Internet-delivered cognitive behavioral therapy for anxiety among university students: A systematic review and meta-analysis

University years are marked by multiple stressors. Consequently, university students often report anxiety symptoms or disorders, but most remain untreated. Internet-delivered cognitive behavioral therapy (ICBT) has been proposed as an alternative to address known help-seeking barriers, which were aggravated during the COVID-19 pandemic. This meta-analysis aims to evaluate the efficacy of ICBT for university students with anxiety. A systematic search on three databases, EBSCOhost, PubMed, and Web of Science, and a manual search were performed. Fifteen studies were identified, including a total of 1619 participants. Seven studies evaluated ICBT treatment for both anxiety and depression, three for social anxiety, two for generalized anxiety, while the remaining (k = 3) only targeted anxiety, test anxiety, and comorbidity between anxiety and insomnia. Analyses were performed based on a random-effects model using the metafor package in R. The results indicated that ICBT had a significant and positive effect on university students with anxiety compared to controls at post-test (g =-0.48; 95 % CI:-0.63,-0.27; p < .001, I2 = 67.30 %). Nevertheless, more research is required to determine the intervention components that are more relevant for therapeutic change, how much guidance is required to produce better outcomes, and how patient engagement can be improved.