Transdiagnostic Internet treatment for anxiety disorders: A randomized controlled trial.
ABSTRACT Clinician-guided Internet-based cognitive behavioural therapy (iCBT) programs are clinically effective at treating specific anxiety disorders. The present study examined the efficacy of a transdiagnostic Internet-based cognitive behavioural treatment (iCBT) program to treat more than one anxiety disorder within the same program (the Anxiety Program). Eighty six individuals meeting diagnostic criteria for generalized anxiety disorder (GAD), panic disorder, and/or social phobia were randomly assigned to a treatment group, or to a waitlist control group. Treatment consisted of CBT based online educational lessons and homework assignments, weekly email or telephone contact from a clinical psychologist, access to a moderated online discussion forum, and automated emails. An intention-to-treat model using the baseline-observation-carried-forward principle was employed for data analyses. Seventy-five percent of treatment group participants completed all 6 lessons within the 8 week program. Post-treatment data was collected from 38/40 treatment group and 38/38 control group participants, and 3-month follow-up data was collected from 32/40 treatment group participants. Relative to controls, treatment group participants reported significantly reduced symptoms of anxiety as measured by the Generalized Anxiety Disorder - 7 Item, Social Phobia Screening Questionnaire, and the Panic Disorder Severity Rating Scale - Self Report Scale, but not on the Penn State Worry Questionnaire, with corresponding between-groups effect sizes (Cohen's d) at post-treatment of 0.78, 0.43, 0.43, and 0.20, respectively. The clinician spent a total mean time of 46min per person over the program, participants rated the procedure as moderately acceptable, and gains were sustained at follow-up. Modifications to the Anxiety program, based on post-treatment feedback from treatment group participants, were associated with improved outcomes in the control group. These results indicate that transdiagnostic programs for anxiety disorders may be successfully administered via the Internet.
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ABSTRACT: Analysis of variance (ANOVA) is a statistical method that is widely used in the psychosomatic literature to analyze the results of randomized trials, yet ANOVA does not provide an estimate for the difference between groups, the key variable of interest in a randomized trial. Although the use of ANOVA is frequently justified on the grounds that a trial incorporates more than two groups, the hypothesis tested by ANOVA for these trials--"Are all groups equivalent?"--is often scientifically uninteresting. Regression methods are not only applicable to trials with many groups, but can be designed to address specific questions arising from the study design. ANOVA is also frequently used for trials with repeated measures, but the consequent reporting of "group effects," "time effects," and "time-by-group interactions" is a distraction from statistics of clinical and scientific value. Given that ANOVA is easily misapplied in the analysis of randomized trials, alternative approaches such as regression methods should be considered in preference.Psychosomatic Medicine 01/2005; 67(4):652-5. · 4.08 Impact Factor
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ABSTRACT: The present report describes the development of the Penn State Worry Questionnaire to measure the trait of worry. The 16-item instrument emerged from factor analysis of a large number of items and was found to possess high internal consistency and good test-retest reliability. The questionnaire correlates predictably with several psychological measures reasonably related to worry, and does not correlate with other measures more remote to the construct. Responses to the questionnaire are not influenced by social desirability. The measure was found to significantly discriminate college samples (a) who met all, some, or none of the DSM-III-R diagnostic criteria for generalized anxiety disorder and (b) who met criteria for GAD vs posttraumatic stress disorder. Among 34 GAD-diagnosed clinical subjects, the worry questionnaire was found not to correlate with other measures of anxiety or depression, indicating that it is tapping an independent construct with severely anxious individuals, and coping desensitization plus cognitive therapy was found to produce significantly greater reductions in the measure than did a nondirective therapy condition.Behaviour Research and Therapy 02/1990; 28(6):487-95. · 3.30 Impact Factor
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ABSTRACT: Comorbidity in epidemiological surveys of mental disorders is common and of uncertain importance. To explore the correlates of current comorbidity. Data from the Australian National Survey of Mental Health and Well-Being were used to evaluate the relationships between comorbidity, disability and service utilisation associated with particular mental disorders. The number of current comorbid disorders predicted disability, distress, neuroticism score and service utilisation. Comorbidity is more frequent than expected, which might be due to the effect of one disorder on the symptom level of another, or to the action of common causes on both. The combination of affective and anxiety disorders was more predictive of disability and service utilisation than any other two or three group combinations. When people nominated their principal disorder as the set of symptoms that troubled them the most, the affective and anxiety disorders together were associated with four-fifths of the disability and service utilisation. To make clinical interventions more practical, current comorbidity is best reduced to a principal disorder and subsidiary disorders.The British Journal of Psychiatry 11/2002; 181:306-14. · 6.61 Impact Factor