Cognitive behavioural therapy, or CBT, is a well-established talking therapy for anxiety. Most of that evidence comes from in-person sessions. A recent systematic review and meta-analysis asked a narrower question: whether CBT still helps older adults with anxiety when it is delivered remotely, by phone, video or a guided online program.
The researchers pooled six randomised controlled trials involving 633 people, with an average age of 66.6 years. Each trial compared remote CBT against a group that received no CBT. Anxiety was measured with standard questionnaires that people complete themselves.
Remote CBT came out ahead. It reduced self-reported anxiety more than the control conditions, and the difference was moderate in size, with a between-group effect of -0.63. It also reduced self-reported symptoms of depression, with a slightly larger effect of -0.74. The authors concluded that remote CBT is more effective than no CBT for easing anxiety and low mood in this age group.
That matters in a practical way. Many older adults cannot easily travel to appointments. Others would simply rather be seen at home. If anxiety is wearing you down, your GP or a psychologist can help you find a format that suits you.
What the researchers did
This was a systematic review and meta-analysis. The team searched four research databases up to the end of March 2021 for randomised controlled trials that compared remote CBT with a non-CBT control in older adults with anxiety. Remote CBT here means structured cognitive behavioural therapy delivered without both people being in the same room, for example by telephone, videoconference or a guided online program. Six trials met the criteria. Together they included 633 participants, with a pooled mean age of 66.6 years.
Anxiety was the main outcome. It was measured with self-report scales, meaning questionnaires the person fills in about their own symptoms, including the Generalised Anxiety Disorder 7-item scale and the Penn State Worry Questionnaire. Depressive symptoms were a secondary outcome, measured with scales such as the Patient Health Questionnaire. For each study the researchers worked out how much a group changed from before to after treatment, then took the difference between the remote CBT groups and the control groups as the effect size for comparison across studies. These were combined using a random-effects model, an approach that allows for the true effect varying from one study to another.
What they found
Remote CBT reduced self-reported anxiety more than the control conditions. The pooled between-group effect size was -0.63, with a 95% confidence interval from -0.99 to -0.28. A confidence interval that does not cross zero points to a statistically significant result, and an effect of this size is usually called moderate. The benefit for depressive symptoms was slightly larger, at -0.74, with a confidence interval from -1.24 to -0.25. The authors' conclusion was plain. For older adults, remote CBT is more effective than no CBT at reducing both anxiety and depressive symptoms.
Why it matters in practice
Anxiety in later life is common, and it often goes untreated. Getting to a clinic can be hard for people who no longer drive, who have mobility or health problems, or who live a long way from services. Evidence that therapy still works when it is delivered by phone or video widens the group of people who can realistically receive it. It also gives services a way to reach people on long waiting lists sooner. Telehealth removes some of the practical friction that stops people starting therapy at all, such as arranging transport or relying on family to drive them. For families and referrers, that supports offering a remote option rather than assuming an older person will miss out if they cannot attend in person.
The limits
Six trials is a small body of evidence, and the search was current only to early 2021. The review compared remote CBT against groups that received no CBT, so it does not tell us how remote therapy stacks up directly against face-to-face therapy. Every outcome was self-reported, so the results reflect how people rated their own anxiety rather than a clinician's judgement. The analysis also combined different forms of remote delivery and different control conditions, which adds variation that a single number cannot fully capture. Findings like these describe older adults with anxiety as a group. Any one person's result will depend on the individual, the therapist and the severity of the problem. A conversation with a GP or psychologist is the right place to work out whether a remote or in-person format is the better fit for you.