Transdiagnostic Internet treatment for anxiety disorders: A randomized controlled trial

University of New South Wales, Sydney, Australia.
Behaviour Research and Therapy (Impact Factor: 3.85). 09/2010; 48(9):890-9. DOI: 10.1016/j.brat.2010.05.014
Source: PubMed


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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Available from: Luke Johnston, Sep 05, 2015
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    • "Over the past decade, research has demonstrated the efficacy of ICBT for the treatment of depression and anxiety disorders. In a meta-analysis of 22 controlled studies that compared ICBT for depression and anxiety with or without therapist assistance to a waiting list control condition, effect size superiority over the control group was 0.88 and symptom improvement was shown to be maintained after 26-weeks on average post-treatment (Andrews, Cuijpers, Craske, McEvoy, & Titov, 2010). Results also indicated high levels of accessibility, adherence, and satisfaction with this modality. "
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    ABSTRACT: This dissemination study examined the effectiveness of therapist-assisted Internet-delivered Cognitive Behavior Therapy (ICBT) when offered in clinical practice. A centralized unit screened and coordinated ICBT delivered by newly trained therapists working in six geographically dispersed clinical settings. Using an open trial design, 221 patients were offered 12 modules of ICBT for symptoms of generalized anxiety (n = 112), depression (n = 83), or panic (n = 26). At baseline, midpoint and post-treatment, patients completed self-report measures. On average, patients completed 8 of 12 modules. Latent growth curve modeling identified significant reductions in depression, anxiety, stress and impairment (d = .65 - .78), and improvements in quality of life (d = .48 - .66). Improvements in primary symptoms were large (d = .91-1.25). Overall, therapist-assisted ICBT was effective when coordinated across settings in clinical practice, but further attention should be given to strategies to improve completion of treatment modules.
    Journal of Anxiety Disorders 10/2014; 28(8):884-893. DOI:10.1016/j.janxdis.2014.09.018 · 2.96 Impact Factor
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    • "o passage of time or usual care . This was not done because of ethical considerations of having patients waiting for treatment . Also , it would have been interesting to compare tailored ICBT against either disorder - specific treatment ( i . e . , for one disorder ) or against a unified treatment protocol such as the one by Titov and colleagues ( Titov et al . , 2010 ) . However , we made use of an active control group as a control condition , which is probably more effective than only waiting because at least some of the nonspecific factors in therapy ( e . g . , being monitored and having a contact person to send messages to ) are controlled for . Second , the follow - up measurements suffered fro"
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    ABSTRACT: Unlabelled: A significant proportion of the general population suffers from anxiety disorders, often with comorbid psychiatric conditions. Internet-delivered cognitive behavior therapy (ICBT) has been found to be a potent treatment for patients with specific psychiatric conditions. The aim of this trial was to investigate the effectiveness and cost-effectiveness of ICBT when tailoring the treatment to address comorbidities and preferences for primary-care patients with a principal anxiety disorder. One hundred participants were recruited through their primary-care contact and randomized to either treatment or an active control group. The treatment consisted of 7-10 weekly individually assigned modules guided by online therapists. At post-treatment, 46% of the treatment group had achieved clinically significant improvement on the primary outcome measure (CORE-OM) and between-group effect sizes ranged from d = 0.20 to 0.86, with a mean effect of d = 0.59. At one-year follow-up, within-group effect sizes varied between d = 0.53 to 1.00. Cost analysis showed significant reduction of total costs for the ICBT group, the results were maintained at one-year follow-up and the incremental cost-effectiveness ratio favored ICBT compared to control group. Individually tailored ICBT is an effective and cost-effective treatment for primary-care patients with anxiety disorders with or without comorbidities. Trial registration: NCT01390168.
    Behaviour Research and Therapy 06/2014; 59C:1-11. DOI:10.1016/j.brat.2014.05.007 · 3.85 Impact Factor
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    • "Third, promising research on acceptancebased as well as CBT-based models of TCBT delivered via the Internet has begun (e.g. Boettcher et al., 2014; Dear et al., 2011; Titov, Andrews, Johnston, Robinson, & Spence, 2010). TCBT offers a specialized treatment for comorbid and other-specified anxiety disorders, and potentially adds to diagnosis-specific CBT as a pragmatic, more easily disseminated, evidence-based treatment model for the full range of anxiety disorders. "
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    ABSTRACT: Transdiagnostic approaches to cognitive behaviour therapy (TCBT) of anxiety disorders have drawn increasing interest and empirical testing over the past decade. In this paper, we review evidence of the overall efficacy of TCBT for anxiety disorders, as well as TCBT efficacy compared with wait-list, treatment-as-usual, and diagnosis-specific cognitive behaviour therapy (CBT) controls. A total of 11 studies reporting 12 trials (n = 1933) were included in the systematic review. Results from the meta-analysis of 11 trials suggest that TCBT was generally associated with positive outcome; TCBT patients did better than wait-list and treatment-as-usual patients, and treatment gains were maintained through follow-up. The pooled estimate showed a moderate treatment effect, however with large heterogeneity suggesting differences in treatment effects between the studies. Also, all the included trials, apart from one, were judged to be associated with a high risk of bias. Only one study compared TCBT with diagnosis-specific CBT suggesting treatment effect of TCBT to be as strong as diagnosis-specific CBT. This study not only cautiously supports evidence for the efficacy of TCBT, but also suggests the need for more high-quality, large-scaled studies in this area. Transdiagnostic treatments offer great clinical promise as an affordable and pragmatic treatment for anxiety disorders and as a specialized treatment for co-morbid and other-specified anxiety disorders.
    Cognitive behaviour therapy 03/2014; 43(3). DOI:10.1080/16506073.2014.897367
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