A randomized controlled trial of a transdiagnostic Internet intervention for individuals with panic and phobias – one size fits all
Abstract
Background and objectives Many individuals with anxiety disorders do not receive professional treatment. Internet interventions have shown to be effective in the treatment of anxiety. The present randomized controlled trial was designed to examine the effectiveness of a short-term (4-week) Internet intervention in treating panic disorder, agoraphobia, social anxiety disorder, and specific phobias ('ConfID'). We addressed the questions of whether this transdiagnostic program would affect these disorders to varying degrees and whether there would be moderators of effectiveness.Methods Adults who were recruited in online forums for anxiety underwent an online baseline assessment (N = 179) and were randomized either to the intervention group (ConfID) or the control group (care as usual). Online post-assessment took place 4 weeks later. The primary outcome was assessed with the Beck Anxiety Inventory (BAI); the secondary outcomes targeted the disorder-specific symptoms, depression, and somatization.Results Participants in the intervention group showed a significantly stronger anxiety reduction compared to participants receiving care as usual (small-to-medium effect size between groups in intention-to-treat analysis). The treatment effect was similar for the different disorders and was moderated by participants' attitudes towards Internet interventions. Secondary outcomes yielded effect sizes in the medium range.Limitations Moderate treatment adherence, lack of measures beyond online self-reports, and unavailability of long-term results.Conclusions The study provides further evidence that transdiagnostic Internet interventions are promising in reducing the existing treatment gap in individuals with panic disorder and phobias. Results extend previous findings by showing that significant effects can also be reached by comprehensive short-term programs and that the effects might be moderated by participants' attitudes towards Internet interventions.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Other controlled studies have included specific phobias along with other disorders in their ICBTs.
“Other controlled studies have included specific phobias along with other disorders in their ICBTs.”
From An Internet-based treatment for Flying Phobia using 360° images: Study protocol for a feasibility pilot study (2021) · cites this paper as Schröder et al., 2017
Cites
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910 · see citing works
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.6.593 · Cited by 20,391 · see citing works
(1998) · The Journal of Clinical Psychiatry · Cited by 19,139 · see citing works
An inventory for measuring clinical anxiety: Psychometric properties.
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.56.6.893 · Cited by 14,407 · see citing works
Regression to the mean: what it is and how to deal with it
Barnett, A. G. (2004) · International Journal of Epidemiology · doi:10.1093/ije/dyh299 · Cited by 1,988 · see citing works
The client satisfaction questionnaire
Attkisson, C. C., & Zwick, R. (1982) · Evaluation and Program Planning · doi:10.1016/0149-7189(82)90074-x · Cited by 1,743 · see citing works
Treatment gap in mental health care.
Abramowitz, M. Z., Greenberg, D., & Levav, I. (2008) · PubMed · Cited by 1,482 · see citing works
Hoffman, S. G., & Smits, J. A. J. (2008) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v69n0415 · Cited by 1,420 · see citing works
The treatment gap in mental health care.
(2004) · Europe PMC (PubMed Central) · Cited by 1,419 · see citing works
The prevalence and correlates of untreated serious mental illness.
(2001) · PubMed Central · Cited by 780 · see citing works
Newby, J. M., McKinnon, A., Kuyken, W., Gilbody, S., & Dalgleish, T. (2015) · Clinical Psychology Review · doi:10.1016/j.cpr.2015.06.002 · Cited by 545 · see citing works
Scheffer, J. (2002) · Massey Research Online (Massey University) · Cited by 463 · see citing works
Treatment of panic disorder: live therapy vs. self-help via the Internet
Carlbring, P., Nilsson-Ihrfelt, E., Waara, J., Kollenstam, C., Buhrman, M., Kaldo, V., Söderberg, M., Ekselius, L., & Andersson, G. (2005) · Behaviour Research and Therapy · doi:10.1016/j.brat.2004.10.002 · Cited by 372 · see citing works
Meyer, B., Pilkonis, P. A., Krupnick, J. L., Egan, M. K., Simmens, S. J., & Sotsky, S. M. (2002) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.70.4.1051 · Cited by 322 · see citing works
Bandelow, B. (1995) · International Clinical Psychopharmacology · doi:10.1097/00004850-199506000-00003 · Cited by 314 · see citing works
Griffiths, K. M., Farrer, L., & Christensen, H. (2010) · Medical Journal of Australia · doi:10.5694/j.1326-5377.2010.tb03685.x · Cited by 303 · see citing works
Transdiagnostic internet treatment for anxiety and depression: a randomised controlled trial
Titov, N., Dear, B. F., Schwencke, G., Andrews, G., Johnston, L., Craske, M. G., & McEvoy, P. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.03.007 · Cited by 285 · see citing works
Ebert, D. D., Berking, M., Cuijpers, P., Lehr, D., Pörtner, M., & Baumeister, H. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.01.056 · Cited by 268 · see citing works
Analytic Methods for Questions Pertaining to a Randomized Pretest, Posttest, Follow-Up Design
Rausch, J. R., Maxwell, S. E., & Kelley, K. (2003) · Journal of Clinical Child & Adolescent Psychology · doi:10.1207/s15374424jccp3203_15 · Cited by 239 · see citing works
Dear, B. F., Staples, L. G., Terides, M. D., Karin, E., Zou, J., Johnston, L., Gandy, M., Fogliati, V. J., Wootton, B. M., McEvoy, P. M., et al. (2015) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2015.09.003 · Cited by 230 · see citing works
Titov, N., Dear, B. F., Staples, L. G., Terides, M. D., Karin, E., Sheehan, J., Johnston, L., Gandy, M., Fogliati, V. J., Wootton, B. M., et al. (2015) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2015.08.002 · Cited by 223 · see citing works
Spitzer, C., Hammer, S., Löwe, B., Grabe, H. J., Barnow, S., Rose, M., Wingenfeld, K., Freyberger, H., & Franke, G. H. (2011) · Fortschritte der Neurologie · Psychiatrie · doi:10.1055/s-0031-1281602 · Cited by 220 · see citing works
Transdiagnostic Internet treatment for anxiety disorders: A randomized controlled trial
Titov, N., Andrews, G., Johnston, L., Robinson, E., & Spence, J. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2010.05.014 · Cited by 196 · see citing works
Hilvert-Bruce, Z., Rossouw, P. J., Wong, N., Sunderland, M., & Andrews, G. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.04.001 · Cited by 193 · see citing works
The Brief Social Phobia Scale: a psychometric evaluation
Davidson, J. R. T., MINER, C. M., DeVeaugh-Geiss, J., Tupler, L. A., COLKET, J. T., & Potts, N. L. S. (1997) · Psychological Medicine · doi:10.1017/s0033291796004217 · Cited by 186 · see citing works
Titov, N., Dear, B. F., Staples, L. G., Bennett-Levy, J., Klein, B., Rapee, R. M., Shann, C., Richards, D., Andersson, G., Ritterband, L., et al. (2015) · Psychiatric Services · doi:10.1176/appi.ps.201400477 · Cited by 181 · see citing works
The UCSF Client Satisfaction Scales: I. The Client Satisfaction Questionnaire-8.
Attkisson, C. C., & Greenfield, T. K. (1999) · Cited by 178 · see citing works
Effectiveness of Guided Internet-Based Cognitive Behavior Therapy in Regular Clinical Settings
Andersson, G., & Hedman, E. (2013) · Verhaltenstherapie · doi:10.1159/000354779 · Cited by 165 · see citing works
Berger, T., Boettcher, J., & Caspar, F. (2014) · Psychotherapy · doi:10.1037/a0032527 · Cited by 158 · see citing works
Johnston, L., Titov, N., Andrews, G., Spence, J., & Dear, B. F. (2011) · PLoS ONE · doi:10.1371/journal.pone.0028079 · Cited by 150 · see citing works
Rutherford, B. R., Wager, T., & Roose, S. (2010) · Current Psychiatry Reviews · doi:10.2174/157340010790596571 · Cited by 150 · see citing works
Schröder, J., Sautier, L., Kriston, L., Berger, T., Meyer, B., Späth, C., Köther, U., Nestoriuc, Y., Klein, J. P., & Moritz, S. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.08.044 · Cited by 149 · see citing works
Nordgren, L. B., Hedman, E., Etienne, J., Bodin, J., Kadowaki, Å., Eriksson, S., Lindkvist, E., Andersson, G., & Carlbring, P. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.05.007 · Cited by 145 · see citing works
Online interventions for depression and anxiety – a systematic review
Saddichha, S., Al-Desouki, M., Lamia, A., Linden, I. A., & Krausz, M. (2014) · Health Psychology and Behavioral Medicine · doi:10.1080/21642850.2014.945934 · Cited by 133 · see citing works
Hedman, E., Andersson, E., Ljótsson, B., Andersson, G., Andersson, E., Schalling, M., Lindefors, N., & Rück, C. (2012) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2012.01834.x · Cited by 114 · see citing works
The use of the Internet in the treatment of anxiety disorders.
Andersson, G., Bergström, J., Carlbring, P., & Lindefors, N. (2005) · PubMed · Cited by 103 · see citing works
Online interventions for anxiety disorders
Christensen, H., Batterham, P., & Calear, A. (2014) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000019 · Cited by 95 · see citing works
Interformat Reliability of Digital Psychiatric Self-Report Questionnaires: A Systematic Review
Alfonsson, S., Maathz, P., & Hursti, T. J. (2014) · Journal of Medical Internet Research · doi:10.2196/jmir.3395 · Cited by 94 · see citing works
Fogliati, V. J., Dear, B. F., Staples, L. G., Terides, M. D., Sheehan, J., Johnston, L., Kayrouz, R., Dear, R., McEvoy, P. M., & Titov, N. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.03.005 · Cited by 86 · see citing works
Titov, N., Dear, B. F., Johnston, L., McEvoy, P. M., Wootton, B., Terides, M. D., Gandy, M., Fogliati, V., Kayrouz, R., & Rapee, R. M. (2014) · PLoS ONE · doi:10.1371/journal.pone.0089591 · Cited by 81 · see citing works
Predicting treatment outcome in internet versus face to face treatment of panic disorder
Andersson, G., Carlbring, P., & Grimlund, A. (2008) · Computers in Human Behavior · doi:10.1016/j.chb.2008.02.003 · Cited by 75 · see citing works
Hedman, E., Andersson, E., Lekander, M., & Ljótsson, B. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.11.009 · Cited by 56 · see citing works
Dealing with Missing Data in Family-Based Association Studies: A Multiple Imputation Approach
Croiseau, P., Génin, E., & Cordell, H. J. (2007) · Human Heredity · doi:10.1159/000100481 · Cited by 25 · see citing works
Are Randomized Controlled Trials Relevant to Clinical Practice?
Hollon, S. D., & Wampold, B. E. (2009) · The Canadian Journal of Psychiatry · doi:10.1177/070674370905400909 · Cited by 23 · see citing works
Heart failure with preserved ejection fraction — coming to terms with an oxymoron
Macdonald, P. S. (2010) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2010.tb03390.x · Cited by 18 · see citing works
Assessing the severity of panic disorder and agoraphobia:
Tural, Ü., Fıdaner, H., Alkın, T., & Bandelow, B. (2002) · Journal of Anxiety Disorders · doi:10.1016/s0887-6185(02)00104-4 · Cited by 15 · see citing works
Flagged first, then by citations
4 of the 51 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Transdiagnostic psychiatry: a systematic review
Fusar‐Poli, P., Solmi, M., Brondino, N., Davies, C., Chae, C., Politi, P., Borgwardt, S., Lawrie, S. M., Parnas, J., & McGuire, P. (2019) · World Psychiatry · doi:10.1002/wps.20631 · Cited by 409 · see citing works
Păsărelu, C. R., Andersson, G., Bergman Nordgren, L., & Dobrean, A. (2017) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2016.1231219 · Cited by 335 · see citing works
Pauley, D., Cuijpers, P., Papola, D., Miguel, C., & Karyotaki, E. (2021) · Psychological Medicine · doi:10.1017/s0033291721001999 · Cited by 170 · see citing works
Acceptability of Digital Mental Health Interventions for Depression and Anxiety: Systematic Review
Lau, C. K. Y., Saad, A., Camara, B., Rahman, D., & Bolea-Alamanac, B. (2024) · Journal of Medical Internet Research · doi:10.2196/52609 · Cited by 51 · see citing works
Schröder, J., Werkle, N., Cludius, B., Jelinek, L., Moritz, S., & Westermann, S. (2020) · Depression and Anxiety · doi:10.1002/da.23105 · Cited by 40 · see citing works
Campos, D., Bretón-López, J., Botella, C., Mira, A., Castilla, D., Mor, S., Baños, R., & Quero, S. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2060-4 · Cited by 32 · see citing works
Campos, D., Mira, A., Bretón-López, J., Castilla, D., Botella, C., Baños, R. M., & Quero, S. (2018) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s153041 · Cited by 30 · see citing works
González-Robles, A., Díaz‐García, A., Miguel, C., García‐Palacios, A., & Botella, C. (2018) · PLoS ONE · doi:10.1371/journal.pone.0207396 · Cited by 31 · see citing works
Weisel, K. K., Zarski, A., Berger, T., Krieger, T., Moser, C. T., Schaub, M. P., Görlich, D., Berking, M., & Ebert, D. D. (2020) · Journal of Medical Internet Research · doi:10.2196/16450 · Cited by 26 · see citing works
Apolinário-Hagen, J. (2018) · Psychiatry Investigation · doi:10.30773/pi.2018.06.26 · Cited by 20 · see citing works
Effects of a Brief Transdiagnostic Cognitive Behavioural Group Therapy on Disorder Specific Symptoms
Kristjánsdóttir, H., Sigurðsson, B. H., Salkovskis, P. M., Sigurðsson, E., Sighvatsson, M. B., & Sigurðsson, J. F. (2018) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465818000450 · Cited by 16 · see citing works
Jelinek, L., Schröder, J., Bücker, L., Miegel, F., Baumeister, A., Moritz, S., Sibilis, A., & Schultz, J. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.06.038 · Cited by 13 · see citing works
Stech, E. P., Grierson, A. B., Chen, A. Z., Sharrock, M. J., Mahoney, A., & Newby, J. M. (2020) · Internet Interventions · doi:10.1016/j.invent.2020.100315 · Cited by 15 · see citing works
Transdiagnostic psychological interventions for emotional disorders: A comprehensive meta-analysis
Jiménez-Orenga, N., Miguel, C., González-Robles, A., Fernández‐Álvarez, J., Grimaldos, J., Bretón-López, J. M., Botella, C., Cuijpers, P. J., García‐Palacios, A., Papola, D., et al. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119537 · Cited by 9 · see citing works
Anksiyete Bozukluklarının Tedavisinde İnternet Tabanlı Bilişsel Davranışçı Terapi Uygulamaları
Huyut, B. Ç. (2019) · Yaşam Becerileri Psikoloji Dergisi · doi:10.31461/ybpd.622846 · Cited by 8 · see citing works
Nieder, T. O., Renner, J., Zapf, A., Sehner, S., Hot, A., König, H., Dams, J., Grochtdreis, T., Briken, P., & Dekker, A. (2022) · BMJ Open · doi:10.1136/bmjopen-2020-045980 · Cited by 7 · see citing works
Mor, S., Botella, C., Campos, D., Tur, C., Castilla, D., Soler, C., & Quero, S. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100387 · Cited by 6 · see citing works
Nieder, T. O., Renner, J., Sehner, S., Pepić, A., Zapf, A., Lambert, M., Briken, P., & Dekker, A. (2024) · The Lancet Digital Health · doi:10.1016/s2589-7500(24)00192-4 · Cited by 5 · see citing works
Romero, D., Johansson, M., Hermansson, U., & Lindner, P. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.730153 · Cited by 5 · see citing works
Rubel, J. A., Quest, J., Pruessner, L., Timm, C., Hartmann, S. F., Barnow, S., Rittmeyer, L., Rosenbaum, D., & Lalk, C. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100584 · Cited by 4 · see citing works
Pollmanns, J., Großgarten, K., Wolff, J. K., Nolting, H.-D., Graf, C., Bergmann, F., & Nelles, G. (2022) · JMIR Research Protocols · doi:10.2196/37569 · Cited by 3 · see citing works
Cho, I., Kim, B.-H., Lee, H., Song, Y., Chang, M. J., Kim, J., & Han, E. (2025) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2025.103074 · Cited by 3 · see citing works
The Use of Technology to Augment Clinical Care in Depression and Anxiety Disorders: An Evidence Map
Maher, A. R., Apaydin, E. A., Raaen, L. B., Motala, A., Shanman, R., & Hempel, S. (2019) · RAND Corporation eBooks · doi:10.7249/rr2177 · Cited by 2 · see citing works
Welches digitale Angebot für wen?
Beintner, I., Backes, B., & Voderholzer, U. (2020) · DNP - Der Neurologe und Psychiater · doi:10.1007/s15202-020-0606-4 · Cited by 2 · see citing works
Rubel, J., Quest, J., Pruessner, L., Timm, C., Hartmann, S., Barnow, S., Rittmeyer, L., Rosenbaum, D., & Lalk, C. (2023) · JMIR Research Protocols · doi:10.2196/41440 · Cited by 2 · see citing works
Miqdadi, A. I., Chong, M. C., Yoong, T. L., Koh, O. H., & Alhadidi, M. M. B. (2023) · Journal of Psychosocial Nursing and Mental Health Services · doi:10.3928/02793695-20230919-02 · Cited by 1 · see citing works
Pollmanns, J., Großgarten, K., Wolff, J. K., Nolting, H.-D., Gerber, C., Bergmann, F., & Nelles, G. (2022) · doi:10.2196/preprints.37569
DiGA, weitere psychotherapeutische Anwendungen und primärpräventive Anwendungen
Meisenzahl, E. M., & Sprick, U. (2023) · Springer eBooks · doi:10.1007/978-3-662-64457-7_5
Baumeister, A., Schuurmans, L., Schultz, J., Schröder, J., Moritz, S., & Jelinek, L. (2024) · Behaviour Research and Therapy · doi:10.1016/j.brat.2024.104673
Baumeister, A., Schuurmans, L., & Moritz, S. (2025) · Internet Interventions · doi:10.1016/j.invent.2025.100867
- Authors
- Schröder, J., Jelinek, L., & Moritz, S.
- Affiliations
- University Medical Center Hamburg-Eppendorf (DE)
- Corresponding author
- Schröder, Johanna
- Venue
- Journal of Behavior Therapy and Experimental Psychiatry
- Publisher
- Elsevier BV
- Published
- 2017-03
- Volume
- 54
- Pages
- 17-24
- ISSN
- 0005-7916 (ISSN-L)
- OpenAlex
- W2368036112
- Cited by
- 32
- References
- 51
- Citations by year
- 2025: 3 · 2024: 3 · 2023: 4 · 2022: 5 · 2021: 3 · 2020: 4 · 2019: 5 · 2018: 4 · 2016: 1
- FWCI
- 5.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Behavior Therapy and Experimental Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Boettcher Foundation
- 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 › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- panic disorder, agoraphobia, social anxiety disorder, specific phobia, anxiety disorders, treatment gap, treatment moderators, medication adherence, depression, somatization
- MeSH terms
- Adult, Female, Humans, Male, Middle Aged, Phobic Disorders, Psychiatric Status Rating Scales, Surveys and Questionnaires, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Panic Disorder, Treatment Outcome, Internet
About these checks
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.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
