Psychological Medicine

Review Article

The clinical effectiveness of CBT-based guided self-help interventions for anxiety and depressive disorders: a systematic review

G. Coulla1 c1 and P. G. Morrisa1

a1 Clinical and Health Psychology, University of Edinburgh, UK


Background Cognitive-behavioural therapy (CBT)-based guided self-help (GSH) has been suggested to be an effective intervention for mild to moderate anxiety and depression, yet the evidence seems inconclusive, with some studies reporting that GSH is effective and others finding that GSH is ineffective. GSH differs in important respects from other levels of self-help, yet the literature regarding exclusively guided self-help interventions for anxiety and depression has not been reviewed systematically.

Method A literature search for randomized controlled trials (RCTs) examining CBT-based GSH interventions for anxiety and depressive disorders was conducted. Multiple electronic databases were searched; several journals spanning key disciplines were hand-searched; reference lists of included review articles were scanned and relevant first authors were contacted.

Results Thirteen studies met the inclusion criteria. Meta-analysis indicated the effectiveness of GSH at post-treatment, although GSH was found to have limited effectiveness at follow-up or among more clinically representative samples. Studies that reported greater effectiveness of GSH tended to be of lower methodological quality and generally involved participants who were self-selected rather than recruited through clinical referrals.

Conclusions Although there is support for the effectiveness of CBT-based GSH among media-recruited individuals, the finding that the reviewed RCTs had limited effectiveness within routine clinical practice demonstrates that the evidence is not conclusive. Further rigorous evidence based on clinical populations that examines longer-term outcomes is required before CBT-based GSH interventions can be deemed effective for adults accessing primary care services for treatment of anxiety and depression.

(Received June 07 2010)

(Revised February 04 2011)

(Accepted February 07 2011)

(Online publication June 15 2011)


c1 Address for correspondence: Dr G. Coull, Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh EH8 9AG, UK. (Email: