# The intervention effect of internet-based cognitive behavioral therapy on anxiety, depression, and stress in college students: a systematic review and meta-analysis based on randomized controlled trials

## TL;DR

Internet-based cognitive behavioral therapy (iCBT) effectively reduces anxiety, depression, and stress in college students, with benefits lasting over time.

## Contribution

This study provides a comprehensive meta-analysis of RCTs confirming the long-term effectiveness of iCBT for mental health in college students.

## Key findings

- iCBT significantly reduced anxiety, depression, and stress in college students compared to control groups.
- Chatbot-based interventions showed promise for depression, while web platforms were more effective for anxiety.
- Longer iCBT interventions (>4 weeks) had better outcomes than shorter ones.

## Abstract

College students face rising anxiety, depression, and stress, with traditional mental health services unable to meet demand. iCBT offers an accessible, low-cost alternative, yet evidence remains inconsistent regarding its effectiveness.

This systematic review and meta-analysis synthesizes evidence from RCTs to evaluate iCBT’s effects on anxiety, depression, and stress in college students.

We systematically searched eight databases and one trial registry for studies published up to October 2025. Two reviewers independently screened studies, extracted data, and assessed bias using the Cochrane RoB 2 tool. Inter-rater agreement was measured using Cohen’s kappa coefficient. Meta-analysis and subgroup analyses were conducted using RevMan 5.4 and Stata 17.0.

This systematic review included 30 RCTs involving 5,169 college students, 29 of which were included in the meta-analysis. The meta-analysis results showed that, compared to the control group, internet-based Cognitive Behavioral Therapy significantly alleviated anxiety symptoms (SMD = −0.24, 95% CI −0.31 to −0.18, p < 0.001), depressive symptoms (SMD = −0.42, 95% CI −0.54 to −0.30, p < 0.001), and stress levels (SMD = −0.37, 95% CI −0.47 to −0.27; p < 0.001) in college students. Subgroup analysis tentatively suggested that chatbot-based interventions may be promising for alleviating depression, while web platform-based interventions appeared more effective in improving anxiety. Furthermore, longer intervention durations (>4 weeks) yielded superior effects compared to shorter ones. Follow-up meta-analysis demonstrated that iCBT had a sustained impact on improving college students’ mental health (Depression: SMD = −0.28, 95% CI −0.39 to −0.18, p < 0.001; Anxiety: SMD = −0.17, 95% CI −0.30 to −0.03, p = 0.01; Stress: SMD = −0.32, 95% CI −0.45 to −0.18, p < 0.001).

Our study found that iCBT is an effective approach for improving anxiety, depression, and stress among college students, with relatively long-term effects.

https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD420251177558, identifier (CRD420251177558).