Internet-Delivered Cognitive Behavioral Therapy for Generalized Anxiety Disorder in Nationwide Routine Care: Effectiveness Study

Abstract

Background Therapist-supported, internet-delivered cognitive behavioral therapy (iCBT) is efficacious for generalized anxiety disorder (GAD), but few studies are yet to report its effectiveness in routine care. Objective In this study, we aim to examine whether a new 12-session iCBT program for GAD is effective in nationwide routine care. Methods We administered a specialized, clinic-delivered, therapist-supported iCBT for GAD in 1099 physician-referred patients. The program was free of charge for patients, and the completion time was not predetermined. We measured symptoms with web-based questionnaires. The primary measure of anxiety was the GAD 7-item scale (GAD-7); secondary measures were, for pathological worry, the Penn State Worry Questionnaire and, for anxiety and impairment, the Overall Anxiety Severity and Impairment Scale. Results Patients completed a mean 7.8 (SD 4.2; 65.1%) of 12 sessions, and 44.1% (485/1099) of patients completed all sessions. The effect size in the whole sample for GAD-7 was large (Cohen d=0.97, 95% CI 0.88-1.06). For completers, effect sizes were very large (Cohen d=1.34, 95% CI 1.25-1.53 for GAD-7; Cohen d=1.14, 95% CI 1.00-1.27 for Penn State Worry Questionnaire; and Cohen d=1.23, 95% CI 1.09-1.37 for Overall Anxiety Severity and Impairment Scale). Noncompleters 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 a baseline GAD-7 score ≥10, approximately 421 (47.1%) achieved reliable recovery. Conclusions This nationwide, free-of-charge, therapist-supported HUS Helsinki University Hospital–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.

Evaluation of an online-based self-help program for patients with generalized anxiety disorder - A randomized controlled trial

“…This effect is comparable to those reported in meta-analytic reviews on iCBT for GAD ( g = 0.79, Eilert et al, 2021 ) and even traditional CBT ( g = 0.84; Cuijpers et al, 2014 ). Also, similar to other iCBT trials (e.g., Ritola et al, 2022 ), effect size seemed to be affected by adherence: Patients with at least 4 of altogether 12 completed modules had an even bigger effect size ( d = 1.24). The robustness of the effect is supported by the effects on worry ( d = 0.47) and anxiety ( d = 0.38).…”

Text Topics and Treatment Response in Internet-Delivered Cognitive Behavioral Therapy for Generalized Anxiety Disorder: Text Mining Study

“…The exclusion criteria are suicidality, acute psychosis, serious personality disorder, and neurological or neuropsychiatric disorders that affect cognitive functioning. For a more detailed description of the treatment, see Ritola et al [ 2 ].…”

“…Internet-delivered cognitive behavioral therapy (iCBT) is an effective treatment for generalized anxiety disorder (GAD) [1][2][3][4]. Additionally, iCBT programs typically store data automatically, which is convenient in terms of computerized text analysis methods, or text mining.…”

“…In this paper, we applied topic modeling to a large, naturalistic set of text data from iCBT for GAD that is offered as a part of public health care in Finland [ 2 ]. As a central element in GAD is worry, we focused on worry diary task sheets that contain patients’ descriptions of their worrisome thoughts.…”

Update on treatments for anxiety-related disorders

“…Internet-delivered treatment for GAD was effective for anxiety, worry, depression, functional impairment and quality of life [48,49]. A meta-analysis showed that internet-delivered cognitive behaviour therapy (ICBT) and face-to-face CBT created similar effects in treating anxiety disorders [50].…”