JMIR Publications

ABSTRACT

Background:

Cognitive behavioral therapy (CBT) has been established as effective for anxiety disorders. The accessibility to CBT has been limited in Japan due to a shortage of therapists. While an open-source e-learning system can be utilized to create a simple Internet-based CBT (ICBT), the safety and outpatient acceptance of this treatment approach have not been explored in Japan.

Objective:

This study aimed to investigate the feasibility of guided ICBT using an e-learning system for Japanese outpatients with panic disorder (PD) and social anxiety disorder (SAD).

Methods:

Six adults, including four males and two females, were enrolled in a single-arm trial. The intervention involved guided ICBT comprising 12 sessions, including text of CBT, comprehension confirmation tests, and explanatory video about cognitive behavioral model, accessible through a website. The therapist guided participants to access the ICBT program and answered their questions via a chat tool. The primary outcome was the severity of anxiety, assessed using the State-Trait Anxiety Inventory-Trait (STAI-T). Secondary outcomes included the Panic Disorder Severity Scale (PDSS), Liebowitz Social Anxiety Scale (LSAS), Beck Anxiety Inventory (BAI), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) and Working Alliance Inventory-Short Form (WAI-SF). Statistical analyses were performed using paired t-tests to assess changes in clinical symptoms. The total WAI-SF score at the final session was used to evaluate the therapeutic alliance.

Results:

Clinical symptoms decreased across all outcomes, with a significant reduction observed only in BAI (P=0.03). The therapeutic alliance measured by WAI-SF was moderate. No adverse events were reported. Of the participants, 66.6% (4/6) showed the treatment response, and 50.0% (3/6) achieved a remission state after the intervention.

Conclusions:

While the generalizability is limited due to the small sample size, the study results suggest that guided ICBT is likely feasible for Japanese patients with PD and SAD. Clinical Trial: UMIN0000038118.