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Cited by 13Digital Mental Health InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

Outpatient and self-referred participants: adherence to treatment components and outcome in an internet intervention targeting anxiety disorders.

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Arndt, Alice, Rubel, Julian, Berger, Thomas, Lutz, Wolfgang·2020·Internet Interventions
DOI 10.1016/j.invent.2020.100319PMC PMC7178477
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Abstract

OBJECTIVE: While adherence is an important factor influencing the effectiveness of internet interventions, many studies operationalize adherence only by the number of sessions and do not report adherence to specific treatment components. The goal of this study was to investigate adherence to treatment components as well as outcome in outpatients and self-referred participants who participated in an internet intervention targeting anxiety. METHOD: -test and χ2 tests adherence to treatment components based on the number of completed exercises was compared between participant groups. A 2 × 2 repeated measures ANOVA was used to compare pre-to post symptom change between participant groups. Primary measures included the Generalized Anxiety Disorder Scale-7 (GAD-7) and the Mini Social Phobia Inventory (Mini-SPIN). Using nonparametric bootstrap analyses number of sessions and adherence to treatment components were investigated as potential mediators of the relationship between participant group and outcome. Finally, predictors of adherence to treatment components in outpatient participants were investigated using LASSO and logistic regression. RESULTS: Self-referred participants were more adherent than outpatient participants, however the groups did not differ significantly in outcome. Outpatient participants who adhered to relaxation showed greater improvement during the waiting period than the matched outpatient waitlist sample. The effect of participant group on outcome was mediated via adherence to exposure and number of sessions. CONCLUSIONS: In internet interventions adherence to treatment components differs between participant groups and has a mediating effect on treatment outcome. Therefore, it should be fostered, especially when participants are not self-referred. In line with these findings more studies should investigate relevant participant characteristics in more depth.

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  • All participants were self-referred from a patient-volunteer list.

    “All participants were self-referred from a patient-volunteer list (Arndt et al., 2020).”

    From Online ACT intervention for fibromyalgia: An exploratory study of feasibility and preliminary effectiveness with smartphone-delivered experiential sampling assessment (2022) · cites this paper as Arndt et al., 2020

    The Methods section (“Flow of participants”) describes two groups, not a sample composed entirely of self-referred participants. Outpatients were recruited through an outpatient clinic, while self-referred participants were recruited through newspaper and university-press advertisements; it does not describe a patient-volunteer list. (LLM, conf=0.92)

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  • Adherence reflects the degree to which participants receive the active ingredients of the program and was supported to be a significant mediator toward treatment outcomes.

    “Adherence reflects the degree to which participants receive the “active ingredients” of the program (Danaher et al., 2006), and was supported to be a significant mediator toward treatment outcomes (Arndt et al., 2020).”

    From Can We Boost Treatment Adherence to an Online Transdiagnostic Intervention by Adding Self-Enhancement Strategies? Results From a Randomized Controlled Non-inferiority Trial (2021) · cites this paper as Arndt et al., 2020

    The Results section ('Mediation model predicting change in anxiety symptoms'; page unavailable) reports a significant indirect effect of participant group on GAD-7 outcome through adherence to exposure and number of sessions. The claim is broader than that finding: other adherence measures did not significantly mediate the effect, and the mediation was not significant for the social-anxiety outcome. (LLM, conf=0.86)

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Authors
Arndt, A., Rubel, J., Berger, T., & Lutz, W.
Affiliations
  • Universität Trier (DE)
  • Justus-Liebig-Universität Gießen (DE)
  • University of Bern (CH)
Corresponding author
Lutz, Wolfgang
ORCID
Venue
Internet Interventions
Publisher
Elsevier BV
Published
2020-04
Volume
20
Pages
100319
ISSN
2214-7829 (ISSN-L)
DOI
10.1016/j.invent.2020.100319
PMC
PMC7178477
OpenAlex
W3015380354
Cited by
13
References
37
Citations by year
2026: 1 · 2025: 2 · 2024: 2 · 2023: 2 · 2022: 3 · 2021: 2 · 2020: 1
FWCI
1.81
Type
journal article
Language
en
Open access
Licence
Locations
  • Internet Interventions (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • BORIS (University Library Bern) (submittedVersion, cc-by-nc-nd)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Open Access CRIS of the University of Bern
Funders
Deutsche Forschungsgemeinschaft (LU 660/8-1, LU 660/10-1)
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 › Psychotherapy Techniques and Applications
Keywords
medication adherence, treatment components, anxiety disorders, generalized anxiety disorder, social anxiety disorder, relaxation techniques, exposure therapy, number of sessions, mediation, predictors of adherence

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