Cochrane for Clinicians

Putting Evidence into Practice

Therapist-Supported Online Cognitive Behavior Therapy for Adult Anxiety


Am Fam Physician. 2016 Jan 1;93(1):19-20.

Author disclosure: No relevant financial affiliations.

Clinical Question

Does therapist-supported online cognitive behavior therapy (CBT) improve anxiety and reduce symptoms in adults with anxiety disorders?

Evidence-Based Answer

Therapist-supported online CBT is more effective than no treatment and as effective as face-to-face CBT for reducing overall anxiety as well as symptoms, and improving quality of life in adults with anxiety disorders. (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.)

Practice Pointers

Anxiety disorders include panic disorder, agoraphobia, social phobia, posttraumatic stress disorder, acute stress disorder, generalized anxiety disorder, obsessive-compulsive disorder, and specific phobia. As many as 18% of adults in the United States experience an anxiety disorder each year, with an estimated economic impact of $40 billion per year. CBT improves symptoms of anxiety disorders by treating maladaptive thoughts and behaviors, yet less than one-third of patients who have psychiatric diagnoses receive appropriate treatment. CBT delivered over the Internet with a therapist providing support by telephone or e-mail could overcome some access-related barriers to care,

Author disclosure: No relevant financial affiliations.


Olthuis JV, Watt MC, Bailey K, Hayden JA, Stewart SH. Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database Syst Rev. 2015;(3):CD011565.


show all references

1. Mayo-Wilson E, Montgomery P. Media-delivered cognitive behavioural therapy and behavioural therapy (self-help) for anxiety disorders in adults. Cochrane Database Syst Rev. 2013;(9):CD005330....

2. Barak A, Hen L, Boniel-Nissim M, Shapira N. A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions. J Technol Hum Serv. 2008;26(2–4):109–160.

3. Spek V, Cuijpers P, Nyklícek I, Riper H, Keyzer J, Pop V. Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med. 2007;37(3):319–328.

4. National Institute for Health and Care Excellence (NICE). Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults. Clinical guidelines no. 113. London, United Kingdom: NICE; 2011. Accessed November 25, 2015.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at


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