Transdiagnostic Internet treatment for anxiety disorders: A randomized controlled trial
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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[Show abstract] [Hide abstract] ABSTRACT: Background Efficacy of self-help internet-based cognitive behavior therapy (ICBT) for anxiety disorders has been confirmed in several randomized controlled trials. However, the amount and type of therapist guidance needed in ICBT are still under debate. Previous studies have shown divergent results regarding the role of therapist guidance and its impact on treatment outcome. This issue is central to the development of ICBT programs and needs to be addressed directly. The present study aims to compare the benefits of regular therapist guidance via online real-time audio-video communication (i.e. Skype) to no therapist guidance during a 12-week Romanian self-help ICBT program for Panic Disorder. Both treatments are compared to a waiting-list control group. Methods/Design A parallel group randomized controlled trial is proposed. The participants, 192 Romanian adults fulfilling diagnostic criteria for panic disorder according to a diagnostic interview, conducted via secured Skype or telephone, are randomly assigned to one of the three conditions: independent use of the internet-based self-help program PAXonline, the same self-help treatment with regular therapist support via secured Skype, and waiting-list control group. The primary outcomes are severity of self-report panic symptoms (PDSS-SR) and diagnostic status (assessors are blind to group assignment), at the end of the intervention (12 weeks) and at follow-up (months 3 and 6). The secondary measures address symptoms of comorbid anxiety disorders, depression, quality of life, adherence and satisfaction with ICBT. Additional measures of socio-demographic characteristics, personality traits, treatment expectancies, catastrophic cognitions, body vigilance and working alliance are considered as potential moderators and/ or mediators of treatment outcome. Discussion To the best of our knowledge, the present study is the first effort to investigate the efficacy of a self-help internet-based intervention with therapist guidance via real-time video communication. A direct comparison between therapist guided versus unguided self-directed intervention for panic disorder will also be addressed for the first time. Findings from this study will inform researchers and practitioners about the added value of online video-therapy guidance sessions and the type of patients who may benefit the most from guided and unguided ICBT for Panic disorder. Trial registration ACTRN12614000547 640 (Australian New Zealand Clinical Trials Registry). Registered 22/05/2014.
- "Because half of all lifetime cases of mental disorders start by age 14 years and the median age of onset for anxiety is 11 years  , it should be mentioned that ICBT shows promising results not just for adults, but also for treating anxiety and depression in youth [23, 24]. Anxiety disorders seem to be one of the most approachable and treatable types of mental disorder through online therapy25262728293031. Panic disorder (PD) with or without agoraphobia is one of the conditions for which ICBT programs have been developed since the late 1990s and there are several empirical studies supporting their efficacy and effectiveness [13, 17, 19,3233343536373839404142. In Romania, only one internet-based treatment has been tested so far, the Swedish program Sofie . "
[Show abstract] [Hide abstract] ABSTRACT: Many individuals with anxiety disorders do not receive professional treatment. Internet interventions have shown to be effective in the treatment of anxiety. The present randomized controlled trial was designed to examine the effectiveness of a short-term (4-week) Internet intervention in treating panic disorder, agoraphobia, social anxiety disorder, and specific phobias (‘ConfID’). We addressed the questions of whether this transdiagnostic program would affect these disorders to varying degrees and whether there would be moderators of effectiveness. Adults who were recruited in online forums for anxiety underwent an online baseline assessment (N = 179) and were randomized either to the intervention group (ConfID) or the control group (care as usual). Online post-assessment took place 4 weeks later. The primary outcome was assessed with the Beck Anxiety Inventory (BAI); the secondary outcomes targeted the disorder-specific symptoms, depression, and somatization. Participants in the intervention group showed a significantly stronger anxiety reduction compared to participants receiving care as usual (small-to-medium effect size between groups in intention-to-treat analysis). The treatment effect was similar for the different disorders and was moderated by participants’ attitudes towards Internet interventions. Secondary outcomes yielded effect sizes in the medium range. Limitations: Moderate treatment adherence, lack of measures beyond online self-reports, and unavailability of long-term results. The study provides further evidence that transdiagnostic Internet interventions are promising in reducing the existing treatment gap in individuals with panic disorder and phobias. Results extend previous findings by showing that significant effects can also be reached by comprehensive short-term programs and that the effects might be moderated by participants’ attitudes towards Internet interventions.
- "Meta-analyses on Internet interventions for anxiety disorders mostly yield moderate to large effect sizes (Andersson & Hedman, 2013; Griffiths, Farrer, & Christensen, 2010; Saddichha, Al-Desouki, Lamia, Linden, & Krausz, 2014). Transdiagnostic iCBT programs for various anxiety disorders (Johnston, Titov, Andrews, Spence, & Dear, 2011; Titov, Andrews, Johnston, Robinson, & Spence, 2010) and comorbid depression (Titov et al., 2011, Titov, Dear, Staples, & Bennett-Levy, et al., 2015, Titov, Dear, Staples, & Terides, et al., 2015) show promising results. Recent studies in the field of Internet interventions may further suggest that transdiagnostic approaches have similar effects to disorder-specific approaches (Berger et al., 2014; Dear et al., 2015; Fogliati et al., 2015), but more research is needed. "
[Show abstract] [Hide abstract] ABSTRACT: Effective treatment strategies exist for obsessive-compulsive disorder (OCD), however, many individuals do not receive professional help. Media-delivered self-help is increasingly sought to narrow the treatment gap. Previous studies included personal contact with a clinician, making it difficult to delineate the specific effect of the medium. We developed "myMCT" for OCD, a (meta-)cognitive manual for self-application. We conducted a randomized-controlled trial with 128 OCD participants receiving myMCT versus psychoeducation, adopting low-threshold recruitment approaches without any face-to-face contact. Diagnoses were verified with telephone interviews paralleling online surveys at pre, post (4 weeks) and follow-up (6 months). Participants benefited significantly from both interventions. MyMCT showed stronger reduction of OCD symptoms on Y-BOCS total score (p=.023, η2partial=.04), obsessions (p=.002, η2partial=.07), depression (BDI: p=.022, η2partial=.04), and cognitive biases (OBQ: p=.016, η2partial=.05) after 4 weeks. After 6 months, individuals with myMCT showed decreased levels of cognitive biases (OBQ). The current study provides further evidence that myMCT is a promising approach to target OCD-related psychopathology as mere self-help. Although effect sizes were below those usually found in (therapist-)guided self-help, myMCT could be of value for the large subgroup of individuals without treatment.
- "Moreover, the present study demonstrates that low-threshold interventions, such as psychoeducation and a (meta-)cognitive self-help manual, are not able to substitute psychotherapy but could act as an important complementary tool in the framework of comprehensive (e.g., stepped-care) treatment programs for OCD. In fact, there is accumulating evidence of generally positive attitudes towards self-help both from patients (e.g., Carlbring, Bohman et al., 2006, Carlbring, Nilsson-Ihrfelt et al., 2006 Titov, Andrews, Johnston, Robinson, & Spence, 2010) as well as from mental health practitioners (e.g., MacLeod, Martinez, & Williams, 2009; Nordgreen et al., 2012 ). It has been shown that a greater understanding of OCD and the potential gravity of the disorder may enhance treatment seeking in this under-treated group (Belloch, Valle, Morillo, Carrió, & Cabedo, 2009; Levy, McLean, Yadin, & Foa, 2013). "