Effectiveness and outcomes of digital telehealth third-wave cognitive behavioral therapy for depression and anxiety: a systematic review and meta-analysis

Third-wave Cognitive Behavioral Therapy (CBT) interventions, which integrate mindfulness and acceptance-based strategies, have demonstrated efficacy in reducing anxiety and depression. However, barriers such as cost and limited access to in-person therapy restrict widespread usage. Digital delivery of third-wave CBT provides a promising, cost-effective alternative. This meta-analysis aims to synthesize the evidence for the effectiveness of digital telehealth third-wave CBT interventions in reducing symptoms of depression and anxiety through a comprehensive search of randomized controlled trials. Secondary objectives include subgroup analyses of additional psychosocial outcomes. A total of 13 studies were included with <i>n</i> = 2123 total participants. Results indicated a small-to-moderate reduction in anxiety symptoms (g = -0.38, 95% CI [-0.68, -0.09], df = 9, <i>p</i> = 0.01) with substantial heterogeneity. Depression outcome analysis showed consistent reduction in depressive symptoms (g = -0.41, 95% CI [-0.55, -0.27]), with low heterogeneity. Digital third-wave CBT interventions have the potential to reduce symptoms of depression and anxiety and offer accessibility while being comparable to traditional therapy formats. These findings highlight the potential of digital mental health interventions to address global disparities in mental health care as well as the need for improved trial design and methodologies.We have registered this study with the International Prospective Register of Systematic Reviews (PROSPERO) under CRD42024541721.