A new review published in JMIR Mental Health offers a fresh look at digital mental health treatments for individuals waiting to see a therapist in person. The new paper suggests that while these digital treatments can help reduce feelings of depression and anxiety, they do not appear to be any more effective than simply waiting or using a self-help book. The review also highlights challenges with user engagement, including high dropout rates, which may limit the overall benefits of these digital programs.
The review was conducted in response to a growing problem in mental health care: long wait times for therapy. Across many countries, patients often face months-long delays before they can begin treatment with a psychotherapist. This waiting period can be a critical time for individuals struggling with depression and anxiety, as symptoms may worsen without intervention. Digital mental health interventions—ranging from self-help websites to mobile therapy apps—have been proposed as a way to provide support to those waiting for face-to-face treatment. However, their effectiveness for this specific purpose had not been systematically reviewed until now.
“The increasing prevalence of depression and anxiety, coupled with long waiting lists for psychotherapy, motivated our research. Digital mental health interventions offer a scalable and accessible way to provide support during these waiting periods,”
“As the supervising researcher, I saw an opportunity to explore how digital mental health interventions could complement traditional face-to-face therapy by offering interventions before the therapy begins, while individuals are on waiting lists for psychotherapy. Moreover, the research team and I identified that no earlier literature reviews had specifically investigated the impact of digital mental health interventions for individuals on psychotherapy waiting lists. By focusing on this area, we aimed to fill a critical gap and make a meaningful contribution to the field.”
To assess whether digital mental health interventions offer meaningful benefits to patients on waiting lists, the researchers conducted a systematic review of existing studies. They searched four major scientific databases—PubMed, PsycINFO, Cochrane, and Web of Science—to identify relevant studies published before June 2024. The studies included in the review had to involve digital interventions for individuals waiting for psychotherapy, with clear psychological outcome measures related to depression and anxiety. After screening thousands of articles, the researchers selected eight studies that met their criteria.
“It was surprising that there was such a limited pool of high-quality studies in such an important area or research. Out of over 9,000 screened records, we found only a small number of randomized controlled trials meeting our criteria.”
Of these eight studies, five were randomized controlled trials, which are considered the gold standard for evaluating treatment effectiveness. The remaining three were feasibility or nonrandomized studies. The interventions studied varied in format, including internet-based cognitive behavioral therapy programs, problem-solving therapy, and guided self-help interventions. Some were fully automated self-help programs, while others involved limited guidance from a therapist or coach. The researchers examined how these interventions affected depression and anxiety symptoms, as well as factors like user engagement and perceived credibility.
The review found that, overall, digital interventions led to moderate reductions in depression and anxiety symptoms. However, most of the randomized controlled trials found no significant differences between the intervention groups and the control groups. In many cases, control groups either received a self-help book or simply remained on the waiting list without any intervention, yet they showed similar symptom improvements to those using digital programs.
Only one of the randomized controlled trials reported a significant difference in symptom reduction between the intervention group and the control group. The remaining trials found small or negligible differences, suggesting that digital interventions were not consistently more effective than waiting or using a self-help book.
One of the biggest challenges identified in the review was user engagement. Many participants dropped out of digital interventions before completing the full program. Previous research has shown that guided interventions—where users receive some level of human support—tend to have higher engagement levels than fully self-guided programs. In this review, guided interventions generally had lower dropout rates than unguided ones. Additionally, factors such as age, education level, and perceived credibility of the intervention appeared to influence engagement. Some participants reported that they did not expect the digital interventions to be as effective as face-to-face therapy, which may have contributed to low adherence.
“The main takeaway is that while digital mental health interventions show some potential during waiting lists, their benefits are modest at best. As lead author Sijia Huang, a PhD student in Clinical Psychology at Rowan University, noted, ‘Unfortunately, our findings show that most digital mental health tools did not outperform control groups where patients either simply waited without intervention or used self-help books.’ So, although digital mental health interventions have potential as a pre-treatment for individuals on psychotherapy waiting lists, improving engagement and adherence is crucial to enhancing their effectiveness.”
The review also noted that the studies included were highly variable in terms of design, intervention type, and outcome measures. This variability made it difficult to draw strong conclusions about which features of digital interventions are most effective for patients on waiting lists. While some studies showed promising results, the overall evidence remains inconclusive. The researchers emphasized the need for more high-quality randomized controlled trials with larger sample sizes to better understand how digital interventions can be optimized for this population.
Despite these limitations, digital mental health interventions still hold promise as an accessible and scalable option for mental health support. The researchers suggested that future studies should focus on making these interventions more engaging and personalized. Features such as tailored feedback, interactive components, and therapist support may help improve adherence and effectiveness. They also highlighted the need to investigate digital interventions in more diverse populations, including individuals in low-income and non-English-speaking communities, where access to mental health care is often even more limited.
“This research was a collaborative effort between researchers in Psychology and Public Health at NYU Shanghai, the University of Reading, and Rowan University. Our goals with this article were to raise awareness about the importance of evaluating interventions during waiting lists for psychotherapy and to highlight the need for more empirical research in this area. Given the likelihood of increasing waiting list times in the future, we hope to engage other researchers in developing and investigating more engaging, personalized, and effective interventions that are accessible to diverse populations. This will hopefully help address the global mental health crisis by providing effective support to those in need.”
“While digital mental health interventions are generally useful, our review shows that their effectiveness during psychotherapy waiting lists is limited. A key challenge is the variation in study designs, which makes it difficult to compare results and identify the most effective intervention features. As these methods evolve, a stronger focus on user experience, long-term engagement, and clinical effectiveness will most likely be essential. Further research is needed to investigate the effectiveness of digital mental health interventions for individuals on psychotherapy waiting lists.”
The study, “Digital Mental Health Interventions for Alleviating Depression and Anxiety During Psychotherapy Waiting Lists: Systematic Review,” was authored by Sijia Huang, Yiyue Wang, Gen Li, Brian J. Hall, and Thomas J. Nyman
