Transdiagnostic Internet treatment for anxiety disorders: A randomized controlled trial

Titov, Nickolai; Andrews, Gavin; Johnston, Luke; Robinson, Emma; Spence, Jay

doi:10.1016/j.brat.2010.05.014

Cited by 196Digital Mental Health InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and Assessments

Transdiagnostic Internet treatment for anxiety disorders: A randomized controlled trial

Titov, Nickolai, Andrews, Gavin, Johnston, Luke, Robinson, Emma, Spence, Jay·2010·Behaviour Research and Therapy

DOI 10.1016/j.brat.2010.05.014

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Abstract

Clinician-guided Internet-based cognitive behavioural therapy (iCBT) programs are clinically effective at treating specific anxiety disorders. The present study examined the efficacy of a transdiagnostic Internet-based cognitive behavioural treatment (iCBT) program to treat more than one anxiety disorder within the same program (the Anxiety Program). Eighty six individuals meeting diagnostic criteria for generalized anxiety disorder (GAD), panic disorder, and/or social phobia were randomly assigned to a treatment group, or to a waitlist control group. Treatment consisted of CBT based online educational lessons and homework assignments, weekly email or telephone contact from a clinical psychologist, access to a moderated online discussion forum, and automated emails. An intention-to-treat model using the baseline-observation-carried-forward principle was employed for data analyses. Seventy-five percent of treatment group participants completed all 6 lessons within the 8 week program. Post-treatment data was collected from 38/40 treatment group and 38/38 control group participants, and 3-month follow-up data was collected from 32/40 treatment group participants. Relative to controls, treatment group participants reported significantly reduced symptoms of anxiety as measured by the Generalized Anxiety Disorder - 7 Item, Social Phobia Screening Questionnaire, and the Panic Disorder Severity Rating Scale - Self Report Scale, but not on the Penn State Worry Questionnaire, with corresponding between-groups effect sizes (Cohen's d) at post-treatment of 0.78, 0.43, 0.43, and 0.20, respectively. The clinician spent a total mean time of 46min per person over the program, participants rated the procedure as moderately acceptable, and gains were sustained at follow-up. Modifications to the Anxiety program, based on post-treatment feedback from treatment group participants, were associated with improved outcomes in the control group. These results indicate that transdiagnostic programs for anxiety disorders may be successfully administered via the Internet.

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Focus on common transdiagnostic elements of CBT has been found effective when delivered via the internet.
“One proposed solution has been to focus on the common transdiagnostic elements of CBT [31], and this has also been found to be effective when delivered via the internet [32].”
From The promise and pitfalls of the internet for cognitive behavioral therapy (2010) · cites this paper as [32]
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 [79]
Internet-based or computer-based CBT programs have demonstrated utility for GAD.
“Several studies have demonstrated the utility of internetbased or computer-based CBT programs [79,524-526].”
From Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders (2014) · cites this paper as [79]
ICBT is significantly more effective than wait-list control for GAD, with benefits maintained at long-term follow-up.
“ICBT has been shown to be significantly more effective than wait-list control [79,524,525], with benefits being maintained at long-term follow-up [525].”
From Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders (2014) · cites this paper as [79]
The results of this trial are consistent with previous trials of iCBT for panic disorder and transdiagnostic iCBT treatment for anxiety.
“The results of this trial, with moderate to large effect sizes, are consistent with previous trials of iCBT for panic disorder [16] and transdiagnostic iCBT treatment for anxiety [37], which shares some features with our treatment approach.”
From Individually Tailored Internet-Based Treatment for Young Adults and Adults With Panic Attacks: Randomized Controlled Trial (2012) · cites this paper as [37]

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Randomized controlled trial of Internet-delivered cognitive behavioral therapy for posttraumatic stress disorder
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Psychotherapies for Generalized Anxiety Disorder in Adults
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Brief internet-delivered cognitive behavioral therapy for anxiety in older adults: A feasibility trial
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Individually Tailored Internet-Based Treatment for Young Adults and Adults With Panic Attacks: Randomized Controlled Trial
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Internet-Delivered Cognitive Therapy for Social Anxiety Disorder: A Development Pilot Series
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Internet-Based Interventions for Social Anxiety Disorder - an Overview
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“T 59.35 (8.3) BDI 24.04 (10.71) ‐ ‐ Titov et al. (2010) GAD‐7 ‐ PHQ‐9 ‐ PSWQ 65.68 (9.28) Titov et al. (2011) GAD‐7 11.40 (3.76) PHQ‐9 13.04 (6.57) PSWQ 59.89 (8.26) Titov et al. (2009) GAD‐7 13.98 (4.01) PHQ‐9 12.29 (5.72) PSWQ 66.23 (10.48) Abbreviations: BAI, Beck Anxiety Inventory; Beck…”
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Internet-Delivered Cognitive Behavioral Therapy for Anxiety Disorders in Open Community Versus Clinical Service Recruitment: Meta-Analysis
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Acceptability of Digital Mental Health Interventions for Depression and Anxiety: Systematic Review
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Educating patients about Internet-delivered cognitive behaviour therapy: Perceptions among treatment seekers and non-treatment seekers before and after viewing an educational video
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A systematic review of the efficacy of self-management programs for increasing physical activity in community-dwelling adults with acquired brain injury (ABI)
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Examining internet-delivered cognitive behaviour therapy for patients with chronic kidney disease on haemodialysis: A feasibility open trial.
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Comorbidity and Internet-Delivered Transdiagnostic Cognitive Behavioural Therapy for Anxiety Disorders
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Dissemination of Therapist-Assisted Internet Cognitive Behaviour Therapy: Development and Open Pilot Study of a Workshop
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Short-term effectiveness of an online behavioral training in migraine self-management: A randomized controlled trial
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CBT-informed psychological interventions for adult patients with anxiety and depression symptoms: A narrative review of digital treatment options
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Changes in risk-taking over the course of an internet-delivered cognitive behavioral therapy treatment for generalized anxiety disorder
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“Transdiagnostic iCBT programs have been shown to be effective in the treatment of mixed and comorbid anxiety disorders (Johnston et al., 2011; Titov et al., 2010; Nordgren et al., 2014), as well as anxiety co-morbid with depression (Titov et al.”
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Transdiagnostic internet treatment for anxiety and depression: a randomised controlled trial
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A RCT of a transdiagnostic internet-delivered treatment for three anxiety disorders: Examination of support roles and disorder-specific outcomes
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Anxiety unplugged: Effectiveness of an unguided, transdiagnostic, web-based intervention for anxiety disorders—A randomized controlled trial
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Development and evaluation of a transdiagnostic internet-delivered cognitive behavioural therapy program for three anxiety disorders
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Current perspectives on Internet delivered cognitive behavioral therapy for adults with anxiety and related disorders
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Authors: Titov, N., Andrews, G., Johnston, L., Robinson, E., & Spence, J.
Affiliations: UNSW Sydney (AU)
St Vincent's Hospital Sydney (AU)
Corresponding author: Titov, Nickolai
ORCID: Titov, Nickolai
Andrews, Gavin
Venue: Behaviour Research and Therapy
Publisher: Elsevier BV
Published: 2010-09
Volume: 48
Issue: 9
Pages: 890-899
ISSN: 0005-7967 (ISSN-L)
DOI: 10.1016/j.brat.2010.05.014
OpenAlex: W1993968385
Cited by: 196
References: 58
Citations by year: 2026: 4 · 2025: 6 · 2024: 6 · 2023: 15 · 2022: 4 · 2021: 12 · 2020: 12 · 2019: 11 · 2018: 8 · 2017: 11 · 2016: 21 · 2015: 14 · 2014: 28 · 2013: 19 · 2012: 16
FWCI: 21.21
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Behaviour Research and Therapy (publishedVersion)
PubMed (publishedVersion)
Funders: New South Wales Institute of Psychiatry
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: transdiagnostic treatment, internet-based cognitive behavioral therapy, anxiety disorders, generalized anxiety disorder, panic disorder, social anxiety disorder, treatment acceptability, symptom relief
MeSH terms: Adolescent, Adult, Aged, Analysis of Variance, Anxiety Disorders, Computer-Assisted Instruction, Female, Health Services Accessibility, Humans, Male, Middle Aged, Phobic Disorders, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Panic Disorder, Treatment Outcome, Telemedicine, Internet, Young Adult

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Transdiagnostic Internet treatment for anxiety disorders: A randomized controlled trial

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