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Transdiagnostic Internet treatment for anxiety disorders: A randomized controlled trial
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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“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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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Kleiboer, A., Sorbi, M., van Silfhout, M., Kooistra, L., & Passchier, J. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.07.009 · Cited by 37
Hauschildt, M., Schröder, J., & Moritz, S. (2016) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2016.04.010 · Cited by 37
Johnston, L., Dear, B. F., Gandy, M., Fogliati, V. J., Kayrouz, R., Sheehan, J., Rapee, R. M., & Titov, N. (2014) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867414527524 · Cited by 37
Self-citationBiagianti, B., Foti, G., Liberto, A. D., Bressi, C., & Brambilla, P. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.01.057 · Cited by 44
Lorian, C. N., Titov, N., & Grisham, J. R. (2011) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2011.10.003 · Cited by 37
Self-citationSchröder, J., Jelinek, L., & Moritz, S. (2017) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2016.05.002 · Cited by 32
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Kladnitski, N., Smith, J., Allen, A., Andrews, G., & Newby, J. M. (2018) · Internet Interventions · doi:10.1016/j.invent.2018.06.003 · Cited by 37
“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.”
BackgroundSelf-citationGonzález‐Robles, A., García‐Palacios, A., Baños, R., Riera, A., Llorca, G., Traver, F., Haro, G., Palop, V., Calatayud, G. L., Romeu, J. E., et al. (2015) · Trials · doi:10.1186/s13063-015-1024-3 · Cited by 32
TRANSDIAGNOSTIC INTERNET TREATMENT FOR ANXIETY AND DEPRESSION
Titov, N., Dear, B. F., Johnston, L., & Terides, M. D. (2012) · Revista de Psicopatología y Psicología Clínica · Cited by 31
Self-citationGonzález-Robles, A., Díaz‐García, A., Miguel, C., García‐Palacios, A., & Botella, C. (2018) · PLoS ONE · doi:10.1371/journal.pone.0207396 · Cited by 32
Understanding adherence to web-based interventions
Kelders, S. M. (2012) · doi:10.3990/1.9789036534178 · Cited by 29
Teng, E. J., Hiatt, E. L., McClair, V. L., Kunik, M. E., Frueh, B. C., & Stanley, M. A. (2013) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12039 · Cited by 24
Internet-Delivered Cognitive Behaviour Therapy
Richards, D., Enrique, Á., Palacios, J. E., & Duffy, D. J. (2018) · InTech eBooks · doi:10.5772/intechopen.71412 · Cited by 24
Metadata
- 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
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2010-09
- Volume
- 48
- Issue
- 9
- Pages
- 890-899
- ISSN
- 0005-7967 (ISSN-L)
- 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
- 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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