Effectiveness and Outcomes of Digital Telehealth Third-Wave Cognitive Behavioral Therapy for Depression and Anxiety: A Systematic Review and Meta-Analysis

Background: Depression and anxiety are among the most prevalent mental health disorders globally, contributing significantly to the overall burden of disease worldwide.Third-wave Cognitive Behavioral Therapy (CBT) interventions, which integrate mindfulness and acceptance-based strategies, have demonstrated efficacy. 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, with improved accessibility for hard to reach populations.Objective: This meta-analysis aims to synthesize evidence for the effectiveness of digital third-wave CBT interventions in reducing symptoms of depression and anxiety. Secondary objectives include subgroup analyses of additional psychosocial outcomes.Methods: Between May and June 2024, a comprehensive search was conducted across databases (PubMed, PsycINFO, Medline, Embase, CINAHL, and Web of Science) to identify randomized controlled trials (RCTs), evaluating digital third-wave CBT interventions for adults experiencing depression or anxiety. Inclusion criteria required digital interventions exclusively using third-wave CBT. Data extraction followed the Cochrane Handbook, and meta-analytic techniques were used to assess intervention effectiveness.Results: For anxiety outcomes, data revealed a small-to-moderate reduction in anxiety symptoms with substantial heterogeneity. Depression outcomes showed a more consistent reduction in symptoms, with low heterogeneity. Mindfulness-based interventions were the most common among the digital therapies reviewed, suggesting future research should further explore and compare mindfulness with other therapeutic approaches.Conclusion: Digital third-wave CBT interventions effectively reduce symptoms of depression and anxiety and offer accessibility while proving comparably effective to traditional therapy formats. These findings highlight the potential of digital mental health interventions to address global disparities in mental health care.