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

Background 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. Objective This systematic review and meta-analysis synthesizes evidence from RCTs to evaluate iCBT’s effects on anxiety, depression, and stress in college students. Methods 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. Results 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). Conclusion Our study found that iCBT is an effective approach for improving anxiety, depression, and stress among college students, with relatively long-term effects. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD420251177558 , identifier (CRD420251177558).