Study: Digital, face-to-face cognitive behavioral therapy both effective for depression


Both digital and face-to-face cognitive behavioral therapy (CBT) “may be suitable interventions for patients with more severe forms of depression,” according to a review published in npj Digital Medicine.

“Overall, our results indicate that after controlling for a number of potential confounders, face-to-face and digital CBT might be comparable in terms of clinical effectiveness for treating depression. We identify a number of relevant factors that moderate the treatment response such as the duration of the intervention, baseline severity, adherence and the level of human guidance in digital CBT interventions,” the study notes.

Guided digital CBT was more effective than unguided digital CBT in decreasing depressive symptoms and psychosocial functioning. Researchers found no superiority regarding adherence between guided and unguided digital CBT. 

No distinctions existed between face-to-face CBT, guided digital CBT and unguided digital CBT regarding anxiety symptoms.

Interestingly, the results of the study differed compared to earlier findings. Upon initial evaluation of the literature, face-to-face treatment appeared to outweigh the effectiveness of guided digital CBT in improving depressive symptoms and psychosocial functioning, and in ensuring treatment adherence.

After accounting for confounders like depression severity and the use of antidepressants, researchers stated their “analyses revealed no significant differences between the face-to-face and digital interventions, suggesting that these approaches might have more comparable clinical effectiveness when accounting for moderators.”

Results were based on a systematic literature search in the PubMed database, where researchers compared 106 studies and over 11,000 adult patients published until January 11, 2021.

The study notes that a previous meta-analysis of CBT treatment effectiveness via face-to-face interactions versus digital means revealed only minor effects. Still, the study in npj Digital Medicine underlines the importance of treatment intensity.

Researchers found a higher number of sessions was a positive predictor of the success of digital therapeutic interventions. In contrast, treatment intensity (the number of sessions per week) showed more significant promise with traditional face-to-face methods. 


The number of digital health platforms offering CBT or other mental health interventions has increased immensely over the past few years, especially since the pandemic’s beginning. These platforms can hold numerous potential advantages, such as cost-effectiveness and improved access to evidence-based care, especially for people living in remote communities. 

Though several platforms materialized since the emergence of COVID-19, many are not regulated by the FDA, and some make claims not yet substantiated by clinical research. 

Studying the effectiveness of digital health tools versus traditional face-to-face interventions is vital to ensuring the safety and efficacy of these newly minted digital models in healthcare offerings.


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