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. 2021 Jul 31;57(8):793. doi: 10.3390/medicina57080793

Table 2.

Summary of retrieved papers.

Study Sample Features Intervention Advantages Findings
Anxiety
[29] 49 children (M 33; F 16), aged 7–13 yy, with a principal anxiety disorder

  • The sample was randomly assigned to CCCAL, a computer-assisted CBT for anxiety in youth, to individual CBT, or to a computer-assisted education support and attention (CESA) condition.

  • Independent diagnostic interviews and self-report measures were completed at pre-, post-treatment, and 3-month follow-up.

 Findings support the feasibility, acceptability and beneficial effects of CCAL for anxious youth.

  • At post-treatment ICBT or CCAL children showed significantly better gains than CESA children.

  • 70%, 81% and 19% respectively, no longer met criteria for their principal anxiety diagnosis.

  • Gains were maintained at follow-up, with no significant differences between ICBT and CCAL.

  • CCAL and ICBT has higher satisfaction than CESA.
[30] 115 clinically anxious adolescent, aged 12 to 18 yy (M 47; F 68) and their parents

  • The sample was randomly assigned to an online CBT therapy for youth with anxiety disorders (BRAVE-ONLINE) versus clinic delivery CBT or WLC.

  • The BRAVE-ONLIne program is delivered through 10 weekly sessions for adolescents and five sessions for parents, each of approximately 60 min in duration. At 1 month and 3 month following treatment, booster sessions are provided for parents and adolescents to consolidate previously acquired skills.

  • Adolescents also receive 15-min telephone calls following sessions 5.

  • Prior to treatment, each family was assigned to a therapist who monitored their progress.

  • The outcomes were evaluated through ADISC/P, CGAD, SCAS and a 5-item questionnaire to evaluate the treatment expectancy and satisfaction.

 Online CBT, with minimal therapist contact, for adolescent anxiety disorders offer an efficacious alternative to clinic-based treatment.

  • Assessment at 12 weeks post-baseline showed significantly greater reductions on anxiety diagnosis and anxiety symptoms for both online e clinic CBT compared to waitlist control.

  • 68% of adolescents in the online CBT group no longer met criteria for the principal anxiety diagnosis at 12-month follow-up compared with 80.6% in the clinic group.

  • Satisfaction ratings by adolescents were equivalent for online-CBT and clinic-CBT, whereas parents indicated slightly higher satisfaction ratings for the clinical format.
[31] 52 pre-school r children (M 24; F 28), aged 3–6 yy, with clinical anxiety disorders (ADIS-C)

  • The sample was randomly allocated into an internet-based, parent-focused CBT (NET) versus WLC

  • The intervention group consisted of 6 parent online sessions and 2 boosters BRAVO-ONLINE for children, together with phone and video consultation and weekly email

  • Intervening so early in the development of anxiety has the potential to prevent problematic trajectories that frequently results in life-long suffering.

  • The use of internet programs has the potential to reach many more families than face-to-face therapy.

  • At post-treatment 39.1% of the NET children compared to 25.9% of the WLC were free of their primary diagnosis.

  • By 6-month follow-up for the complete sample, 70.6% of children were free of their primary diagnosis.

  • Satisfaction levels, as measured by a 8-item questionnaire, reported moderate to high rate satisfaction
[32] 433 parents of children aged 3 to 6 yy, with an inhibited temperament (OAPA)

  • The sample was randomly assigned to the online parenting program or to a 24-week WLC.

  • The online program consists of 8 interactive modules providing strategies that parents can implement and a telephone consultation support with psychologists.

  • Offering an online adaptation of the Cool Little Kid parenting program appears to be effective in reducing anxiety in inhibited young children.

  • The follow-up at 12 and 24 months guaranteed to collect longitudinal data.

  • The intervention group showed significantly greater improvement over time in child anxiety symptoms compared to the control group (d = 0.38), greater reductions in anxiety life interference (ds = 0.33–0.35) and lower rates of anxiety disorders than the control group (40% versus 54%).
[33] 73 children (33 M; 40 F) with anxiety disorders (ADIS-C/P), aged 7–12 yy, and their parents.

  • The sample was randomly assigned to NET or WLC.

  • The NET consists of the BRAVO-ONLINE. Satisfaction with the program was measured, after 10-week, through an 8-items rating scale. Two booster sessions were conducted 1 and 3 month following the end of treatment.

  • Approaches incorporating only minimal therapist contact for CBT treatment of child anxiety disorders can produce clinically and statistically significant reductions in anxiety.

  • This type of approach is well accepted by families as shown from the satisfaction questionnaire.

  • Children in NET intervention showed small but significantly greater reductions in anxiety symptoms and increases in functioning than WLC participants.

  • These improvements were enhanced during the 6-month follow-up period, with 75% of NET children free of their primary diagnosis.
[34] 72 clinically anxious children (M 42; F 30), aged 7–14 yy

  • The sample was randomly allocated to an online CBT based program, to clinic-based on or to WLC.

  • The online programme consists of 10 child sessions and 6 parent sessions, plus booster sessions at 1 and 3-months post-treatment. The child group sessions were 60 min in duration, conducted once a week for 10 consecutive weeks. Parent sessions were also 60 min in duration, conducted in a group format over 6 weeks.

 The internet treatment content was highly acceptable to families, with minimal dropout and a high level of therapy compliance.

  • Children in the clinic and clinic-plus-internet conditions showed significantly greater reduction in anxiety from pre-to post-treatment compared to WLC.

  • Improvements were maintained at 12-month follow-up for both therapy conditions.
[35] 5 adolescents (M 1; F 4), aged 14–16 yy, with anxiety disorder (ADIS-C)

  • Participants used the 8-module Cool Teen CD-ROM over a 12-week period on their home computer.

  • Every 2 weeks, they received a brief telephone call from a clinical psychologist.

 Participants were generally satisfied with multimedia content, the modules and the delivery format of the program.

  • Two participants no longer met diagnostic criteria (ADIS) for at least one clinical anxiety disorder.

  • These participants no longer met diagnostic criteria for any clinical anxiety disorder at 3-month follow-up.
[36] 43 adolescents (M 16; F 27), aged 17–17 yy, with primary diagnosis of anxiety (ADIS-C/P & SCAS-C/P)

  • Adolescents were randomly allocated to the Cool Teens program, an eight-session, CD-ROM-based program for anxiety management, or a 12-week WLC.

  • The program uses a combination of multimedia formats (text, audio, illustrations, cartoons, video) and, also telephone sessions.

 The Cool Teens program is an efficacious option for the treatment of adolescent anxiety.

  • Adolescents in the Cool Teens condition, compared with those on the WLC, were found to have significant reductions in the total number of anxiety disorders.

  • There was also a significant reduction in the clinical severity of the primary anxiety disorder in the Cool Teens group compared with the WLC group.

  • At post-treatment, 41% of participants in the Cool Teens group no longer met diagnostic criteria for their primary anxiety disorder.

  • This reduction was also maintained at the 3-month follow-up assessment.
[37] 19 high school students, aged 15–21 yy, with social anxiety disorder (SPSQ-C & MADRS-S)

  • The sample was randomly allocated into NET or WLC.

  • The NET consists of 9 weeks of an Internet-delivered CBT.

 Internet-delivered CBT could be an option to treat high school students although strategies to increase compliance should be found.

  • Significant improvements were found on measures of social anxiety, general anxiety, and depression.

  • The average number of complete modules in the CBT program was low.
[38] 66 distressed university students (DASS-21)

  • The students were randomly assigned to either Immediate Access or a 6-week Delayed Access condition.

  • The online program consists of 5 core modules. Each module is organized in a multimedia workbook format (including psycho-education, real-life examples, videos, audio files, pictures, phone call, weekly email).

  • A 10-items questionnaire at the end of each module.

 An individual-adaptable, internet-based, self-help programs can reduce psychological distress in university students.

  • Access participants reported significantly greater reductions in depression, anxiety and stress, in comparison to participants waiting to do the program.

  • These improvements were maintained at six-month follow-up.
[39] 558 internet users, recruited via the Australian Electoral Roll The sample was randomly assigned to 5 arms:

  • Group 1: received combined psychoeducation, ICBT, physical activity and relaxation

  • Group 2: received the identical Web program plus weekly telephone reminder calls

  • Group 3: instead telephone reminder, weekly email reminder

  • Group 4: received a placebo website.

  • Group 5: placebo website plus telephone calls.

 This trial is not able to demonstrate the preventative effects of the website on anxiety symptoms as measured by the GAD-7.

  • GAD-7 symptoms reduced over post-test, 6-month, and a 12-months follow-up.

  • There were no significant differences between Group 4 and Group 1,2,3, or 5 at any follow-up.
[40] A three-arm cluster stratified randomised controlled trial take in consideration 1767 students (M 37.2%; F 62.8%) about anxiety disorder

  • Each student was randomly assigned to receive externally-supported intervention, teacher-supported intervention or WLC.

  • The online program is based on the e-couch Anxiety and Worry program, an online program for generalised anxiety, delivered over 6 sessions and consists of two core sections psychoeducation and CBT, relaxation and physical activity.

  • Outcomes were measured by the GAD 7-item scale, MINI, CES-D, ASI, PSWQ.

 The e-couch Anxiety and Worry program did not have a significant positive effect on participants.

  • At post-interventions, 6 and 12-month follow-up no significant differences were observed between the intervention and control conditions for generalized anxiety (d= 0.14 to 0.15), social anxiety (d= 0.04−0.23), anxiety sensitivity (d = −0.07 to 0.07), depressive symptoms (d = −0.05 to 0.04) or mental wellbeing (d = −0.06 to −0.30).
[41] 340 adolescents (M 42.4%; F 57.6%), aged 11–18 yy, recruited from 14 regular high schools in the Netherlands To evaluate the efficacy of CBM-A, the sample was randomly allocated to eight sessions of a dot-probe (DP), or a visual search-based (VS) attentional training, or one of two corresponding placebo control conditions and received 8 sessions of an online training over four weeks. More research is needed to investigate and improve the efficacy of CBM-A in adolescents.

  • One year of follow-up, showed that VS training was effective in reducing attentional bias, compared to DP training.

  • Primary and secondary emotional outcome measures revealed a general improvement in emotional functioning irrespective of condition.

  • CBM-A in its current form, seems to be ineffective in reducing anxiety or depressive symptoms in unselected adolescents.
[42] 108 adolescents (M 33.3%; F 66.7%), aged 11–19 yy, with symptoms of anxiety and/or depression (SCARED & CDI) The current study investigated the effects of eight online sessions of visual search (VS) ABM, following four weeks, compared to both a VS placebo-training and a no-training control group online training sessions. There is no evidence for the efficacy of online visual search ABM in reducing anxiety or depression or increasing emotional resilience in selected adolescents.

  • VS-ABM training reduced attentional bias compared to both control groups, with stronger effects for participants who completed more training sessions.
[43] 173 participants

  • Adolescents were randomized over one of two training groups: a CBM-I training, consisting of eight online sessions, or a placebo-control training.

  • Emotional measures were administered both pre- and post- training, and at three, six and 12-months follow-up

 Results suggest that interpretation training as implemented in this study has no added value in reducing symptoms or enhancing resilience in unselected adolescents.

  • Compared to placebo, interpretation training marginally increased positive interpretations.

  • Change in interpretation bias, baseline interpretation bias, stressful life events, or number of training sessions completed did not moderate the effects on anxiety or depression.
[44] 13 youth (M 6; F 7), aged 8–13 yy, with a primary/co-primary anxiety disorder diagnosis and their mothers

  • Participants were randomly assigned to 1 of 3 baseline intervals (two-week baseline interval, three-week, four-week).

  • The online intervention consists of 16 weekly sessions of TMH-FCBT.

  • 44-item parent-report (BTPS) and a 36-item parent-report (WAI) were administered at week 4, mid treatment, week 12 and post-treatment, to evaluate feasibility and acceptability.

  • An 8-item (CSQ-8) questionnaire was administered to evaluate satisfaction.

  • The outcomes were evaluated through ADIS-C/P; CGI; MASC-C/P; CBCL; FACLIS.

 Videoconferencing treatment formats may serve to improve the quality care of youth anxiety disorders.
  • ○

    The intervention was feasible and acceptable to families who reported high treatment retention, high satisfaction, strong therapeutic alliance and low barriers to participation.

  • ○

    The treatment showed the efficacy with 76.9% of the intention-to-treat sample and 90.9% of treatment completers.

  • ○

    Gains were largely maintained at 3-month follow-up.
[45] 49 undergraduate students (M 4; F 45) who were seeking counseling for mild to moderate anxiety

  • Undergraduate participants were randomly assigned to online, synchronous video counseling or in-person treatment for anxiety using solution-focused brief therapy (SFBT).

  • The outcomes were evaluated with BAI and CCAPS.

 The findings provide support for the treatment of college students with anxiety with SFBT through online, synchronous video counseling.
  • ○

    In both types of interventions have been found changes in BAI and in social anxiety levels, even though without any significant differences in the effectiveness of two delivery methods (p = 0.580).
[46] Develop a Therapist-assisted Online Parenting Strategies (TOPS) program that is acceptable to parents whose adolescents have anxiety and/or depressive disorders, using a consumer consultation approach TOPS intervention was developed via three linked studies.
  • ○

    Study 1: involved content analysis of feedback from participants (n = 56) who received a web-based preventive parenting intervention called Partners in Parenting (PiP), as part of a randomised controlled trial.

  • ○

    Study 2: involved stakeholder consultations with parents of adolescents aged 12–17 yy (n = 6) and mental health professionals (n = 28), to identify adaptations to PiP.

  • ○

    Study 3: a pilot of the resulting TOPS program with professionals (n = 10) and a small sample of parents (n = 3) to assess the acceptability of the program content and format.

 This study provided preliminary support for the feasibility, acceptability and perceived usefulness of the TOPS program
  • ○

    Study 1 indicated a need for an enhanced program for parents whose adolescents are experiencing anxiety and depressive disorders, while findings from Study 2 informed the content of the new TOPS program.

  • ○

    In Study 3, mental health professionals endorsed the structure and content, while parents affirmed the acceptability of the TOPS program.

  • ○

    Feedback from Studies 2 and 3 indicated that the therapist-coach was a valuable resource to (i) provide parents with strategies that are associated with the alleviation of adolescent anxiety and depression, (ii) discuss difficulties in implementing these strategies, (iii) assist parents with overcoming these difficulties; and (iv) support the development of a relapse prevention plan.

  • ○

    Professionals felt that the TOPS program would broaden parental knowledge about how to recognise and respond to symptoms of clinical anxiety and depression in their adolescent.
Depression
[9] Observational an 18-month program for children less than 18 years (n = 87) who received physical and mental health assessment by ED physician Wabash Valley Rural Telehealth Network utilizes an on-demand design with a centralized “hub” of medical providers that delivers specialty based psychiatric care via a regional telehealth network. Decreasing waiting time in ED for those children and adolescents who need a CAP specialist in remote areas without CAP.
  • ○

    49% of children presented with depression or anxiety-related disorders; 46% with suicidal ideation/attempt or self-harm; 5% with substance abuse/overdose.

  • ○

    63% of cases treated are in the 14–17 age range, mainly females (66%) and white (98.5%).
[47] 1477 students (M 651; F 826), aged 12–17 yy, from 32 schools across Australia

  • Each school was randomly allocated to the online, self-directed CBT program (MoodGYM) or WLC.

  • The MoodGYM program consists of 5 modules, one module each week. Classroom teacher supervised the students.

  • The outcome was measured with RCMAS and CES-D.

 Although small to moderate, the effects obtained in the current study provide support for the utility if prevention programs in schools.
  • ○

    At post-intervention and 6-month follow-up, participants had significantly lower levels of anxiety than the WLC group (d = 0.15–0.25).

  • ○

    The effects of the MoodGYM program on depressive symptoms were less strong (d = 0.27–0.43).
[48] 38 families e 28 children (20 M; 6 F), aged 8–14 yy, with childhood depression (K-SADS-P & CDI)

  • The patients were randomly assigned to a face-to-face CBT versus VC-CBT.

  • The current project was an adjunct to Kansas University Medical Center’s TeleKidcare project and consists of 8 weekly sessions.

 NA
  • ○

    The CBT treatment across both delivery methods was effective in decreasing depression. 82% of the 28 children no longer met the depression criteria at the end of the study.

  • ○

    The VC group reported a greater decrease in depressive symptoms over time as compared do the F2F group.

  • ○

    Good satisfaction with both types of treatment was found through the Telemedicine Satisfaction Questionnaire.
[49] 297 patients (M 32%; F 68%), aged 18–75 yy, having a new episode of depression (BDI & CIS-R)

  • The study evaluated the cost-effectiveness of therapist-delivered internet CBT compared with usual care for primary care patients with depression through randomised controlled trials.

  • The outcomes were measured through BDI and QALYs.

 This type of therapy appeals in particular to those who like to write their feelings down, those who value the opportunity to review and reflect on the dialogue of the therapy session, and those who prefer the anonymity offered by this method of delivering CBT.It could be an alternative to face-to-face treatment for those whose first language is not English.The intervention may also be useful when traveling is difficult or expensive because of rurality, disability or social phobia.
  • ○

    Online CBT was more expensive than usual care, although the outcomes for the CBT group was better.
[50] 244 young people, aged 16–25 yy, with depressive symptoms (CES-D)

  • Individuals were randomly assigned to a Web-based group course called Grip op Je Dio (Master Your Mood), designed for people aged 16 to 25 yy with depressive symptoms, and to a WLC.

  • The course is based on six online-chat sessions.

  • Outcomes were measured with CES-D; HADS.

 MYM course was effective in reducing depressive and anxiety symptoms and increasing mastery in young people.
  • ○

    The MYM group showed significantly greater improvement in depressive symptoms at 3 months than control group (p < 0.001).

  • ○

    The MYM group also showed greater improvement in anxiety (p < 0.001) and mastery.

  • ○

    Improvements in the MYM group were maintained at 6 months.
[51] 363 children and adolescents, aged ≥ 12 yy, with subsyndromal symptoms of depression (PHQ-A) recruited at five sites across Germany, by the German ProHEAD consortium.

  • The sample was randomly allocated to a clinical-guided self-management program (iFightDepression), to a clinical-guided group chat intervention based on CBT approach and to a control intervention (psycho-educational website).

  • All interventions had a duration of six weeks.

  • The first intervention consists of six core modules. Each module comprises written information, worksheets, exercise, psychological training.

  • The second intervention consists of six 90-min group chat sessions, once a week.
  • ○

    The results of the study should be still published.
[52] 79 boys, aged 15–16 yy

  • The boys were allocated to either undertake a CBT therapy Internet program (MoodGYM) or to standard personal development activities.

  • The MoodGYM program was based on 5 modules that took 30–60 min, one module per week, and a tutor group meet weekly.

  • Outcomes were measured before commencement, post-program and 16-weeks post-program with CES-D, CASQ-R, RSES.

 Considering the high drop-out rate there is the need to review the appropriateness and difficulty of the material as well as the formats used in Internet programs.
  • ○

    There were no significant between-group differences in change scores pre- to post or pre-to follow-up.

  • ○

    Both groups showed improvements in their beliefs about depression at follow-up, with the control group showing moderate relative benefits.

  • ○

    The risk of being classified as vulnerable to depression reduced by 17% in the MoodGYM group at post-treatment compared with non-change risk for the control group. These reductions in risk were not sustained at follow-up.
[53] 157 girls, aged 15–16 yy, come from a single sex school in Canberra, Australia Students were allocated to undertake either MoodGYM or their usual curriculum.

  • MoodGYM brings benefit on self-reported depressive symptoms, even though it had low rates of completion.

  • Overall, findings offered encouragement to the development of effective school-based interventions for reducing depression in adolescents via the Internet.
  • ○

    MoodGYM produced a significantly faster rate of decline in depressive symptoms over the trial period than the control condition.

  • ○

    The effect size for MoodGYM was not significant immediately after the intervention (d = 0.19) but was moderate and significant 20 weeks after (d = 0.46).

  • ○

    Girls with high depression scores before intervention showed the strongest benefits on self-reported depression at follow-up.

  • ○

    There were no significant intervention effects on depression status, attributional style, depression literacy and attitudes.
[54] 263 young individuals aged 12–22 yy with depressive symptoms (CES-D)

  • Young individuals were randomly assigned to a web-based SFBT intervention (PratenOnline) or WLC.

  • Outcomes were evaluated by CES-D after 9 weeks and 4.5 months.

 Chat condition demonstrated a reliable and clinically significant improvement at 4.5 months, but not yet at 9 weeks.
  • ○

    The intervention group showed significantly improvement compared to WLC in depressive symptoms at 9 weeks and 4–5 months on the CES-D (d = 0.18 and 0.79, respectively).

  • ○

    A reliable and clinically significant change in depression was significantly larger for the SFBT intervention at 4.5 months only.

  • ○

    At 7.5 months, SFBT group shower further improvements.
[55] 84 adolescents, aged 14–21 yy, at risk for developing major depression (PHQ-A) were selected through the CATCH-IT project

  • The sample was randomly allocated to two groups: brief advice (BA; 1–2 min) + Internet program versus motivational interview (MI; 5–15 min.) + Interne program.

  • In the MI group, the physician used a non-directive approach to help the adolescent develop a favorable cost/benefit assessment toward completing the intervention and building resiliency. In the MI group also received three motivational phone calls from the case manager.

  • The internet intervention included 14 Internet-based modules based on CBT, IPT and a community resiliency concept.

  • A workbook was given to the parents of adolescents under age 18.

  • Outcomes were evaluated with a questionnaire created by the authors, CES-D and ANDHEALTH questionnaire.

 In the BA condition, the physician takes a directive approach and advises the adolescent that he is experiencing a depressed mood and refers the adolescent to the CATCH-IT internet site.
  • ○

    Both groups demonstrated declines in depressive mood.

  • ○

    Both groups demonstrated increases in social support by peers and reductions in depression related impairment in school.
[56] 84 adolescents, aged 14–24 yy, recruited when they visited the primary care provider for risk of depressive disorder, as well as through advertisements posted in and around the clinics.

  • The sample was randomly assigned to primary care physician motivational interview (MI) + Internet program versus brief advice (BA) + Internet program.

  • In the BA condition the physician takes a directive approach and advises the adolescent that he is experiencing a depressed mood and refers the adolescent to the CATCH-IT internet site.

  • In the MI group, the physician used a non-directive approach to help the adolescent develop a favourable cost/benefit assessment toward completing the intervention and building resiliency. In the MI group also received three motivational phone calls from the case manager.

  • The Internet intervention consists of 14 modules based on BAC, CBT, IPT and a community resiliency concept model.

  • Outcomes were measured with PHQ-A and CES-D.

 This tool may help extend the services at the disposal of a primary care provider and can provide a bridge for adolescents at risk for depression.
  • ○

    Both groups substantially engaged the Internet site.

  • ○

    For both groups CES-D scores declined from baseline to 12 weeks (MI, 52% to 12%; BA 50% to 15%).

  • ○

    The MI group demonstrated declines in self-harm thoughts and hopelessness and was significantly less likely than the BA group to experience a depressive episode (p = 0.044) or to report hopelessness (p = 0.044) by 12 weeks.
[57] 84 participants (M 43.4%, F 56.6%), with mean age of 17.47 yy, were recruited by screening for risk of depression in 13 primary care practices

  • Randomized comparison of two approaches in engaging adolescents with the Internet intervention: prime care physician (PCP) motivational interview (MI) + CATCH-IT Internet program versus PCP brief advice (BA) + CATCH-IT Internet program.

  • Outcomes were measured with CESD-10, PHQ-A.

 It would be useful to make these interventions more accessible to adolescents given their good effectiveness.
  • ○

    Depressive symptoms scores declined from baseline to 6 weeks with these statistically significant reductions sustained at the 6-months follow-up in both groups.

  • ○

    By 6-months, the MI group demonstrated significantly fewer depressive episodes and reported less hopelessness as compared to the BA group.
[58] 83 adolescents recruited from 12 primary care sites across Southern and Midwestern United States

  • Adolescents recruited were randomly assigned to a version of the CATCH-IT intervention: primary care provider (PCP) motivational interview (MI) + Internet program or PCP brief advice (BA) + Internet program.

  • Outcomes were measured with CESD-10, PHQ-A.

 The tool may help extend the services at the disposal of a primary care provider and can provide a bridge for adolescents at risk for depression.
  • ○

    Both groups demonstrated significant decrease in depressed mood, loneliness, and self-harm ideation.

  • ○

    Fewer participants in the MI group, after one-year, had experienced a depressive episode.

[59] 34 students were recruited from nine schools A pilot study employed a pre-test/post-test design with 8-week intervention based on the Reframe Internet-based program interventions. It consists of 8 modules, based on CBT, each of which takes around 10–20 min to complete. The finding are promising and suggest that young people at risk of suicide can safely be included in trials as long as adequate safety procedures are in place.
  • ○

    21 young people completed the intervention and they found a reduced suicidal ideation, hopelessness and depressive symptoms.

  • ○

    Participants reported enjoying the programme and said they would recommend it to a friend.

[60] 62 participants with major depressive disorder were defined by two age subgroups: adolescents (n = 31), aged 13–18 yy (CDRS-R), and young adults (n = 32), aged 19–24 yy (HAMD).

  • Participants in each subgroup were randomized into the intervention group or WLC.

  • The intervention consists of an 8-week online spirituality informed e-mental health intervention (LEAP project) in which there is the use of fresh graphic designs, video clips, music clips, youth autobiographical story, off-line activity, relaxation techniques, online journals and others.

 Spirituality is increasing as an important consideration in mental Health and mental health interventions.
  • ○

    At baseline, there was no statistical difference between study and WLC for both age subgroups. After the intervention, depression severity was significantly reduced.

  • ○

    Self-concept improved significantly for younger participants immediately after the intervention and over time in the study arm. In older participants, change was minimal.
[61] 3224 youth (M 1676; F 1568), aged 11–18 yy, selected from 5 schools in the Red Deer Public School system

  • All these students were entered in the EMPATHY program. They were screened for depression, suicidality, anxiety, use of drugs, alcohol, or tobacco, quality of life and self-esteem. Additionally, all students in Grades 7 and 8, also received an 8-session CBT based program.

  • The intervention consisted of an interview with the student and their family followed by offering a guided internet-based CBT program.

  • Outcomes were evaluated using PHQ-A, HADS, RSE, K-10, CRAAFT questions.

 Suggesting that a multimodal school-based program may provide an effective and pragmatic approach to help reduce youth depression and suicidality.
  • ○

    The 2790 students who completed scale at both baseline and 12-week follow-up showed significant decreases in depression and suicidality.

  • ○

    There was a marked decrease in the number of students who were actively suicidal (from 125 to 30).

  • ○

    Of the 503 students offered the CBT program, 163 (32%) took part and this group had significantly lower depression scores compared to those who did not.
[62] 42 youth (M 22; F22), aged 15–25 yy, affected by depression in partial or full remission

  • Participants had access to the Rebound platform for at least 12 weeks, including the social networking, peer and clinical moderator and therapy components.

  • Rebound is an online platform, based on the MOST model and included: peer-to-peer online social networking, individually tailored interactive psychosocial interventions and involvement of expert mental health and peer moderator.

 These types of online social networking are well appreciated by the young people, and further studies would be needed to perfect their development.
  • ○

    There was High system usage. Almost 70% of users had >10 logins over the 12 weeks with 78.5% in over at least 2 months of the pilot.

  • ○

    84% of participants rated the intervention as helpful.

  • ○

    There was a significant improvement between the number of participants in full remission at baseline.

  • ○

    There was a significant improvement to interviewer-rated depression scores (MADRS; p = 0.014).
[63] 104 participants, aged 18–25 yy, with moderate depression symptomatology (DASS-21) and use of alcohol at hazardous levels (AUDIT)

  • The sample was randomly allocated to the DEAL Project or Web-based attention-control condition.

  • The trial consisted of a 4-week intervention phase, including four 1-h modules in the areas of CBT, MI, BA, psychoeducation, relaxing, mindfulness and coping strategies, with follow-up assessment at post-treatment and at 3 and 6 months post-baseline.

  • The outcomes were evaluated by PHQ-9 and TOT-AL.

 DEAL Project it could be a good option for patients with both depression symptoms and alcohol use.
  • ○

    The DEAl Project was associated with statistically significant improvement in depression symptom severity (d = 0.71) and reductions in alcohol use quantity (d = 0.99) and frequency (d = 0.76) in the short term compared to the control group.

  • ○

    At 6-month follow-up, the improvements in the intervention group were maintained, although the difference between the interventions and control groups were no longer statistically significant.
[64] 257 Chinese adolescents, aged 13–17 yy, with mild-to-moderate depressive symptoms were recruited from three secondary schools in Hong Kong

  • The participants were randomly assigned to receive either intervention or attention control.

  • The intervention is based on Grasping the Opportunity, a Chinese modified internet version of CATCH-IT. It is an internet program with 10 modules and includes monthly reminders by phone call or by messages through social media.

  • The outcomes were evaluated by CESD-R at the 12-month follow-up.

 Poor completion rate is the major challenge in the study.
  • ○

    Only 10% of the participants completed the intervention.

  • ○

    Compared to the attention control, Grasp the Opportunity led to reductions in depressive symptoms at the 12-month follow-up.
[65] 208 Dutch female adolescents with elevated depressive symptoms (RADS-2)

  • The sample was randomly allocated to one of four conditions: OVK program, SPARX program, OVK and SPARX combined and a monitoring control condition.

  • Girls in the OVK condition were given eight lessons of OVK program by a professional psychologist at school, approximately 1-h per week. The SPARX condition consisted of weekly game play of SPARX, a fantasy game, at home, at the time of their choosing, asking to complete one level (20–40 min) per week.

  • Depressive symptoms were measured at pre-test, weekly, at post-test, and at 3–6 and 12-month follow-up.

 Videogames could be a good strategy to improve the compliance of adolescents for computerized CBT.
  • ○

    Depressive symptoms decrease in all conditions.

  • ○

    There is a maintenance in the reduction of depressive symptomatology at the 12-month follow-up.
[66] 107 participants (M 8%, F 92%), aged 17–48 yy, recruited at The University of Queensland Health Service

  • The sample was randomly assigned to LI-CBT arm versus self-help control arm.

  • Outcomes were evaluated by K10, DASS-21, CSE, University Connectedness Scale, AUDIT.

 It could be useful to introduce LI-CBT in the university system, even if further studies are needed.
  • ○

    Only 11% of distressed students agreed to join the treatment, and only 58% of LI-CBT participants attended any sessions.

  • ○

    The study arm showed a significant improvement in depression and anxiety at 2 months and over 12-month follow-up.
[67] 206 female students, aged 18–25 yy, at very high risk for eating disorder onset (WCS)

  • Women were randomized to IaM, a 10-week online preventive intervention including CBT, IPT, BA, stress management and problem solving or WLC.

  • Assessments included EDI-2, EDE-Q, SCID and BDI-II.

 IaM is an inexpensive, easy intervention that can reduce ED onset in high-risk women.
  • ○

    ED attitudes and behaviours improved more in the intervention than control group (p = 0.02).

  • ○

    For the 27 individuals with depression at baseline. Depressive symptomatology improved more in the intervention than control group (p = 0.016).
[68] Web-based awareness and self-management protocol to mild-to-moderate depression

  • iFightDepression tool was based on cognitive behavioural therapy and addressed behavioural activation (monitoring and planning daily activities), cognitive restructuring (identifying and challenging unhelpful thoughts), sleep regulation, mood monitoring and healthy lifestyle habits.

  • The tool is accompanied by a 3-h training intervention for health care professionals.

 Protocol for the development, implementation and evaluation of the iFight Depression tool, cost-free, multilingual, guided, self-management program for mild-to-moderate depression cases.
  • ○

    Findings should be still collected, being a protocol.
[69] 927 students, enrolled in universities in Massachusetts, were recruited to join the web-based screening survey for depression.

  • Participants who screened positive, thorough PHQ-9, received a direct link to an online depression toolkit (including two websites, psychoeducational materials, information on a local suicide prevention helpline).

  • Participants who screened positive for MDD or suicidality were given an opportunity to schedule a Skype consultation with a psychiatrist.

 Current online technologies can provide depression screening and psychiatric consultation to college students.
  • ○

    285 students screened positive of the 972 total students.

  • ○

    76.4% found the interview useful in helping them understand their depression.

  • ○

    88.2% thought that psychologists and psychiatrists could successfully see patients via VC.
Obsessive-Compulsive Disorder
[70] 31 youth (19 M; 12 F), aged 7–16 yy, with OCD (CY-BOCS & ADIS-C/P)

  • The sample was randomly assigned to W-CBT or WLC.

  • The online program consists of 14 sessions of family-based CBT over 12 weeks.

 This preliminary study suggests the possible role of W-CBT in reducing OC symptoms in youth with OCD.
  • ○

    81% of youth in the W-CBT arm were treatment responders, versus only 13% individuals in the WLC.

  • ○

    56% of the individuals in the W-CBT group met remission criteria, versus only 13% in the WLC group.
[71] 22 child (13 M; 9 F), aged 4–8 yy, with OCD (ADIS-C/P & CY-BOCS)

  • The VTC-FB-CBT consists of 14 weeks of treatment through the VTC platform which uses computer games to enhance children’s understanding of treatment concepts.

  • An 8-item and 36-item assessment were used to evaluate satisfaction and therapeutic alliance.

 VTC methods may offer solutions to overcoming traditional barriers to care for early-onset OCD.
  • ○

    At post treatment, 72.7% on Internet cases and 60% of Clinic cases showed “excellent response”.

  • ○

    At follow-up 80% of Internet cases and 66.7% of Clinical cases showed “excellent response”.

  • ○

    VTC-FB-CBT showed strong engagement and satisfaction verified through the questionnaire.

[72] 3 female patients with a story of OCD

  • The patients were randomly assigned to a 1, 2 or 3-week baseline period prior to beginning the 12-week manualized CBT intervention.

  • Sessions were delivered via VC, once a week and all sessions were 60 min in length. ERP was the primary intervention method.

  • The assessment was made by SCID-I/P, Y-BOSC, CGI, WSAS, HDRS, WAI.

 Manualized CBT for OCD can be effectively delivered via a VC network.

  • All three patients complete the entire 12 weeks of treatment.

  • Substantial decrease in total Y-BOCS scores were observed.

  • Follow-up ratings support the durability of VC-CBT for OCD.
[73] 6 patients (M 1; F 5) with history of OCD (ADIS)

  • The sample received 15 sessions of therapy delivered only over teleconference (six sessions) and cell phones (nine sessions) over a 3-month period.

  • ERP was the primary intervention method.

 Internet-delivery CBT may be a promise method treatment for OCD patients.
  • ○

    4 patients, at the end of the therapy, were highly improved and no longer met diagnostic criteria for OCD according to ADIS and Y-BOCS.

  • ○

    The same was true at 3-month follow up although some small increases in OCD symptoms had occurred.
[74] 15 adults (M 13.3%; F 86.7%) with OCD

  • Patients were treated with a VC-mediated, twice weekly, ERP for adults.

  • Assessments consist of SCID-IV, Y-BOCS, CGI, QLESQ, RTQ, WAI-S, CSS, TVS, PEAS.

 This study adds to the growing body of literature suggesting that videoconference-based interventions are viable alternatives to face-to-face treatment.
  • ○

    All participants had improvements in OCD symptoms.

  • ○

    10 individuals completed a 3-month follow-up assessment and 30% of participants no longer met the criteria for OCD.

  • ○

    0% of participants were rated as very much or much improved in the CGI.
[75] 21 participants, aged 12–17 yy, with OCD (MINI-KID) and their parents

  • The intervention consists of a 12-week, 12 chapters, ICBT treatment delivered through film, exercises, animation, psychoeducational tools and interactive scripts.

  • The outcomes measured through CY-BOCS, ChOCI-R, COIS-R, CGAS, SCAS C/P, CDI-s, SDQ, FAS-PR.

 ICBT could be efficacious, acceptable and cost-effective for adolescents with OCD.
  • ○

    Treatment yielded significant improvements on all clinician-parent and most self-administered outcome measures.

  • ○

    At 6-month follow-up, 71% were classified as responders and 76% as being in remission.
[76] 72 adolescents, aged 11–18 yy, with OCD and their parents

  • The sample was randomized to receive specialist TCBT or face-to-face CBT.

  • All participants received up to 14 sessions of CBT.

 TCBT is an effective treatment and is not inferior to standard clinic-based CBT.
  • ○

    TCBT was not inferior to face-to-face CBT at post-treatment, 3 month, and 6-month follow-up.

  • ○

    At 12-month follow-up there were no significant between-group differences on the CY-BOCS.

  • ○

    Improvements made during treatment were maintained through to 12-month follow-up.

  • ○

    Participants in each condition report high levels of satisfaction.
[77] 30 children, aged 7-17, with primary diagnosis of OCD, and their parents

  • An open trial where all participants receive a newly developed enhanced CBT (eCBT), that include video conferencing sessions (supervision and guided exposure exercises at home = in addition to face-to face sessions; an app system of interconnected apps for the child, the parents and the therapist; psychoeducational videos; and frequent online self-assessments with direct feedback to patients and the therapist.

  • Assessments are conducted pre-treatment, post-treatment, and at 3- 6- and 12- month follow-up.

 NA
  • ○

    The findings are still ongoing.

CBT: Cognitive Behavioural Therapy; ICBT: internet based CBT; TCBT: Telephone CBT; W-CBT: web-camera CBT; VC: Videoconferencing; VTC: Video Teleconferencing; F: Female; M: Male; NET: Internet-based CBT; WLC: Waitlist control; CCAL: Camp Cope-A-Lot; TMH: Telemental Health; IPT: Interpersonal Psychotherapy techniques; BAC: Behavioral Activation; FCBT: family based CBT; VTC-FB-CBT: Video Teleconferencing-delivery family-based cognitive-behavioral therapy; CBM-A: Cognitive Bias Modification of Attention; ABM: Attentional Bias Modification; CBM-I: Cognitive Bias Modification for Interpretations; CATCH-IT: Competent Adulthood Transition with Cognitive-behavioral Humanistic and Interpersonal Training; OAPA: Online Assessment of Preschool Anxiety; ADIS-C/P: Anxiety Disorder Interview Schedule: Child and Parent; W-SFBT: Web-Solution Focused Brief Therapy DASS-21: Depression and Anxiety Stress Scale-21 CY-BOCS: Children’s Yale-Brown Obsessive Compulsive Scale; K-SADS-P: Affective Disorders and Schizophrenia for School Age Children-Present Episode; SPSQ-C: Social Phobia Screening Questionnaire for Children up to 18 Years Old; MADRS-S: Montgomery-Åsberg Depression Rating Scale; SCAS-C/P: The Spence Children’s Anxiety Scale-Child/Parent Version CDI: Children’s Depression Inventory; yy: years; OC: Obsessive Compulsive; OCD: Obsessive-compulsive Disorder; BTPS: Barriers to Treatment Participation Scale; WAI: Working Alliance Inventory, Parent-Report and Therapist-Report; CSQ-8: Client Satisfaction Questionnaire; SCARED: Screen for Child Anxiety Related Emotional Disorders; CGI: Clinical Global Impressions Scale; MASC-C/P: Multidimensional Anxiety Scale for Children, Child and Parent Reports; CBCL: Child Behavior Checklist; FACLIS: Family Accommodation Checklist and Interference Scale; BAI: Beck’s Anxiety Inventory; CCAPS College Counseling Assessment of Psychological Symptoms; Therapist-assisted Online Parenting Strategies; BDI: Beck Depression Inventory; CIS-R: Revised Clinical Interview Schedule; QUALYs: quality-adjusted life-years; CES-D: Center for Epidemiologic Studies Depression Scale; HADS: Anxiety subscale of the Hospital Anxiety and Depression Scale; PSWQ: Penn State Worry Questionnaire PHQ-A: Patient health Questionnaire-9 modified for Adolescent; CASQ-R: The Revised Children’s Attributional Style Questionnaire; RSE: Rosenberg Self-Esteem Scale; ADHEALTH: National Longitudinal Study of Adolescent Health; CDSR-R: Children’s Depression Rating Scale Revised; HAMD: Hamilton Depression Rating Scale for Depression; MINI: Mini International Neuropsychiatric Interview; DEAL: Depression Alcohol Project; AUDIT: Alcohol Use Disorders Identification Test; RADS-2: Reynolds Adolescent Depression Scale; OVK: school-based CBT prevention program ‘OP Volle Kracht’; SPARX program: computerized CBT program “SPARX”; LI-CBT: Low-Intensity cognitive-behaviour therapy; K10: Kessler10; CSE: Coping Self-Efficacy scale; WHO5: 5-item World Health Organization Well-Being Index; IaM: Image and Mood program; WCS: Weight Concerns Scale; ED: Eating Disorder; EDE-Q: Eating Disorder Examination Questionnaire; EDI-2: Eating Disorder Inventory BDI-II: Beck Depression Inventory-II; ERP: Exposure and Response Prevention; SCID: Structured Clinical Interview for the DSM; Y-BOSC: Yale-Brown Obsessive Compulsive Scale; WSAS: Work and Social Adjustment Scale; WAI-S: Working Alliance Inventory; MINI-kid: Mini-International Neuropsychiatric Interview for Children and Adolescents; QLESQ: Quality of Life Enjoyment and Satisfaction Questionnaire short form; RTQ: Reaction to Treatment Questionnaire; CSS: Client Satisfaction Survey; TVS: Telepresence in Videoconference Scale; PEAS: Patient EX/RP Adherence Scale; ChOCI-R: Children’s Obsessional Compulsive Inventory Revised; COIS-R: Child Obsessive-Compulsive Impact Scale; CGAS: Children’s Global Assessment Scale; SDQ: Strengths and Difficulties Questionnaire; FAS-PR:: Family Accommodation Scale, Parent-Report.