Hostname: page-component-7d684dbfc8-zgpz2 Total loading time: 0 Render date: 2023-09-28T09:53:07.470Z Has data issue: false Feature Flags: { "corePageComponentGetUserInfoFromSharedSession": true, "coreDisableEcommerce": false, "coreDisableSocialShare": false, "coreDisableEcommerceForArticlePurchase": false, "coreDisableEcommerceForBookPurchase": false, "coreDisableEcommerceForElementPurchase": false, "coreUseNewShare": true, "useRatesEcommerce": true } hasContentIssue false

Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies

Published online by Cambridge University Press:  21 April 2010

P. Cuijpers*
Department of Clinical Psychology, VU University Amsterdam, The Netherlands EMGO Institute for Health and Care Research, VU University Amsterdam and VU University Medical Center, The Netherlands
T. Donker
Department of Clinical Psychology, VU University Amsterdam, The Netherlands EMGO Institute for Health and Care Research, VU University Amsterdam and VU University Medical Center, The Netherlands
A. van Straten
Department of Clinical Psychology, VU University Amsterdam, The Netherlands EMGO Institute for Health and Care Research, VU University Amsterdam and VU University Medical Center, The Netherlands
J. Li
Institute of Psychology, Chinese Academy of Sciences, Beijing, People's Republic of China
G. Andersson
Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Sweden Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden
*Address for correspondence: P. Cuijpers, Ph.D., Professor of Clinical Psychology, Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BTAmsterdam, The Netherlands. (Email:



Although guided self-help for depression and anxiety disorders has been examined in many studies, it is not clear whether it is equally effective as face-to-face treatments.


We conducted a meta-analysis of randomized controlled trials in which the effects of guided self-help on depression and anxiety were compared directly with face-to-face psychotherapies for depression and anxiety disorders. A systematic search in bibliographical databases (PubMed, PsycINFO, EMBASE, Cochrane) resulted in 21 studies with 810 participants.


The overall effect size indicating the difference between guided self-help and face-to-face psychotherapy at post-test was d=−0.02, in favour of guided self-help. At follow-up (up to 1 year) no significant difference was found either. No significant difference was found between the drop-out rates in the two treatments formats.


It seems safe to conclude that guided self-help and face-to-face treatments can have comparable effects. It is time to start thinking about implementation in routine care.

Review Article
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Andersson, G, Carlbring, P, Grimlund, A (2008). Predicting treatment outcome in Internet versus face to face treatment of panic disorder. Computers in Human Behavior 24, 17901801.CrossRefGoogle Scholar
Baker, BL, Cohen, DC, Saunders, JT (1973). Self-directed desensitization for acrophobia. Behaviour Research and Therapy 11, 7989.CrossRefGoogle ScholarPubMed
Beck, AT, Rush, AJ, Shaw, BF, Emery, G (1979). Cognitive Therapy of Depression. Guilford Press: New York.Google Scholar
Borenstein, M, Hedges, LV, Higgins, JPT, Rothstein, HR (2009). Introduction to Meta-Analysis. Wiley: Chichester, UK.CrossRefGoogle Scholar
Brown, RA, Lewinsohn, PM (1984). A psychoeducational approach to the treatment of depression: comparison of group, individual and minimal contact procedures. Journal of Consulting and Clinical Psychology 52, 774783.CrossRefGoogle ScholarPubMed
Carlbring, P, Nilsson-Ihrfelt, E, Waara, J, Kollenstam, C, Buhrman, M, Kaldo, V, Söderberg, M, Ekselius, L, Andersson, G (2005). Treatment of panic disorder: live therapy vs. self-help via Internet. Behaviour Research and Therapy 43, 13211333.CrossRefGoogle ScholarPubMed
Chambless, DL, Hollon, SD (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology 66, 718.CrossRefGoogle ScholarPubMed
Côté, S, Bouchard, S (2008). Virtual reality exposure for phobias: a critical review. Journal of Cyber Therapy and Rehabilitation 1, 7591.Google Scholar
Craske, MG, Rose, RD, Lang, A, Welch, SS, Campbell-Sills, L, Sullivan, G, Sherbourne, C, Bystritsky, A, Stein, MB, Roy-Byrne, PP (2009). Computer-assisted delivery of cognitive behavioral therapy for anxiety disorders in primary-care settings. Depression and Anxiety 26, 235242.CrossRefGoogle ScholarPubMed
Cuijpers, P (1997). Bibliotherapy in unipolar depression. Journal of Behavior Therapy and Experimental Psychiatry 28, 139147.CrossRefGoogle ScholarPubMed
Cuijpers, P, Schuurmans, J (2007). Self-help interventions for anxiety disorders: an overview. Current Psychiatry Reports 9, 284290.CrossRefGoogle ScholarPubMed
Cuijpers, P, van Straten, A, Warmerdam, L, Andersson, G (2008). Psychological treatment of depression: a meta-analytic database of randomized studies. BMC Psychiatry 8, 36.CrossRefGoogle ScholarPubMed
Donner, L, Guerney, BG (1969). Automated group desensitization for test anxiety. Behaviour Research and Therapy 7, 113.CrossRefGoogle ScholarPubMed
Duval, S, Tweedie, R (2000). Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56, 455463.CrossRefGoogle ScholarPubMed
Floyd, M, Scogin, F, McKendree-Smith, NL, Floyd, DL, Rokke, PD (2004). Cognitive therapy for depression: a comparison of individual psychotherapy and bibliotherapy for depressed older adults. Behavior Modification 28, 297318.CrossRefGoogle ScholarPubMed
Gellatly, J, Bower, P, Hennessy, S, Richards, D, Gilbody, S, Lovell, K (2007). What makes self-help interventions effective in the management of depressive symptoms? Meta-analysis and meta-regression. Psychological Medicine 37, 12171228.CrossRefGoogle ScholarPubMed
Ghosh, A, Marks, IM, Carr, A (1988). Therapist contact and outcome of self-exposure treatment for phobias. British Journal of Psychiatry 152, 234238.CrossRefGoogle ScholarPubMed
Gould, RA, Clum, GA, Shapiro, D (1993). The use of bibliotherapy in the treatment of panic: a preliminary investigation. Behavior Therapy 24, 241252.CrossRefGoogle Scholar
Gregory, R, Canning, S, Lee, T, Wise, J (2004). Cognitive bibliotherapy for depression: a meta-analysis. Professional Psychology, Research and Practice 35, 275280.CrossRefGoogle Scholar
Hecker, JE, Losee, MC, Fritzler, BK, Fink, CM (1996). Self-directed versus therapist-directed cognitive behavioral treatment for panic disorder. Journal of Anxiety Disorders 10, 253265.CrossRefGoogle Scholar
Hecker, JE, Losee, MC, Roberson-Nay, R, Maki, K (2004). Mastery of Your Anxiety and Panic and brief therapist contact in the treatment of panic disorder. Journal of Anxiety Disorders 18, 111126.CrossRefGoogle ScholarPubMed
Higgins, JP, Thompson, SG, Deeks, JJ, Altman, DG (2003). Measuring inconsistency in meta-analyses. British Medical Journal 327, 557560.CrossRefGoogle ScholarPubMed
Higgins, JPT, Green, S (2008). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008] ( The Cochrane Collaboration, 2008.CrossRefGoogle Scholar
Hirai, M, Clum, GA (2006). A meta-analytic study of self-help interventions for anxiety problems. Behavior Therapy 37, 99111.CrossRefGoogle ScholarPubMed
Hogan, RA, Kirchner, JH (1968). Implosive, eclectic verbal and bibliotherapy in the treatment of fears of snakes. Behaviour Research and Therapy 6, 167171.CrossRefGoogle ScholarPubMed
Kahn, M, Baker, B (1968). Desensitization with minimal therapist contact. Journal of Abnormal Psychology 73, 198200.CrossRefGoogle ScholarPubMed
Kay-Lambkin, FJ, Baker, AL, Lewin, TJ, Carr, VJ (2009). Computer-based psychological treatment for comorbid depression and problematic alcohol and/or cannabis use: a randomized controlled trial of clinical efficacy. Addiction 104, 378388.CrossRefGoogle ScholarPubMed
Kiropoulos, LA, Klein, B, Austin, DW, Gilson, K, Pier, C, Mitchell, J, Ciechomski, L (2008). Is Internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT? Journal of Anxiety Disorders 22, 12731284.CrossRefGoogle ScholarPubMed
Knaevelsrud, C, Maercker, A (2007). Internet-based treatment for PTSD reduces distress and facilitates the development of a strong therapeutic alliance: a randomized controlled clinical trial. BMC Psychiatry 7, 13.CrossRefGoogle ScholarPubMed
Lau, J, Elliott, MA, Jimenez-Silva, J, Kupelnick, B, Mosteller, F, Chalmers, TC (1992). Cumulative meta-analysis of therapeutic trials for myocardial infarction. New England Journal of Medicine 327, 248254.CrossRefGoogle ScholarPubMed
Lidren, DM, Watkins, PL, Gould, RA, Clum, GA, Asterino, M, Tulloch, HL (1994). A comparison of bibliotherapy and group therapy in the treatment of panic disorder. Journal of Consulting and Clinical Psychology 62, 865869.CrossRefGoogle ScholarPubMed
Lipsey, MW (1990). Design Sensitivity; Statistical Power for Experimental Research. Sage: Newbury Park.Google Scholar
Marks, IM, Kenwright, M, McDonough, M, Whittaker, M, Mataix-Cols, D (2004). Saving clinicians' time by delegating routine aspects of therapy to a computer: a randomised controlled trial in phobia/panic disorder. Psychological Medicine 34, 918.CrossRefGoogle ScholarPubMed
Marrs, RW (1995). A meta-analysis of bibliotherapy studies. American Journal of Community Psychology 23, 843870.CrossRefGoogle ScholarPubMed
Marshall, WL, Presse, L, Andrews, WR (1976). A self-administered program for public speaking anxiety. Behaviour Research and Therapy 14, 3339.CrossRefGoogle ScholarPubMed
Mataix-Cols, D, Cameron, R, Gega, L, Kenwright, M, Marks, IM (2006). Effect of referral source on outcome with cognitive-behavior therapy self-help. Comprehensive Psychiatry 47, 241245.CrossRefGoogle ScholarPubMed
Menchola, M, Arkowitz, HS, Burke, BL (2007). Efficacy of self-administered treatments for depression and anxiety. Professional Psychology, Research and Practice 38, 421429.CrossRefGoogle Scholar
Piaggio, G, Elbourne, DR, Altman, DG, Pocock, SJ, Evans, SJ (2006). Reporting of noninferiority and equivalence randomized trials: an extension of the CONSORT statement. Journal of the American Medical Association 295, 11521160.CrossRefGoogle ScholarPubMed
Rosen, GM, Glasgow, RE, Barrera, Jr. M (1976). A controlled study to assess the clinical efficacy of totally self-administered systematic desensitization. Journal of Consulting and Clinical Psychology 44, 208217.CrossRefGoogle ScholarPubMed
Schmidt, MM, Miller, WR (1983). Amount of therapist contact and outcome in a multidimensional depression treatment program. Acta Psychiatrica Scandinavica 67, 319332.CrossRefGoogle Scholar
Selmi, PM, Klein, MH, Greist, JH, Sorrell, S, Erdman, HP (1990). Computer-administered cognitive-behavioral therapy for depression. American Journal of Psychiatry 147, 5156.Google Scholar
Shadish, WR, Sweeney, RB (1991). Mediators and moderators in meta-analysis: there's a reason we don't let dodo birds tell us which psychotherapies should have prizes. Journal of Consulting and Clinical Psychology 59, 883893.CrossRefGoogle ScholarPubMed
Sharp, DM, Power, KG, Swanson, V (2000). Reducing therapist contact in cognitive behaviour therapy for panic disorder and agoraphobia in primary care: global measures of outcome in a randomised controlled trial. British Journal of General Practice 50, 963968.Google Scholar
Spek, V, Cuijpers, P, Nyklíček, I, Riper, H, Keyzer, J, Pop, V (2007). Internet-based cognitive behavior therapy for mood and anxiety disorders: a meta-analysis. Psychological Medicine 37, 319328.CrossRefGoogle Scholar
Spielmans, GI, Pasek, LF, McFall, JP (2007). What are the active ingredients in cognitive and behavioral psychotherapy for anxious and depressed children? A meta-analytic review. Clinical Psychology Review 27, 642654.CrossRefGoogle ScholarPubMed
Tillfors, M, Carlbring, P, Furmark, T, Lewenhaupt, S, Spak, M, Eriksson, A, Westling, BE, Andersson, G (2008). Treating university students with social phobia and public speaking fears: Internet delivered self-help with or without live group exposure sessions. Depression and Anxiety 25, 708717.CrossRefGoogle ScholarPubMed
Vestre, ND, Judge, TJ (1989). Evaluation of self-administered rational emotive therapy programs for interpersonal anxiety. Journal of Rational-Emotive and Cognitive-Behavior Therapy 7, 141154.CrossRefGoogle Scholar
Watkins, PL, Clum, GA (Eds.) (2008). Handbook of Self-help Therapies. Routledge: New York.Google Scholar
Wollersheim, JP, Wilson, GL (1991). Group treatment of unipolar depression: a comparison of coping, supportive, bibliotherapy, and delayed treatment groups. Professional Psychology, Research and Practice 22, 496502.CrossRefGoogle Scholar
Supplementary material: File

Cuijpers supplementary material


Download Cuijpers supplementary material(File)
File 50 KB