CBT delivered by chat to people with depression or anxiety

Depression and anxiety syndroms are common mental health disorders. Persons suffering from depression or anxiety syndroms may be offered Cognitive behaviour therapy (CBT) as treatment. CBT can be delivered in face-to-face meetings with the therapist, as group therapy or via internet-based programs. Synchronous text message conversations, chat, are becoming increasingly popular in mental health interventions.


What scientific studies are there on CBT delivered by chat to people with depression or anxiety?

Identified literature

No relevant systematic review was identified in the literature search but seven systematic reviews have been listed as studies that may be of interest [1-7]. The systematic reviews have included six primary studies that are relevant to the question [8-13]. The primary studies have not been assessed for risk of bias.


  1. Cox KL, Allida SM, Hackett ML. Text messages to reduce depressive symptoms: Do they work and what makes them effective? A systematic review. Health Education Journal 2020.
  2. Garrido S, Millington C, Cheers D, Boydell K, Schubert E, Meade T, et al. What Works and What Doesn’t Work? A Systematic Review of Digital Mental Health Interventions for Depression and Anxiety in Young People. Frontiers in Psychiatry 2019;10.
  3. Hoermann S, McCabe KL, Milne DN, Calvo RA. Application of Synchronous Text-Based Dialogue Systems in Mental Health Interventions: Systematic Review. [Review]. 2017;1:e267.
  4. Rathbone AL, Prescott J. The Use of Mobile Apps and SMS Messaging as Physical and Mental Health Interventions: Systematic Review. [Review]. 2017;1:e295.
  5. Senanayake B, Wickramasinghe SI, Chatfield MD, Hansen J, Edirippulige S, Smith AC. Effectiveness of text messaging interventions for the management of depression: A systematic review and meta-analysis. Journal of telemedicine and telecare 2019;25:513-523.
  6. Varker T, Brand RM, Ward J, Terhaag S, Phelps A. Efficacy of synchronous telepsychology interventions for people with anxiety, depression, posttraumatic stress disorder, and adjustment disorder: A rapid evidence assessment. 2019;1:621-635.
  7. Watson T, Simpson S, Hughes C. Text messaging interventions for individuals with mental health disorders including substance use: A systematic review. Psychiatry Research 2016;243:255-262.
  8. Anstiss D, Davies A. ‘Reach Out, Rise Up’: The efficacy of text messaging in an intervention package for anxiety and depression severity in young people. Child Youth Serv Rev 2015;58:99-103.
  9. Kessler D, Lewis G, Kaur S, Wiles N, King M, Weich S, et al. Therapist-delivered Internet psychotherapy for depression in primary care: a randomised controlled trial. Lancet 2009;374:628-34.
  10. Kramer J, Conijn B, Oijevaar P, Riper H. Effectiveness of a web-based solution-focused brief chat treatment for depressed adolescents and young adults: randomized controlled trial. J Med Internet Res 2014;16:e141.
  11. Ranney ML, Pittman SK, Dunsiger S, Guthrie KM, Spirito A, Boyer EW, et al. Emergency department text messaging for adolescent violence and depression prevention: A pilot randomized controlled trial. Psychol Serv 2018;15:419-428.
  12. Whittaker R, Merry S, Stasiak K, McDowell H, Doherty I, Shepherd M, et al. MEMO--a mobile phone depression prevention intervention for adolescents: development process and postprogram findings on acceptability from a randomized controlled trial. J Med Internet Res 2012;14:e13.
  13. Whittaker R, Stasiak K, McDowell H, Doherty I, Shepherd M, Chua S, et al. MEMO: an mHealth intervention to prevent the onset of depression in adolescents: a double-blind, randomised, placebo-controlled trial. J Child Psychol Psychiatry 2017;58:1014-1022.

SBU Enquiry Service Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Published: 4/22/2021
Report no: ut202107
Registration no: SBU 2020/710