Long-Term Effectiveness of Internet-Based Versus Traditional Cognitive Behavioral Therapy Across Psychiatric Disorders: A Systematic Review and Meta-Analysis.

Abstract

Background: Internet-delivered cognitive behavioral therapy (iCBT) has become a promising alternative to face-to-face CBT, yet its long-term effectiveness across psychiatric disorders remains unclear. While numerous studies have examined short-term outcomes, it is essential to understand how iCBT compares with traditional CBT over extended periods and which conditions benefit most. Methods: A systematic search of PubMed, Embase, MEDLINE via EBSCO, PsycINFO via APA, Scopus, and Cochrane Library (CENTRAL) was conducted up to May 21, 2025. Randomized controlled trials (RCTs) comparing the long-term effects of iCBT and face-to-face CBT for depression, anxiety disorders, and eating disorders were included. The random-effects model was used to calculate the standardized mean difference (Hedges' g), and a chi-square test assessed adherence differences. Results: Eleven RCTs (1,272 participants) met the inclusion criteria. Pooled analysis showed no significant difference in long-term effectiveness between iCBT and face-to-face CBT (Hedges' g = -0.07, 95% CI: -0.36 to 0.21). Depressive disorders responded best to iCBT, while anxiety disorders showed mixed results, and eating disorders had the least favorable outcomes. Adherence was higher in face-to-face CBT (86.68%) than in iCBT (70.06%), with therapist-guided iCBT improving completion rates (79.09%) compared with self-guided formats (48.17%). Conclusions: iCBT is a promising alternative to traditional face-to-face CBT, demonstrating treatment effectiveness even in the long term. However, dropout rates are higher in iCBT, particularly in unguided formats, suggesting that therapist support may be crucial for ensuring participant adherence. Future research should optimize iCBT delivery, tailor it to specific disorders, and develop strategies to improve engagement.