Self-help treatment of anxiety disorders: A meta-analysis and meta-regression of effects and potential moderators

Abstract

Self-help treatments have the potential to increase the availability and affordability of evidence-based treatments for anxiety disorders. Although promising, previous research results are heterogeneous, indicating a need to identify factors that moderate treatment outcome. The present article reviews the literature on self-help treatment for anxiety disorders among adults, with a total sample of 56 articles with 82 comparisons. When self-help treatment was compared to wait-list or placebo, a meta-analysis indicated a moderate to large effect size (g=0.78). When self-help treatment was compared to face-to-face treatment, results indicated a small effect that favored the latter (g=-0.20). When self-help was compared to wait-list or placebo, subgroup analyses indicated that self-help treatment format, primary anxiety diagnosis and procedures for recruitment of subjects were related to treatment outcome in bivariate analyses, but only recruitment procedures remained significant in a multiple meta-regression analysis. When self-help was compared to face-to-face treatment, a multiple meta-regression indicated that the type of comparison group, treatment format and gender were significantly related to outcome. We conclude that self-help is effective in the treatment of anxiety disorders, and should be offered as part of stepped care treatment models in community services. Implications of the results and future directions are discussed.

Stepped care versus face-to–face cognitive behavior therapy for panic disorder and social anxiety disorder: Predictors and moderators of outcome

“…The results indicated patients without a comorbid depressive disorder had better outcomes from FtF-CBT compared to guided self-help, but there were no differences in the outcome between the two treatment conditions for patients with a comorbid depression. Previous research results are equivocal but indicate a trend toward a negative association between depression and outcome for both guided self-help and face-to-face CBT for anxiety disorders (Allen et al, 2010;Brown et al, 1995;Chambless et al, 1997;Eskildsen et al, 2010;Hedman et al, 2012;McCabe & Gifford, 2008;Nordgreen et al, 2012;Nordgreen et al, 2010). We did find a similar effect on the self-reported outcome for the Immediate FtF-CBT condition but not for guided self-help, and as mentioned only differences in effect of the treatments among the patients with no comorbid depression.…”

“…Some studies have indicated that lower age and longer duration of the disorder (Nordgreen et al, 2010) and the presence of cluster C personality disorders (Andersson, Carlbring, & Grimund, 2008) are associated with a worse outcome of ICBT for PD. Hedman et al (2012) reported that comorbid anxiety and depression were related to a worse outcome of ICBT for SAD, whereas another study did not find this association (Nordgreen et al, 2012). Thus, the most consistent findings in the research literature on non-specific predictors indicate that patients with more intense primary symptoms and comorbid disorders have a poorer end state from FtF-CBT of PD and SAD, but the results are in general equivocal and inconclusive, particularly for predictors of improvement from treatment.…”

“…Contact with a therapist is minimal and only facilitative or supportive in nature (Cuijpers & Schuurmans, 2007). In particular CBT-based self-help programs delivered over the internet (ICBT) have reported promising findings (Haug et al, 2012). This is reflected in the clinical guidelines for the treatment of anxiety disorders where CBT in the format of FtF-CBT or as guided self-help is the treatment of choice for a wide range of anxiety disorders (NICE, 2011a(NICE, , 2011b(NICE, , 2013.…”

“…The effects of cognitive behavioral therapy (CBT) are documented for both panic disorder (PD) and social anxiety disorder (SAD) when CBT is delivered as face-to-face (Butler, Chapman, Forman, & Beck, 2006;Hofmann & Smits, 2008;Norton & Price, 2007;Olatunji, Cisler, & Deacon, 2010) and as guided self-help (Haug, Nordgreen, € Ost, & Havik, 2012). In guided self-help patients receive a CBT protocol through e.g.…”

The evaluation of a continuing professional development package for primary care dentists designed to reduce stress, build resilience and improve clinical decision-making

“…Key positive points included; easy to read, author understands with compassion, practical steps provided, includes real vignettes or interviews, and author has been through anxiety. Bibliotherapy can be almost as effective as face-to-face therapy with a counsellor or psychologist 63 and should therefore be more cost effective than a programme with intensive face-to-face contact. Also, the self-help format allows practitioners to access help without losing clinical time.…”