The uptake and outcomes of Internet-based cognitive behavioural therapy for health anxiety symptoms during the COVID-19 pandemic
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Abstract
BACKGROUND: Internet cognitive behavioural therapy (iCBT) for health anxiety has demonstrated efficacy but has not been evaluated during the COVID-19 pandemic. This study presents the first evaluation of the uptake and outcomes of iCBT for health anxiety during the COVID-19 pandemic. METHODS: THIS WAY UP is an Australian digital mental health service which delivers iCBT interventions to community members. We compared the uptake of THIS WAY UP's iCBT course for health anxiety in an Australian adult sample who started the course before the pandemic (12th September 2019-11 th March 2020) to during the pandemic (12th March to 11th June 2020). The course was accessible to Australian adults over 18 years old, with no inclusion criteria. Outcomes included course registrations and commencements, lesson and course completion, and self-reported health anxiety (Short Health Anxiety Inventory), depression (Patient Health Questionnaire 9-item) and distress (Kessler-10). RESULTS: From March to June 2020, we observed significant increases in course registrations (N = 238 vs N = 1057); and course commencements (N = 126 vs. N = 778). Large, significant improvements in health anxiety (g = 0.89), and distress (K10: g = 0.91), and medium improvements in depression (g = 0.55) were found. Course completion during COVID was 30.5%. CONCLUSIONS: iCBT improved health anxiety during the COVID-19 pandemic, and provides scalable intervention that can address increased demands for mental health services in the community.
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A rigid structure could prevent engagement for some young people.
“While web-based cognitive behavioural therapy interventions (i.e., structured approaches) typically required sequential completion [45], a rigid structure could prevent engagement for some young people.”
From Young People’s Barriers and Facilitators of Engagement with Web-Based Mental Health Interventions for Anxiety and Depression: A Qualitative Study (2024) · cites this paper as [45]
Evidence supports the delivery of CBT for health anxiety and IAD online, with large effect sizes when delivered in routine care.
“Evidence also supports the delivery of CBT for health anxiety and IAD online [26, 58, 77], with large effect sizes when delivered in routine care [78, 79].”
From Illness Anxiety Disorder: A Review of the Current Research and Future Directions (2024) · cites this paper as [79]
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Du, X., Hu, J., Shi, C., Liu, X., & Zhihong, R. E. N. (2026) · Current Psychology · doi:10.1007/s12144-025-08745-4
Xu, J., Shen, J., Wang, J., & Huang, G. (2026) · doi:10.2196/preprints.91108
Xu, J., Shen, J., Wang, J., & Huang, G. (2026) · JMIR mhealth and uhealth · doi:10.2196/91108
- Authors
- Sharrock, M. J., Mahoney, A. E. J., Haskelberg, H., Millard, M., & Newby, J. M.
- Affiliations
- UNSW Sydney (AU)
- Black Dog Institute (AU)
- Corresponding author
- Mahoney, Alison E.J.
- Newby, Jill M.
- Venue
- Journal of Anxiety Disorders
- Publisher
- Elsevier BV
- Published
- 2021-12
- Volume
- 84
- Pages
- 102494
- ISSN
- 0887-6185 (ISSN-L)
- PMC
- PMC8570415
- OpenAlex
- W3208966700
- Cited by
- 46
- References
- 61
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 10 · 2023: 15 · 2022: 13
- FWCI
- 8.44
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Licence
- Locations
- Journal of Anxiety Disorders (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
- PsyArXiv (OSF Preprints) (submittedVersion)
- Funders
- Medical Research Future Fund
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- internet-based cognitive behavioral therapy, health anxiety, COVID-19 pandemic, treatment uptake, course completion, depression, psychological distress, digital mental health services, community mental health
- MeSH terms
- COVID-19, SARS-CoV-2, Adolescent, Adult, Anxiety, Australia, Humans, Cognitive Behavioral Therapy, Treatment Outcome, Internet, Pandemics
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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.
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