseline to 8-wks − 7.9 (SD = 15.7; p value NR). 80% CI for SD generated for 8-wks post to baseline change score 12.6 to 21.7. For control, M change in anxiety scores from 8-wks post to baseline − 9.0 (SD = 15.4; p NR). Difference of 4.7 in change scores between control and experimental group (p NR) | 39% (14/36) reported using healthcare resources during BREATHE | |||||
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^O'Connor et al. (2022)* Level 1 |
1. Anxiety (MASC-2) 2. Quality of life (YQOL-SF) 3. Healthcare use (trial-specific measure) |
Post intervention, Δ = 5.5 difference between intervention groups (favoring online CBT; p = 0.019) estimated linear regression effect size of B = 0.32 (effect measurement NR). 3-month f/u, significant anxiety difference between-group mean difference of M = − 4.39 (favoring online CBT; p = 0.04) | At 3-month f/u, NS between-group differences in quality of life (p = 0.23) | Post, intervention group had fewer visits to psychiatrist (%Δ = –41%), social worker (%Δ = –42.5%), hospital-based healthcare (ED visits: %Δ –80%; hospital admission: %Δ –76.1%). Intervention group fewer self-help and alternative treatments (%Δ = –60%). Greatest change for static website group was fewer social worker visits (%Δ = –22.1%) and hospital-based healthcare visits (ED visits: %Δ = –79.4%; hospital admission: %Δ = –42.9%; p NR) | ||||
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Radomski et al. (2020)* Level 1 |
1. Anxiety (MASC-2, GRCS) | NS relation between number of completed sessions and anxiety change on GRCS (rho = 0.02; p = 0.83). With the GRCS, 75% (60/80) improved anxiety post program (M improvement = 2.3 (‘somewhat better’). On MASC-2, MΔ = 13.8 (SD = 18.1). 43% (35/81) of intervention participants were positive treatment responders based on minimal clinically important difference (MCID) threshold. Significant differences between BREATHE and control on all anxiety items (ps < 0.001) with greater improvements in BREATHE intervention | ||||||
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Rodriguez et al. (2021)* Level 1 |
1. Depression (PHQ-9, DASS-21) 2. Anxiety (GAD-7, DASS-21) 3. Stress (DASS-21) 4. Mindfulness (FFMQ) |
NS pre-post depression change as measured on the DASS p = 0.41; d = 0.24. NS pre-post-depression change as measured on the PHQ (p = 0.26; d = 0.33) MIND + significantly greater pre-post depression improvements (interaction estimate = 0.38, SE = 0.16; t330 = 2.37; p = 0.02) than MIND group |
Pre-post change on anxiety for both groups was NS on GAD and DASS: p = 0.80; d = − 0.07; p = 0.72; d = 0.10, respectively. Pre-post effect size for anxiety was large (d = 0.89) | Pre-post change for both groups NS on DASS: p = 0.76; d = 0.09. MIND + significantly greater pre-post improvements in daily stress ratings than MIND (interaction estimate = 0.39, SE = 0.18; t = 2.29; p = 0.02) | Pre-post mindfulness change for both MIND and MIND + groups NS (p = 0.53; d = 0.18) | |||
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Schueller et al. (2019) Level 5 |
1. Depression (PHQ-9) 2. PTSD symptoms (PCL-5) 3. Emotional regulation (DERS) |
NS pre-post-depression (d = 0.27, p > .50). Having no traumatic experience during intervention NS change on depressive symptoms (Δ = 0.33, p NR). Those who experienced a traumatic event throughout intervention period had small ↓in depressive symptoms (M Δ = 2.25), p = 0.30, d = − 0.49, | NS pre-post PTSD change (d = 0.17, p > 0.50). Having no traumatic experience during intervention ↓ PTSD symptoms (MΔ = 6.42, p NR), and poorer emotion regulation from pre to post. Those who experienced a traumatic event ↑ PTSD symptoms (MΔ = 3.78, p = 0.35, d = 0.42 | NS pre-post emotion regulation change (d = 0.10, p > .50). Those who experienced a traumatic event had poorer pre-post emotion regulation (Δ = 1.00, p NR). Those who experienced a traumatic event throughout course of intervention had small ↑ in emotion regulation (Δ = 3.89), p = .63, d = − 0.22 | ||||
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Sit et al. (2022) Level 5 |
1. Depressive symptoms (PHQ-9) 2. Anxiety symptoms (GAD-7) 3. Self-defined stress (PSYCHOLOPS) 4. Wellbeing (WHO-5) |
Significant ↓ depression scores post intervention (t(11) = 4.29, p = 0.001, d = 1.24) | Significant pre-post ↓ anxiety symptoms (p = 0.024, d = 0.754) | Significant pre-post ↓ self-defined stress (p = 0.005, d = 0.99) | NS pre-post ↑ subjective well-being (p = 0.208, d = 0.386) | |||
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Stapinski et al. (2021)* Level 1 |
1. Anxiety (GAD-7) 2. Social anxiety (SIAS + SPS) 3. Depression (DASS-21) 4. Functional impairment (SDS) |
Depression symptoms ↓ 2-month f/u for both groups (Inroads: d = 0.91, p < 0.001; control: d = 0.50, p < 0.001), weak evidence for greater ↓ for Inroads (d = 0.39, p = 0 .049). Ongoing ↓ in depression, with control (d = 0.71, p < 0.001) achieving comparable gains as Inroads by 6-month f/u (d = 0.96; p < 0.001) | Inroads & control significant ↓ general anxiety. Group × time interaction significantly greater ↓ 2-month f/u for Inroads (d = 0.88, p = 0.002). By 6-month f/u, control comparable ↓to Inroads, with no group differences (d = 0.38, p = .238). Social anxiety symptoms ↓ at 2-month f/u for Inroads (d = 0.48, p < 0.001) but not control (d = 0.14, p = .196). Inroads, but not control (d = 0.22; p = .080), significant ↓ social anxiety symptoms at 6-month f/u (d = 0.59; p < 0.001). Significant group x time interaction with Inroads vs. control at 2-month (d = 0.32, p = .045) and 6-month f/u (d = 0.37, p = 0 .043) | Functional impairment ↓for both groups at 2-month (Inroads: d = 0.52, p = .002; control: d = 0.79, p < 0.001) and 6-month f/u (control: d = 0.75, p < 0.001; Inroads: d = 1.01, p < 0.001). NS group x time interaction at 2-months (d = 0.28, p = .202) or 6-months (d = 0.22, p = 0.348). At 6-month f/u Inroads and control reported greater ↓in number of days lost (b = 0.58, p = .038; d = 0.31) and number of unproductive days due to symptoms (p = 0.022; d = 0.46) | ||||
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van Doorn et al. (2022)* Level 3 |
1. Stress (Dutch EMA) 2. Emotional awareness (Dutch S-DERS) |
NS effects on perceived stress post intervention (B = − 0.020, p = 0.562) | Significant ↑ in emotional awareness pre to post intervention (B = 0.030, p = 0.048). Significant time x condition interaction (B = 0.030, p = 0.048), indicating in experimental condition emotional awareness significant ↑ over time | |||||
^Async or sync depending on participant’s preference; ^ Comparative study; * RCT; ≠ No association; ↑ Increase; ↓ Decrease; Δ Average rate of change (delta), ɳ2 Eta squared, ɳp2 Partial eta squared, AD Anderson-Darling goodness of fit, AA anxious arousal, b/B/β beta, CC concentration capacities, CI confidence interval, d Cohen’s d effect size, ES effect size, F F ratio, f/u follow-up, HR hazard ratio, ITT intention-to-treat, M mean, MM mindfulness meditation, NR not reported, NS not significant, P participant, p probability value, ps probability values, rho Spearman’s correlation coefficient, SD standard deviation, SE standard error, SC SilverCloud, t t value, TX treatment only, PTSD post traumatic stress disorder, vs. versus, WL wait list, X2 chi square. Level of evidence: Level 1 = Studies described as randomised controlled trials; Level 2 = described as controlled study; Level 3 = Cohort analytic (two group pre + post); Level 4 = Case control; Level 5 = Cohort (one group pre + post (before and after). Measures: AAQ-II acceptance and action questionnaire-2nd version, AFQ-Y avoidance and fusion questionnaire for youth, ASI anxiety sensitivity index, ATQ-Y avoidance and fusion questionnaire for youth, AUDIT alcohol use disorders identification test, BAI beck anxiety inventory, BDI-II beck depression inventory-2nd version, BFNE brief fear of negative evaluation from others scale, BHS beck hopelessness scale, CBI Copenhagen burnout inventory, CCAPS counseling center assessment of psychological symptoms, CompACT comprehensive assessment of acceptance and commitment therapy, DASS-21/42 depression anxiety and stress scale-21/42 item, DEPS depression scale, DSSI Duke social support index, CDRS-R children’s depression rating scale-revised, DT distress thermometer, DUDIT drug use disorders identification test, ELEI episodic life event interview, EMA ecological momentary assessment, ERQ emotional regulation questionnaire, ESS European Social Survey, EQ-5D EuroQol-5 digit health status, FFMQ five facet mindfulness questionnaire, FMI Freiburg mindfulness inventory, GAD generalized anxiety disorder, GAD-7 generalised anxiety disorder-7 item, GRCS global rating of change scale, HBSC health behavior in school-aged children, INQ interpersonal needs questionnaire, LSAS life skills assessment scale, LSS life satisfaction scale, MAAS mindful attention awareness scale, MAFS multidimensional adolescent functioning scale, MASC-2 multidimensional anxiety scale for children-2nd version, MASQ mood and anxiety questionnaire, MDRS-22 male depression risk scale-22 item, MINI mini international neuropsychiatric interview, MHC-SF mental health continuum short form, MHES multidimensional home environment scale, MOS-SS medical outcomes social support survey, ORS outcome rating scale, OQ-45 outcome questionnaire-45 item, PACS parent-adolescent communication scale, PAF perceptions of academic functioning, PANAS positive and negative affect schedule, PASS perceived academic stress scale, PERS Perth emotional reactivity scale, PCL-5 posttraumatic stress disorder checklist for DSM-5, PFQ2-B personal feelings questionnaire 2-brief, PHQ-9 patient health questionnaire-9 item, PHQ-15 patient health questionnaire-15 item, PSYCHOLOPS psychological outcome profiles, PSS-4 perceived stress scale-4 item, PSWQ Penn State Worry Questionnaire, RRS Rumination Response Scale, RSES Rosenberg self-esteem scale, SCID-I structured clinical interview for DSM disorders-Axis I disorders, SCS self-compassion scale, SCS-SF self-compassion scale short form, S-DERS state difficulties in emotion regulation scale, SDS sheehan disability scale, SIAS social interaction anxiety scale, SMFQ-A short mood and feelings questionnaire-adolescent version, SMFQ-P short mood and feelings questionnaire-parent report version, SPS suicide probability scale, SSAS somatosensory amplification scale, SSD somatic symptom distress, STAI state trait anxiety inventory, STAI-Y state trait anxiety inventory-youth version, SWEMWBS short Warwick Edinburgh Mental Well-Being Scale, SWLS satisfaction with life scale, UCLA University of California Los Angeles Loneliness Scale, WAI-SR work alliance inventory-short revised, WEMWBS Warwick-Edinburgh Mental Well-being Scale, WHO-5 World Health Organisation-5 Well-being Index, WSAS-A work and social adjustment scale-adolescent version, WVS World values survey, WHOQol-BREF World Health Organization Quality of Life-Brief version, YP-CORE young person’s clinical outcomes in routine evaluation, YQoL-SF youth quality of life instrument-short form