Clinical and Cost-Effectiveness of Therapist-Guided Internet-Delivered Cognitive Behavior Therapy for Older Adults With Symptoms of Anxiety: A Randomized Controlled Trial

Dear, Blake F.; Zou, Judy B.; Ali, Shehzad; Lorian, Carolyn N.; Johnston, Luke; Sheehan, Joanne; Staples, Lauren G.; Gandy, Milena; Fogliati, Vincent J.; Klein, Britt; Titov, Nickolai

doi:10.1016/j.beth.2014.09.007

Cited by 109Digital Mental Health InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesTelemedicine and Telehealth Implementation

Clinical and Cost-Effectiveness of Therapist-Guided Internet-Delivered Cognitive Behavior Therapy for Older Adults With Symptoms of Anxiety: A Randomized Controlled Trial

Dear, Blake F., Zou, Judy B., Ali, Shehzad, Lorian, Carolyn N., Johnston, Luke, Sheehan, Joanne, Staples, Lauren G., Gandy, Milena +3 more·2015·Behavior Therapy

DOI 10.1016/j.beth.2014.09.007

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Abstract

Unlabelled There is preliminary support for internet-delivered cognitive behaviour therapy (iCBT) as a way of improving access to treatment among older adults with anxiety. The aim of this randomized controlled trial (RCT) was to examine the efficacy, long-term outcomes, and cost-effectiveness of an iCBT program for adults over 60 years of age with anxiety. Successful applicants were randomly allocated to either the treatment group (n=35) or the waitlist control group (n=37). The online treatment course was delivered over 8 weeks and provided with brief weekly contact with a clinical psychologist via telephone or secure email. Eighty-four percent of participants completed the iCBT course within the 8 weeks and 90% provided data at posttreatment. Significantly lower scores on measures of anxiety (Cohen's d=1.43; 95% CI: 0.89 - 1.93) and depression (Cohen's d=1.79; 95% CI: 1.21 - 2.32) were found among the treatment group compared to the control group at posttreatment. These lower scores were maintained at 3-month and 12-month follow-up and the treatment group rated the iCBT treatment as acceptable. The treatment group had slightly higher costs ($92.2; 95% CI: $38.7 to $149.2) and Quality-Adjusted Life-Years (QALYs=0.010; 95% CI: 0.003 to 0.018) than the control group at posttreatment and the intervention was found to have a greater than 95% probability of being cost-effective. The results support iCBT as an efficacious and cost-effective treatment option for older adults with symptoms of anxiety.Trial registration Trial registration Australian and New Zealand Clinical Trials Registry: ACTRN12611000929909; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000929909.

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To date, only one study has examined an online intervention for older adults with anxiety symptoms.
“To date, only one study has examined an online intervention for older adults with anxiety symptoms.”
From An Internet-based Acceptance and Commitment Therapy intervention for older adults with anxiety complaints: study protocol for a cluster randomized controlled trial. (2018) · cites this paper as [26]
Internet-delivered cognitive behavioral therapy was an efficacious and cost-effective treatment for older adults with subclinical anxiety.
“This randomized controlled trial (RCT) found that Internet-delivered cognitive behavioral therapy (CBT) was an efficacious and cost-effective treatment for older adults with subclinical anxiety [26].”
From An Internet-based Acceptance and Commitment Therapy intervention for older adults with anxiety complaints: study protocol for a cluster randomized controlled trial. (2018) · cites this paper as [26]
Compensating for an anticipated dropout of 25%, 240 participants will have to be included at baseline.
“Compensating for an anticipated dropout of 25% (based on trials similar to the proposed study with regard to either the treatment approach [40, 54] or the study population [26]), 240 participants will have to be included at baseline.”
From An Internet-based Acceptance and Commitment Therapy intervention for older adults with anxiety complaints: study protocol for a cluster randomized controlled trial. (2018) · cites this paper as [26]
The effect sizes for CBT in the Cochrane meta-analysis were smaller than the large effect size for Internet-based CBT for anxiety complaints in older adults, 1.43, in the study of Dear et al.
“These effects were somewhat smaller than those reported in other recent reviews [17, 19–22] and also smaller than the large effect sizes for Internet-based ACT (0.80 and 0.87) in the study of Fledderus et al. [40] and for Internet-based CBT for anxiety complaints in older adults (1.43) in the study of Dear et al. [26].”
From An Internet-based Acceptance and Commitment Therapy intervention for older adults with anxiety complaints: study protocol for a cluster randomized controlled trial. (2018) · cites this paper as [26]
Web-based CBT modules combined with guidance from a clinician are effective in reducing anxiety symptom severity in older adults with heterogeneous anxiety symptomatology.
“To date, studies in older adults with heterogeneous anxiety symptomatology have found web-based CBT modules combined with guidance from a clinician to be effective in reducing symptom severity [12-15].”
From Blended Acceptance and Commitment Therapy Versus Face-to-face Cognitive Behavioral Therapy for Older Adults With Anxiety Symptoms in Primary Care: Pragmatic Single-blind Cluster Randomized Trial. (2021) · cites this paper as [15]

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“D 25.25 (9.7) ‐ ‐ Dahlin et al. (2016) GAD‐7 13.67 (3.9) PHQ‐9 11.29 (4.78) PSWQ 67.17 (6.97) Dear et al. (2015) GAD‐7 12.26 (4.83) PHQ‐9 10.86 (4.37) ‐ ‐ Hirsch et al. (2018) GAD‐7 14.28 (3.32) PHQ‐9 13.14 (4.19) PSWQ 68.29 (6.38) Johansson et al. (2013) GAD‐7 12.67 (3.18) PHQ‐9 13.3 (3.74) ‐ ‐ L.…”
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The pain course: a randomised controlled trial comparing a remote-delivered chronic pain management program when provided in online and workbook formats
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“To date, studies in older adults with heterogeneous anxiety symptomatology have found web-based CBT modules combined with guidance from a clinician to be effective in reducing symptom severity [12-15].”
A randomized controlled trial of internet-delivered cognitive behaviour therapy to prevent the development of depressive disorders in older adults with multimorbidity.
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eHealth Applications to Support Independent Living of Older Persons: Scoping Review of Costs and Benefits Identified in Economic Evaluations
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Cost-effectiveness and cost-utility of an Acceptance and Commitment Therapy intervention vs. a Cognitive Behavioral Therapy intervention for older adults with anxiety symptoms: A randomized controlled trial
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Engaging Adults With Chronic Disease in Online Depressive Symptom Self-Management
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An Internet-based Acceptance and Commitment Therapy intervention for older adults with anxiety complaints: study protocol for a cluster randomized controlled trial.
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Benefits of Digital Mental Health Care Interventions for Correctional Workers and Other Public Safety Personnel: A Narrative Review
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Internet-delivered psychological interventions for older adults with depression: A scoping review
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Psychometric properties of worry and anxiety measures in a sample of african american and caucasian older adults
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Anxiety Disorders in Late Life
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Effectiveness of digital intelligence interventions on depression and anxiety in older adults: A systematic review and meta-analysis.
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Nature-based mindfulness-compassion programs using virtual reality for older adults: A narrative literature review
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Efficacy of low intensity interventions for geriatric depression and anxiety – A systematic review and meta-analysis
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Efficacy of virtual interventions for reducing symptoms of depression in community-dwelling older adults: a systematic review
Goodarzi, Z., Holroyd-Leduc, J., Seitz, D., Ismail, Z., Kirkham, J., Wu, P., Fox, L., Hykaway, W., Grossman, L., Ewa, V., et al. (2022) · International Psychogeriatrics · doi:10.1017/s1041610222000412 · Cited by 14 · see citing works
Challenges and opportunities for e-mental health policy: an Estonian case study
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Effectiveness of information technology-based cognitive behavioral therapy on depression and anxiety symptoms among older adults: Systematic review and meta-analysis.
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The efficacy of internet-based cognitive behavioral therapy for adult binge spectrum eating disorders: A meta-analysis
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Remote cognitive behavioral therapy for older adults with anxiety symptoms: A systematic review and meta-analysis
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The Effectiveness of Cognitive Behavioral Therapy With Mindfulness and an Internet Intervention for Obesity: A Case Series
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Cost-utility analysis of telephone-based cognitive behavior therapy in chronic obstructive pulmonary disease (COPD) patients with anxiety and depression comorbidities: an application for willingness to accept concept
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“Two recently published articles [44,45] showed that”
Online group psychodynamic psychotherapy—The effectiveness and role of attachment—The results of a short study
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Economic evaluation of a home-based programme to reduce concerns about falls in frail, independently-living older people
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Systematic Review of the Clinical Application of Exposure Techniques to Community-Dwelling Older Adults with Anxiety
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Web-Based Interventions to Help Australian Adults Address Depression, Anxiety, Suicidal Ideation, and General Mental Well-being: Scoping Review
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“A rapid review of the evidence for each of these programs’ evaluations is provided in Multimedia Appendix 4 [10,12,17,42-151].”
BackgroundInfluential
Leveraging digital technology to intervene on personality processes to promote healthy aging.
Marsch, L. A., Hegel, M. T., & Greene, M. A. (2019) · Personality Disorders Theory Research and Treatment · doi:10.1037/per0000275 · Cited by 9 · see citing works
Technology-based mental health assessment and intervention
Gould, C. E., Ma, F., Loup, J. R., Juang, C., Sakai, E. Y., & Pepin, R. L. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-800136-3.00024-7 · Cited by 9 · see citing works
The effects of a psychological intervention directed at optimizing immune function: study protocol for a randomized controlled trial
Schakel, L., Veldhuijzen, D. S., van Middendorp, H., Prins, C., Joosten, S. A., Ottenhoff, T. H. M., Visser, L. G., & Evers, A. W. M. (2017) · Trials · doi:10.1186/s13063-017-1983-7 · Cited by 8 · see citing works
Economic evaluation of remote patient monitoring and organizational analysis according to patient involvement: a scoping review
Goff-Pronost, M. L., & Bongiovanni-Delarozière, I. (2023) · International Journal of Technology Assessment in Health Care · doi:10.1017/s0266462323002581 · Cited by 9 · see citing works
Behavioural and psychological telehealth support for people with cardiac conditions: randomized trial of the ‘back on track’ self-management programme
Rogerson, M. C., Jackson, A. C., Navaratnam, H. S., Grande, M. R. L., Higgins, R. O., Clarke, J., & Murphy, B. M. (2023) · European Journal of Cardiovascular Nursing · doi:10.1093/eurjcn/zvad034 · Cited by 8 · see citing works
Tailored multifactorial intervention to improve dizziness symptoms and quality of life, balance and gait in dizziness sufferers aged over 50 years: protocol for a randomised controlled trial
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Cost Effectiveness of Digital Interventions for Generalised Anxiety Disorder: A Model-Based Analysis
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Couples Therapy Delivered Through Videoconferencing: Effects on Relationship Outcomes, Mental Health and the Therapeutic Alliance
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Acceptability and effectiveness study of therapist-assisted internet-delivered cognitive behaviour therapy for agriculture producers
Beck, C. D., Peynenburg, V. A., Patterson, T., Titov, N., Dear, B. F., & Hadjistavropoulos, H. D. (2024) · Internet Interventions · doi:10.1016/j.invent.2024.100709 · Cited by 5 · see citing works
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CBT-based self-help guided by a lay provider for generalized anxiety in older adults: A randomized controlled trial.
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Anxiety Disorders in Later Life
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Self-help guided by trained lay providers for generalized anxiety disorder in older adults: study protocol for a randomized controlled trial
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Advances in the Psychological Management of Older Adult Mental Health
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Leveraging Aging Service Providers to Support Internet-Based Cognitive Behavioral Therapy for Depression in Homebound Older Adults: Protocol for a Type 1 Hybrid Effectiveness-Implementation Randomized Controlled Trial
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Neuroscience-based approaches in chronic pain management: integration of mind-body interventions in rehabilitation
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The Use of Technology to Augment Clinical Care in Depression and Anxiety Disorders: An Evidence Map
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Effectiveness of web-based interventions on depression and anxiety in older adults: a systematic review and meta-analysis of randomized controlled trials.
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Quelle place pour les thérapies cognitives et comportementales chez le sujet âgé ?
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Internet-Delivered Cognitive Behaviour Therapy (ICBT) for Older Adults with Anxiety and Depression
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Improving care for patients with non-cardiac chest pain : Description of psychological distress and costs, and evaluation of an Internet-delivered intervention
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Cognitive Behavioral Therapy in Late Life
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A home-based program to manage concerns about falls
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True technology-enabled mental health care: when will we trust the computers and robots?
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Cost-effectiveness of eHealth interventions compared to treatment as usual for people with mental disorders: a systematic review and meta-analysis of randomized controlled trials (Preprint)Preprint
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Psychosocial Treatment of Anxiety in Later Life
Ramos, K., & Stanley, M. A. (2021) · Cambridge University Press eBooks · doi:10.1017/9781139087469.011

Examining self-guided internet-delivered cognitive behavior therapy for older adults with symptoms of anxiety and depression: Two feasibility open trials
Dear, B. F., Zou, J. B., Ali, S., Lorian, C. N., Johnston, L., Terides, M. D., Staples, L. G., Gandy, M., Fogliati, V. J., Klein, B., et al. (2015) · Internet Interventions · doi:10.1016/j.invent.2014.11.002 · Cited by 36 · see citing works
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Clinical and cost-effectiveness of therapist-guided internet-delivered cognitive behavior therapy for older adults with symptoms of depression: a randomized controlled trial
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Effectiveness and cost-effectiveness of individually tailored Internet-delivered cognitive behavior therapy for anxiety disorders in a primary care population: A randomized controlled trial
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A randomized controlled trial of guided internet-delivered cognitive behaviour therapy for older adults with generalized anxiety
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Brief internet-delivered cognitive behavioral therapy for anxiety in older adults: A feasibility trial
Zou, J. B., Dear, B. F., Titov, N., Lorian, C. N., Johnston, L., Spence, J., Knight, R. G., Anderson, T. M., & Sachdev, P. S. (2012) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2012.04.002 · Cited by 71 · see citing works
Self-citation

Authors: Dear, B. F., Zou, J. B., Ali, S., Lorian, C. N., Johnston, L., Sheehan, J., Staples, L. G., Gandy, M., Fogliati, V. J., Klein, B., & Titov, N.
Affiliations: Macquarie University (AU)
University of York (GB)
Australian National University (AU)
Corresponding author: Dear, Blake F.
ORCID: Dear, Blake F.
Ali, Shehzad
Staples, Lauren G.
Gandy, Milena
Fogliati, Vincent J.
Klein, Britt
Titov, Nickolai
Venue: Behavior Therapy
Publisher: Elsevier BV
Published: 2015-03
Volume: 46
Issue: 2
Pages: 206-217
ISSN: 0005-7894 (ISSN-L)
DOI: 10.1016/j.beth.2014.09.007
OpenAlex: W4235688983
Cited by: 108
References: 44
Citations by year: 2026: 4 · 2025: 8 · 2024: 4 · 2023: 8 · 2022: 15 · 2021: 7 · 2020: 14 · 2019: 8 · 2018: 9 · 2017: 10 · 2016: 10 · 2015: 11
FWCI: 16.12
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Behavior Therapy (publishedVersion)
FedUni ResearchOnline (Federation University Australia) (submittedVersion)
ANU Open Research (Australian National University) (submittedVersion)
Topics: Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
Keywords: internet-based cognitive behavioral therapy, older adults, anxiety, depression, cost-effectiveness, quality-adjusted life years, long-term treatment outcomes, treatment acceptability, access to mental health care

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Clinical and Cost-Effectiveness of Therapist-Guided Internet-Delivered Cognitive Behavior Therapy for Older Adults With Symptoms of Anxiety: A Randomized Controlled Trial

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