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Cited by 170Digital Mental Health InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and Assessments

Computer-assisted delivery of cognitive behavioral therapy for anxiety disorders in primary-care settings.

Open access
Craske, Michelle G., Rose, Raphael D., Lang, Ariel, Welch, Stacy Shaw, Campbell-Sills, Laura, Sullivan, Greer, Sherbourne, Cathy, Bystritsky, Alexander +2 more·2009·Depression and Anxiety
DOI 10.1002/da.20542PMC PMC2906395
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Abstract

Objectives: This article describes a computer-assisted cognitive behavioral therapy (CBT) program designed to support the delivery of evidenced-based CBT for the four most commonly occurring anxiety disorders (panic disorder, posttraumatic stress disorder, generalized anxiety disorder, and social anxiety disorder) in primary-care settings. The purpose of the current report is to (1) present the structure and format of the computer-assisted CBT program, and (2) to present evidence for acceptance of the program by clinicians and the effectiveness of the program for patients.Methods: Thirteen clinicians using the computer-assisted CBT program with patients in our ongoing Coordinated Anxiety Learning and Management study provided Likert-scale ratings and open-ended responses about the program. Rating scale data from 261 patients who completed at least one CBT session were also collected.Results: Overall, the program was highly rated and modally described as very helpful. Results indicate that the patients fully participated (i.e., attendance and homework compliance), understood the program material, and acquired CBT skills. In addition, significant and substantial improvements occurred to the same degree in randomly audited subsets of each of the four primary anxiety disorders (N=74), in terms of self ratings of anxiety, depression, and expectations for improvement.Conclusions: Computer-assisted CBT programs provide a practice-based system for disseminating evidence-based mental health treatment in primary-care settings while maintaining treatment fidelity, even in the hands of novice clinicians.

Integrity signals

Registry

Crossref · 10.1002/da.20542

Cites

61 of 61 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

6 of 40 cited sources checked · 3 supported · 1 flagged · accuracy not yet measured

  • Findingown data

    Of 290 patients who completed 12 months since entering the CALM intervention, 261 received at least one CBT session.

    “To date, 290 patients completed 12 months (i.e., the maximum duration of the intervention phase of the study) since they entered the CALM intervention. Of those, 261 received at least one CBT session”
    Quote in the paperNot a substantial claim
  • Findingown data

    Benzodiazepine use significantly moderated changes in self-efficacy expectancies, with F(1,65)=6.1, p<.05, and ES=.10.

    “However, the presence of benzodiazepines, in particular, significantly moderated changes in self efficacy (F(1,65) = 6.1, p < .05, ES = .10).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Mean self-rated understanding of the material was high across modules, ranging from 80.3 to 91.6 on a 0-100 scale.

    “In terms of self rating (0-100 point scale) of understanding the material, mean ratings for each module were as follows: Education, 80.3 (SD=21.4); Calm Recording, 87.2 (SD=12.9); Calm List, 85.4 (SD=14.2); Calm Breathing, 91.6 (SD=9.3); Calm Thinking, 91.4 (SD=9.0); Calm Living, 90.7 (SD=11.9); Calm Feeling, 91.5 (SD=9.8).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Clinicians who used the CALM Tools for Living program rated it very highly.

    “The clinicians (n=13) judged the CALM Tools for Living program very highly.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Change in OASIS scores correlated with patient-rated understanding of the Calm List, Calm Breathing, Calm Living, and Calm Feeling modules.

    “The degree to which OASIS scores changed from the first to the last CBT session correlated with patient ratings of the degree to which they understood the following CALM Tools for Living modules; Calm List, r=.36, p < .05; Calm Breathing, r=.37, p < .05; Calm Living, r = .43, p < .05; and Calm Feeling, r = .44, p < .05.”
    Quote in the paperSubstantial claim
  • May combine two claims. 24
  • Classified as probably not a substantial claim. 15

  • May combine two claims.

    Premisecitation

    Stand-alone computerized CBT is associated with higher drop-out or refusal rates and lower therapy satisfaction than live clinician therapy.

    “However, they are associated with higher rates of drop-out or refusals, and lower rates of satisfaction with therapy, compared to a live clinician (44).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [44] Christensen, 2004, Delivering interventions for depression using the Internet randomized controlled trial, Br Med J source

      In “Findings and their implications” (page unavailable), the paper describes dropout from its internet interventions as remarkably low compared with other interventions, the opposite of the claimed higher dropout. It does not report a direct comparison with live-clinician therapy or measure therapy satisfaction. (LLM, conf=0.78)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    There is good evidence that medication and CBT are efficacious for anxiety disorders.

    “There is good evidence for the efficacy of medication (3, 4) and cognitive behavioral therapy (CBT) (5, 6).”
    Quote in the paperSubstantial claim1 of 4 sources checked
    • cites [3] Stein, 2005

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [4] Roy-Byrne, 2007 source
    • cites [5] Norton, 2007, A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders, J Nerv Ment Dis source
    • cites [6] Butler, 2006, The empirical status of cognitive-behavioral therapy: a review of meta-analyses, Clin Psychol Rev source

  • May combine two claims.

    Premisecitation

    Collaborative care has been tested extensively in primary care for depression and less extensively for panic disorder and generalized anxiety disorder.

    “The collaborative care approach has been tested extensively in primary care settings for depression (14,15,16,17) and, to a lesser extent, panic disorder (18, 20) and GAD (19).”
    Quote in the paperNot a substantial claim1 of 7 sources checked
    • cites [14] Katon, 2006, Incremental cost-effectiveness of a collaborative care intervention for panic disorder, Psychol Med source
    • cites [15] Wells, 2000, Impact of disseminating quality improvement programs for depression in managed primary care: a randomized controlled trial, J Am Med Assoc source
    • cites [16] Simon, 2002, Cost-effectiveness of a program to prevent depression relapse in primary care, Med Care source
    • cites [17] Unutzer, 2001, Two-year effects of quality improvement programs on medication management for depression, Arch Gen Psychiatry source
    • cites [18] Roy-Byrne, 2001, A randomized effectiveness trial of collaborative care for patients with panic disorder in primary care, Arch Gen Psychiatry source
    • cites [20] Rollman, 2005, A randomized trial to improve the quality of treatment for panic and generalized anxiety disorders in primary care, Arch Gen Psychiatry source
    • cites [19] Roy-Byrne, 2005, A randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder, Arch Gen Psychiatry source

  • May combine two claims.

    Premisecitation

    Stand-alone computerized CBT is generally acceptable and effective for depression and anxiety, including specific anxiety disorders.

    “Stand-alone (i.e., without clinician involvement) computerized versions of CBT are well researched, and have been shown to be generally acceptable to patients and effective in treating depression and anxiety (34,35), as well as specific anxiety disorders, including PD (36,37,38), SAD (39,40), PTSD (41), and obsessive compulsive disorder (42,43).”
    Quote in the paperSubstantial claim1 of 7 sources checked
    • cites [34] Gega, 2004, Computer-aided CBT self-help for anxiety and depressive disorders: experience of a London clinic and future directions, J Consult Clin Psychol source
    • cites [35] Proudfoot, 2003, Computerized, interactive, multimedial cognitive behavioural program for anxiety and depression in general practice, Psychol Med source
    • cites [36] Carlbring, 2006, Remote treatment of panic disorder: a randomized trial of Internet-based cognitive behavior therapy supplemented with telephone calls, Am J Psychiatry source

      The Discussion (page not provided) reports that Internet-based CBT with therapist e-mail contact and weekly telephone calls was effective for panic disorder. It does not establish effectiveness without clinician involvement; the study also does not establish general acceptability or effectiveness across depression and anxiety disorders. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
    • cites [37] Carlbring, 2005, Treatment of panic disorder: live therapy vs. self-help via the Internet, Behav Res Ther source
    • cites [38] Richards, 2003, Internet-based treatment for panic disorder, Cogn Behav Ther source
    • cites [39] Botella, 2004, A self-applied, Internet-based intervention for fear of public speaking, J Clin Psychol source
    • cites [40] Carlbring, 2006, An open study of Internet-based bibliotherapy with minimal therapist contact via email for social phobia, Clin Psychol source

  • May combine two claims.

    Premisecitation

    Computer-assisted programs have been used in training clinicians in CBT but had not previously been used for ongoing assistance in delivering CBT.

    “Computer-assisted programs already have been used in training clinicians in CBT (32, 33), but they have not before been used for ongoing assistance for delivery of CBT.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [32] Carroll, 2007, A vision of the next generation of behavioral therapies research in the additcions, Addiction source
    • cites [33] Gega, 2007, Computer-aided vs. tutor-delivered teaching of exposure therapy for phobia/panic: randomized controlled trial with pre-registration nursing students, Int J Nurs Stud source
    • Rests on an assumption: Computer-assisted programs had not previously been used for ongoing assistance in delivering CBT.

  • May combine two claims.

    Premisecitation

    Computerized CBT programs are more acceptable and more successful when clinician involvement is offered.

    “In contrast, computerized programs are more acceptable and more successful when clinician involvement is offered (37,43,38,45).”
    Quote in the paperSubstantial claim1 of 4 sources checked
    • cites [37] Carlbring, 2005, Treatment of panic disorder: live therapy vs. self-help via the Internet, Behav Res Ther source
    • cites [43] Kenwright, 2005, Brief scheduled phone support from a clinician to enhance computer-aided self-help for obsessive-compulsive disorder: randomized controlled trial, J Clin Psychol source
    • cites [38] Richards, 2003, Internet-based treatment for panic disorder, Cogn Behav Ther source
    • cites [45] Spek, 2007, Internet-based cognitive behavioural therapy for symptoms of depression and anxiety: a meta-analysis, Psychol Med source

      The supplied passages labeled Abstract contain bibliographic information, not findings about clinician involvement. Searches of our indexed copy for therapist support, acceptability, and effects returned no relevant passage, so it cannot verify either part of the claim. (LLM, conf=0.72)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    Changes in expectancies for treatment success were not moderated by targeted anxiety disorder, any psychotropic medication, or benzodiazepines.

    “These changes were not moderated by type of anxiety disorder targeted (F(3,65) = .97, ns) or presence of any psychoptropic medication (F(1,65) = 1.56, ns) or, particularly, benzodiazepines (F(1,65) = 3.1, ns).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Clinicians identified simplification of language, less text, removal of redundancy, and greater flexibility as areas needing improvement.

    “Clinicians noted areas for improvement, including simplification of the language, reduction in the amount of text and elimination of redundancy, and greater flexibility.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Mean clinician ratings on four additional 1-7 Likert items were 6.15 for ease of use, 5.39 for ease of patient language understanding, 5.69 for patients' overall opinion, and 6.08 for clinicians' overall opinion.

    ““How easy was it for you to use the computer program?”, 6.15 (SD=0.69); “How easy was the language used in the program for your patients to understand?”, 5.39 (SD=0.77); “What was your patients' overall opinion of the computer program?”, 5.69 (SD=1.25); and “What was your overall opinion of the computer program?”, 6.08 (SD=0.95).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Self-efficacy expectancies increased significantly from the first to the last session, with F(1,65)=3.92, p=.05, and ES=.06.

    “The same was the case for expectancies for being able to carry out the requirements of treatment, which increased significantly, F(1, 65) = 3.92, p = .05, ES = .06.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Self-efficacy increased from the first to the last session for patients not taking benzodiazepines but did not significantly change for those taking benzodiazepines.

    “Self efficacy increased from the first to last session for those not taking benzodiazepines (t (52) = -3.59, p < .01), whereas it did not significantly change for those taking benzodiazepines (t(19) = .77, ns).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    PHQ depression score changes were not moderated by targeted anxiety disorder, any psychotropic medication, or benzodiazepines.

    “and were not moderated by the type of anxiety disorder targeted in CBT (F(3,65) = .56, ns) or the presence of any psychotropic medication (F(1,65) = 1.0, ns) or, in particular, benzodiazepines (F91,65) = .33, ns).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Among the 261 patients who received CBT, 53.6% were taking antidepressants, 27.6% benzodiazepines, 18% other psychotropic medications, and 69.7% one or more medications.

    “of these, 53.6% were taking antidepressants, 27.6% benzodiazepines, and 18% other psychotropic medications. 69.7% were taking one or more medications”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    OASIS change did not correlate with understanding ratings for Education, Calm Recording, or Calm Thinking, nor with quiz performance for any module.

    “Other module ratings of understanding (i.e., Education, Calm Recording, and Calm Thinking) did not correlate with outcomes. Also, outcomes did not correlate with quiz performance for any module, possibly due to the truncated range of scores.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In hierarchical regression, only patient-rated understanding of the Calm Living module predicted final-session OASIS scores, contributing 21% unique variance, R2=.21, Beta=-.48, p<.05.

    “Only patient rated understanding of the Calm Living module predicted final session OASIS scores, even after controlling for all other variables. Understanding contributed 21% unique variance, R2 = .21, Beta = -.48, p < .05.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Patient engagement in the CALM Tools for Living program was substantial and did not vary by the targeted anxiety disorder.

    “Of the 261 patients who received at least one CBT session, engagement in the CALM Tools for Living program was substantial and did not vary based on the specific anxiety disorder targeted.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Patients practiced in vivo exposure to feared situations an average of 4.2 times and exposure to feared memories, images, or sensations an average of 4.1 times, with no differences across the four anxiety disorder targets.

    “The corresponding numbers were 4.2 times (SD=3.5) for in vivo exposure practices to feared situations, and 4.1 times (SD=1.6) for exposure to feared memories, images or physical sensations, again with no differences across the four anxiety disorder targets.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based). May combine two claims.

    Findingown data

    Changes in self-efficacy expectancies were not moderated by targeted anxiety disorder or any psychotropic medication.

    “Increases again were not moderated by the anxiety disorder targeted (F(3,65) = .31, ns) or the presence of any psychotropic medication (F(1,65) = .55, ns).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    In open-ended responses, clinicians named the program's clear session agenda, overall structure, easy CBT guide, comprehensive information, individualized print workbooks, skill videos, and interactivity as strengths.

    “clinicians appreciated the way in which the program provided a clear agenda per session and overall structure, as well as an easy-to-use guide for CBT concepts. They also cited the comprehensiveness of the information, the print functions for creating individualized-patient “workbooks”, the video demonstrates of specific skills, and the interactive nature of the program as strengths”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The anxiety management clinicians had some patient care experience, but only 7 had prior mental health care experience, and none had expertise in anxiety management or CBT.

    “Anxiety management clinicians who delivered the intervention (n=13) had some patient care experience (although only 7 had prior mental health care experience) and some exposure to primary care settings, but without expertise in anxiety management or CBT.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    User-friendliness of interventions is believed to be central to successful implementation.

    “The “user-friendliness” of these interventions is believed to be central to successful implementation (21)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Pincus, 2006, Depression in primary care: learning lessons in a Narional Quality Improvement program, Adm Policy Ment Health Ment Health Serv Res source

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    The computer-assisted CBT program is designed to facilitate delivery and maintain CBT fidelity by novice clinicians.

    “Thus, our computer-assisted CBT is designed to facilitate delivery and to maintain fidelity of CBT by novice clinicians.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    During computer-assisted CBT, clinicians maintain focus on the primary anxiety disorder, which in many cases will help ameliorate comorbid anxiety and mood disorders.

    “During computer-assisted CBT, clinicians maintain focus on the primary anxiety disorder, which in many cases will help to ameliorate comorbid anxiety and mood disorders.”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [25] Brown, 1995, Long-term outcome in cognitive-behavioral treatment of panic disorder: clinical predictors and alternative strategies for assessment, J Consult Clin Psychol source
    • cites [26] Tsao, 1998, The effects of cognitive-behavioral therapy for panic disorder on comorbid conditions, J Anxiety Disord source
    • cites [27] Tsao, 2002, Effects of cognitive-behavioral therapy for panic disorder on comorbid conditions: replication and extension, Behav Ther source
    • cites [28] Tsao, 2005, Impact of cognitive-behavioral therapy for panic disorder on comorbidity: a controlled investigation, Behav Res Ther source
    • cites [29] Borkovec, 1995, Effects of psychotherapy on comorbid conditions in generalized anxiety disorder, J Consult Clin Psychol source
    • cites [30] Stanley, 1996, Treatment of generalized anxiety disorder in older adults: a preliminary comparison of cognitive-behavioral and supportive approaches, Behav Ther source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    Providing on-line guidance may keep novice clinicians on task and thereby maintain CBT integrity.

    “By providing on-line guidance, the computer assisted program may keep novice clinicians on task and thereby maintain CBT integrity.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Patients entering the CALM study were randomized to treatment as usual or to the collaborative care intervention.

    “Patients who entered the CALM study were randomized to either treatment as usual or our collaborative care intervention.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Symptom and expectancy analyses used randomly selected subsets for GAD, SAD, and panic disorder and all PTSD patients.

    “Self reported levels of anxiety and depression symptoms as well as expectancies for improvement were evaluated across randomly selected subsets whose treatment targeted generalized anxiety disorder (n=20), social anxiety disorder (n=20) and panic disorder (n=20), and all patients whose treatment targeted posttraumatic stress disorder (n=14).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    Eligible patients met diagnostic criteria for GAD, SAD, panic disorder, or PTSD as determined by the MINI Version 5.0 and scored at least 8 on the OASIS.

    “Eligible patients were at least 18 years old, met diagnostic criteria for generalized anxiety disorder, social anxiety disorder, panic disorder or posttraumatic stress disorder (as determined through administration of the Mini International Neuropsychiatric Interview (MINI; Version 5.0) (46).”
    • Also stated in: § Participants · plain
      “patients had to score at least 8 on a scale from 0 to 20 (indicative of moderate or greater severity) on the Overall Anxiety Severity and Impairment Scale (OASIS)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [46] Lecrubier, 1997, The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI, Eur Psychiatry source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Clinician training included readings, five days of workshops, role-plays, two to four training cases with proficiency evaluation by expert psychologists, and ongoing weekly group supervision by an expert psychologist.

    “clinicians took on two to four “training cases” and their proficiency at delivering CBT was evaluated by expert psychologists.”
    • Also stated in: § Participants · plain
      “clinicians delivering the program received on-going group supervision for approximately one hour per week from an expert psychologist.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Each module ended with an assessment including self ratings of understanding, multiple-choice quizzes, and clinician ratings of demonstrated skill acquisition to assess understanding and competency.

    “An assessment at the end of each module includes self ratings of understanding, multiple choice quizzes, and clinician ratings of the patient's demonstrated skill acquisition and is designed to assess understanding of and competency with the material.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The OASIS has been shown to be internally consistent and to have good convergent and discriminant validity.

    “which we have shown to be internally consistent and to possess good convergent and discriminant validity.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The hierarchical regression controlled for first-session OASIS scores, type of anxiety disorder, number of sessions attended, and first-session self-efficacy and outcome expectancies.

    “first session OASIS scores were entered on Step I, type of anxiety disorder targeted and number of sessions attended were entered on Step II, self efficacy and outcome expectancies at the first session were entered on Step III, and patient rated understanding of the module that most highly correlated with outcomes (i.e., Calm Living) was tested on Step IV.”
    Quote in the paperSubstantial claim
31 of 31

  • The paper relies on this without support.

    The evidence for medication and CBT efficacy is based mostly on studies conducted in clinical research settings.

    “However, the evidence is based mostly on studies in clinical research settings.”

  • The paper relies on this without support.

    Adapting evidence-based treatments to real-world settings remains a challenge, and service delivery models are needed to support their application.

    “Adapting the delivery of these treatments to real world settings remains a challenge and there is a need for service delivery models to support the application of these evidence-based treatments.”

  • The authors state this as an assumption.

    Comorbid anxiety and mood disorders are presumed to improve when treatment focuses on the most distressing and impairing anxiety disorder.

    “Comorbid anxiety as well as mood disorders (22,23,24) are presumed to improve as a result of this focused attention”

  • The paper relies on this without support.

    Computer-assisted programs had not previously been used for ongoing assistance in delivering CBT.

    “but they have not before been used for ongoing assistance for delivery of CBT.”

  • The authors state this as an assumption.

    It is reasonable to assume that the computer-assisted program involving a clinician would improve outcomes relative to a self-directed version of CALM Tools for Living.

    “Hence, it is reasonable to assume that our computer-assisted program involving a clinician would also improve outcomes relative to a self-directed version of CALM Tools for Living.”

  • The paper relies on this without support.

    The core elements of CBT are the same across the four anxiety disorders addressed by the program.

    “In this program, the core elements of CBT are the same across the four anxiety disorders, whereas other elements are tailored to the features unique to each anxiety disorder through branching mechanisms.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The CBT protocol focused on anxiety symptoms and did not specifically address sleep complaints.

    “The primary focus of the CBT protocol, which has been described elsewhere (Craske et al., 2009), was on anxiety symptomatology; sleep complaints were not specifically addressed in the protocol.”

    From Sleep Quality Improvement During Cognitive Behavioral Therapy for Anxiety Disorders (2016) · cites this paper as Craske et al., 2009

    The Discussion (page unavailable) says clinicians maintain focus on the primary anxiety disorder, supporting the stated focus of the CBT protocol. The Results’ module list (page unavailable) does not include a sleep-specific module, but the copy does not explicitly establish that sleep complaints were not specifically addressed anywhere in the protocol. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • A variety of self-directed or minimal intervention formats have demonstrated significant improvements in anxiety symptoms.

    “In addition, a variety of self-directed or minimal intervention formats (e.g., bibliotherapy/self-help books, or internet/ computer-based programs with or without minimal therapist contact) have demonstrated significant improvements in anxiety symptoms [74-79].”

    From Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders (2014) · cites this paper as [77]

    The Results (Patient Symptom Data; page not provided) report significant improvement in anxiety symptoms with a computer-assisted CBT program. The paper also describes stand-alone computerized CBT as effective for anxiety, but its own program involved a clinician throughout treatment; the cited passages do not establish the claim for bibliotherapy or other minimal-intervention formats. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Previous studies have combined computerized manuals with face-to-face treatment, used technological adjuncts in therapy, or used the Internet after treatment completion to help prevent relapse.

    “Previous studies have combined computerized manuals with face-to-face treatment [20,21], used technological adjuncts in therapy [22], or used the Internet after treatment completion to help prevent relapse [23,24].”

    From Development and initial evaluation of an Internet-based support system for face-to-face cognitive behavior therapy: a proof of concept study (2013) · cites this paper as [20]

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • ConsistentF(3, 74) = 0.1reported n.s. · recomputed p = .960

    “F(3, 74) = .10, ns”

  • ConsistentF(1, 66) = 56.3reported p < .001 · recomputed p < .001

    “F(1, 66) = 56.3, p < .001”

  • ConsistentF(3, 66) = 0.59reported n.s. · recomputed p = .624

    “F(3,66) = .59, ns”

  • ConsistentF(1, 66) = 0.58reported n.s. · recomputed p = .449

    “F(1,66) = .58, ns”

  • ConsistentF(1, 65) = 33.3reported p < .001 · recomputed p < .001

    “F(1, 65) = 33.3, p < .001”

  • ConsistentF(3, 65) = 0.56reported n.s. · recomputed p = .643

    “F(3,65) = .56, ns”

  • ConsistentF(1, 65) = 1reported n.s. · recomputed p = .321

    “F(1,65) = 1.0, ns”

  • ConsistentF(1, 65) = 27.5reported p < .001 · recomputed p < .001

    “F (1, 65) = 27.5, p < .001”

  • ConsistentF(3, 65) = 0.97reported n.s. · recomputed p = .412

    “F(3,65) = .97, ns”

  • ConsistentF(1, 65) = 1.56reported n.s. · recomputed p = .216

    “F(1,65) = 1.56, ns”

  • ConsistentF(1, 65) = 3.1reported n.s. · recomputed p = .083

    “F(1,65) = 3.1, ns”

  • ConsistentF(1, 65) = 3.92reported p = .05 · recomputed p = .052

    “F(1, 65) = 3.92, p = .05”

  • ConsistentF(3, 65) = 0.31reported n.s. · recomputed p = .818

    “F(3,65) = .31, ns”

  • ConsistentF(1, 65) = 0.55reported n.s. · recomputed p = .461

    “F(1,65) = .55, ns”

  • ConsistentF(1, 65) = 6.1reported p < .05 · recomputed p = .016

    “F(1,65) = 6.1, p < .05”

  • Consistentt(52) = -3.59reported p < .01 · recomputed p < .001

    “t (52) = -3.59, p < .01”

  • Consistentt(19) = 0.77reported n.s. · recomputed p = .451

    “t(19) = .77, ns”

17 of 17

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Attendance analysis degrees of freedom do not match the stated group

    Minor

    The text presents the attendance comparison as applying to the 261 patients. For a conventional four-group ANOVA, F(3, 74) corresponds to 78 patients, leaving the smaller analysis sample unexplained.

    Reported 261 · recomputed 78

  • Calm Living is incorrectly identified as the strongest correlation

    Minor

    Calm Feeling has the larger reported correlation with OASIS change (.44 versus .43 for Calm Living), but the regression description calls Calm Living the most highly correlated module.

  • Scale minimum conflicts with item ratings

    Minor

    Five items each rated from 1 to 4 have a minimum total of 5, not 0.

    Reported 0 · recomputed 5

3 of 3

Cites

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1 of the 62 references couldn’t be matched to a known paper.

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Authors
Craske, M. G., Rose, R. D., Lang, A., Welch, S. S., Campbell-Sills, L., Sullivan, G., Sherbourne, C., Bystritsky, A., Stein, M. B., & Roy-Byrne, P. P.
Affiliations
  • University of California, Los Angeles (US)
  • University of California San Diego (US)
  • RAND Corporation (US)
Corresponding author
Craske, Michelle G.
ORCID
Venue
Depression and Anxiety
Publisher
Hindawi Limited
Published
2009-03
Volume
26
Issue
3
Pages
235-242
ISSN
  • 1091-4269 (ISSN-L)
  • 1520-6394
DOI
10.1002/da.20542
PMC
PMC2906395
OpenAlex
W2140643819
Cited by
170
References
62
Citations by year
2026: 2 · 2025: 1 · 2024: 1 · 2023: 3 · 2022: 4 · 2021: 8 · 2020: 6 · 2019: 9 · 2018: 10 · 2017: 17 · 2016: 8 · 2015: 9 · 2014: 18 · 2013: 23 · 2012: 15
FWCI
19.81
Type
journal article
Language
en
Open access
Licence
Locations
  • Depression and Anxiety (publishedVersion, public-domain)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health
  • National Institute of Mental Health (U01MH057835, MH065324, MH-64122, K24MH065324, UO1 MH057858, K24MH064122, MH058915, MH057858, U01MH070022, U01MH070018, U01MH057858, MH070022, U01MH058915, MH057835)
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
Keywords
anxiety disorders, primary care, dissemination of evidence-based treatment, intervention fidelity, panic disorder, post-traumatic stress disorder, generalized anxiety disorder, social anxiety disorder, clinician acceptance, patient satisfaction, homework compliance
MeSH terms
Adult, Anxiety Disorders, Major Depressive Disorder, Female, Humans, Middle Aged, Patient Compliance, Primary Health Care, Surveys and Questionnaires, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, In Vitro Techniques

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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