Internet-based CBT for social phobia and panic disorder in a specialised anxiety clinic in routine care: Results of a pilot randomised controlled trial

Abstract

Ample studies have demonstrated that internet-based cognitive behavioural therapy (iCBT) for anxiety disorders is effective and acceptable in controlled settings. Studies assessing the clinical effectiveness of iCBT for anxiety disorders among routine care populations are, however, not as numerous. The purpose of this study was to assess the effectiveness of iCBT among anxiety patients, who were on a waiting list for intensive outpatient treatment, in a specialised routine care clinic.1A randomised controlled pilot trial was conducted. Recruited patients were on a waiting list and had a primary diagnosis of either social phobia or panic disorder. Participants were randomised into either receiving iCBT with minimal therapist contact (received access to the programme FearFighter® (FF) and received support from a clinician via telephone) or no treatment (stayed on the waiting list). The primary outcome was self-reported symptomatic change of anxiety on Beck Anxiety Inventory (BAI). The secondary outcomes were comorbid depression measured on Beck Depression Inventory (BDI-II) and quality of life measured with the EuroQol one-item visual-analogue scale (EQ-vas). All results were analysed by intention-to-treat analyses using a mixed-effects approach. N = 158 patients were assessed for eligibility of which N = 67 met all eligibility inclusion criteria, signed informed consent forms, and were randomised. Post-treatment assessment was completed by N = 47 (70%). In the intervention group, N = 11 (31%) completed all modules of FF. No significant differences of change of symptomatic levels were found between the intervention and control group for anxiety (BAI: mean diff. = 2.42; 95% CI − 1.03 to 5.86; p = 0.17; d = 0.06) or for depression (BDI-II: mean diff. 1.87; 95% CI − 2.25 to 6.00; p = 0.37; d = 0.02). A large and significant effect was found in self-reported quality of life in favour of the experimental group (EQ-vas: mean diff. − 20.88; 95% CI − 30.64 to − 11.11; p < 0.001; d = 0.81).This study was not able to document statistically significant clinical effect of iCBT with minimal therapist contact compared to a waiting list control group in a specialised anxiety clinic in routine care. However, a large and significant effect was seen on self-reported quality of life. Although these results offer an interesting perspective on iCBT in specialised care, they should be interpreted with caution, due to the limitations of the study. A large scale fully powered RCT is recommended.

Adherence to a web-based pre-treatment for phobias in outpatient clinics

“…The current study, being one of the first in this outpatient setting, shows low adherence rates. This is corroborated by two recent studies in comparable outpatient settings ( Kolovos et al, 2016 , Mathiasen et al, 2016 ). The results suggest that patients with better clinical status at baseline are more likely to keep using the intervention, which is in line with previous research in non-clinical populations and unguided Internet interventions ( Karyotaki et al, 2015 ).…”

Implementing internet-delivered cognitive behavior therapy for common mental health disorders: A comparative case study of implementation challenges perceived by therapists and managers in five European internet services

“…In a British study of attitudes towards iCBT in the general population it was found that web-based treatments were expected to be convenient but to have lower appeal and credibility than face-to-face therapy ( Musiat et al, 2014 ). In a study of the use of the iCBT program FearFighter for anxiety on waiting list patients in a Danish secondary routine care clinic no treatment effect was found ( Mathiasen et al, 2016 ) even though the program had been shown to be effective in earlier studies ( Marks et al, 2004 ). As the authors speculate, low treatment expectancy may partly have hampered the treatment effect which was also indicated from interviews conducted with the participants ( Mathiasen et al, 2016 ).…”

“…In a study of the use of the iCBT program FearFighter for anxiety on waiting list patients in a Danish secondary routine care clinic no treatment effect was found ( Mathiasen et al, 2016 ) even though the program had been shown to be effective in earlier studies ( Marks et al, 2004 ). As the authors speculate, low treatment expectancy may partly have hampered the treatment effect which was also indicated from interviews conducted with the participants ( Mathiasen et al, 2016 ). Taken together, the present study confirms existing literature on clinicians' worries about therapeutic relationship and patients' worries about treatment effect, emphasizing a need to carefully investigate and address such expectations when implementing iCBT services.…”

“…However, the route from promising results based on efficacy studies to routine clinical practice is less travelled with treatment effect at times being miniscule or absent (e.g. Mathiasen et al, 2016 ). According to Andersson and Hedman (2013) , it is possible to transfer iCBT into routine clinical practice with moderate to large effect sizes; however, which service model should be used for iCBT and how to disseminate iCBT is an open question, since few implementation studies of internet-delivered treatments have been performed in routine care settings ( Hadjistavropoulos et al, 2014 ; Ebert and Baumeister, 2017 ; Hadjistavropoulos et al, 2017 ; Titov et al, 2017 ; Nordgreen et al, 2018 ).…”

Review of computerised cognitive behavioural therapies: Products and outcomes for people with mental health needs

“…There were no significant differences between treatment and control on the primary PTSD measure or secondary anxiety and depression outcome measures. Mathiasen et al (2016) Anxiety Depression There were no significant differences between treatment and control on the primary anxiety measure or secondary depression outcome measures. Wootton et al (2013) OCD Depression The cCBT treatment group made significant improvements compared with control on the primary OCD measure, but not on the secondary depression outcome measures.…”