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)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
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:
The program was free-of-charge for patients and its completion time was unrestricted. A specialized iCBT clinic delivered iCBT to 1,099 physician-referred patients. 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=0.96; 95%CI: 0.87-1.05). 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 relief (GAD-7) was associated with more completed sessions, older age, and being referred from private or occupational care. Of 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 comparative effectiveness 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
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