Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Apr 5, 2021
Open Peer Review Period: Apr 5, 2021 - May 31, 2021
Date Accepted: Dec 16, 2021
(closed for review but you can still tweet)
Internet-delivered Cognitive-Behavioral Therapy for Generalized Anxiety Disorder: Its Effectiveness in Nationwide Routine Care
ABSTRACT
Background:
Internet-delivered, therapist-supported Cognitive Behavioral Therapy (iCBT) is efficacious for Generalized Anxiety Disorder (GAD), but few studies have as yet reported its effectiveness in routine care.
Objective:
To examine whether a new 12-session iCBT program for GAD is effective in nationwide routine care.
Methods:
A specialized iCBT clinic delivered therapist-supported iCBT for GAD to 1,099 physician-referred patients. The program was free-of-charge for patients and its completion time was not predetermined. We measured symptoms with online questionnaires. The primary measure of anxiety was the GAD-7; secondary measures were, for pathological worry, the Penn State Worry Questionnaire (PSWQ) and, for anxiety and impairment, the Overall Anxiety Severity and Impairment Scale (OASIS).
Results:
Patients completed a mean 7.8 (65.1%) of 12 sessions, and 44.1% of patients completed all sessions. Effect size in the whole sample for GAD-7 was large (d=0.97; 95%CI: 0.88-1.06). For completers, effect sizes were very large, d=1.34 (95%CI: 1.25-1.53) for GAD-7, d=1.14 (95%CI:1.00-1.27) for PSWQ, and 1.23 (95%CI:1.09-1.37) for OASIS. Patients who dropped out also benefited from the treatment. Greater symptomatic GAD-7 measured relief was associated with more completed sessions, older age, and being referred from private or occupational care. Of the 894 patients with baseline GAD-7 score ≥10, those achieving a reliable recovery amounted to 421 (47.1%).
Conclusions:
This nationwide, free-of-charge, therapist-supported HUS-iCBT for GAD was effective in routine care, but further research must establish effectiveness against other treatments and optimize the design of iCBT for GAD for different patient groups and individual patients. Clinical Trial: Nationwide internet-delivered computer-assisted cognitive-behavioral therapy (iCBT) for psychiatric disorders. https://www.isrctn.com/ISRCTN55123131
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.