Psychological Medicine

Review Article

Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies

P. Cuijpersa1a2 c1, T. Donkera1a2, A. van Stratena1a2, J. Lia3 and G. Anderssona4a5

a1 Department of Clinical Psychology, VU University Amsterdam, The Netherlands

a2 EMGO Institute for Health and Care Research, VU University Amsterdam and VU University Medical Center, The Netherlands

a3 Institute of Psychology, Chinese Academy of Sciences, Beijing, People's Republic of China

a4 Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Sweden

a5 Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden


Background Although guided self-help for depression and anxiety disorders has been examined in many studies, it is not clear whether it is equally effective as face-to-face treatments.

Method We conducted a meta-analysis of randomized controlled trials in which the effects of guided self-help on depression and anxiety were compared directly with face-to-face psychotherapies for depression and anxiety disorders. A systematic search in bibliographical databases (PubMed, PsycINFO, EMBASE, Cochrane) resulted in 21 studies with 810 participants.

Results The overall effect size indicating the difference between guided self-help and face-to-face psychotherapy at post-test was d=−0.02, in favour of guided self-help. At follow-up (up to 1 year) no significant difference was found either. No significant difference was found between the drop-out rates in the two treatments formats.

Conclusions It seems safe to conclude that guided self-help and face-to-face treatments can have comparable effects. It is time to start thinking about implementation in routine care.

(Received December 12 2009)

(Revised March 11 2010)

(Accepted March 15 2010)

(Online publication April 21 2010)


c1 Address for correspondence: P. Cuijpers, Ph.D., Professor of Clinical Psychology, Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. (Email: