The effectiveness of supplemental and replacement blended cognitive behavioral therapy for internalizing disorders: a meta-analysis

Blended cognitive behavioral therapy (bCBT) combines the use of traditional in-clinic, face-to-face therapy sessions with online therapy platforms. The blended aspect can either be supplementary to face-to-face sessions, or a partial replacement of face-to-face sessions. While bCBT has been available for two decades, there is no statistically synthesized overview of its effectiveness in treating internalizing disorders, including anxiety and depression. In this study, we examined effectiveness in two meta-analyses: 1) comparing bCBT to treatment as usual; 2) comparing bCBT change scores from pre- to post-treatment. We tested the influence of moderators on effectiveness: blended method, online therapist contact, and diagnosis. In line with expectations, results from meta-analysis one (k = 19 studies, N = 2749) showed that supplementary bCBT leads to a significantly superior treatment effect over treatment as usual (Cohen’s d = 0.41, 95% CI [0.24, 0.59]) while replacement bCBT is on par with treatment as usual (d = -0.01, 95% CI [−0.18, 0.17]). Meta-analysis two included 32 studies (N = 1895) and showed significant improvement with bCBT (Morris’s D = 1.12, 95% CI [0.92, 1.33]), irrespective of blended method or therapist contact. Findings suggest that bCBT is a worthwhile form of treatment for both anxiety and depression.