The DOI matches its Crossref record; 53 of the 53 references it cites were found in a registry or an index.
Clinician-Assisted Internet-Based Treatment is Effective for Generalized Anxiety Disorder: Randomized Controlled Trial
Abstract
Objective: The aim of the present study was to determine the efficacy of an Internet-based clinician-assisted computerized cognitive behavioural treatment (CaCCBT) programme for generalized anxiety disorder (the Worry programme). Methods: Forty-eight individuals meeting diagnostic criteria for generalized anxiety disorder (GAD) were randomly assigned to the Worry programme or to a waitlist control group. In the clinician-assisted Worry programme, participants complete six online lessons, weekly homework assignments, receive weekly email contact from a clinical psychologist, and contribute to a moderated online discussion forum with other participants. An intention-to-treat model was used for data analyses. The main outcome measures were Generalized Anxiety Disorder–7 Item Scale (GAD-7) and the Penn State Worry Questionnaire (PSWQ). Results: A total of 75% of treatment group participants completed all six lessons within the 9 week programme and post-treatment data were collected from 21/24 treatment group and 19/21 control group participants. Treatment group participants reported significantly reduced symptoms of worry as measured on the GAD-7 and PSWQ and reduced symptoms of depression as measured on the Patient Health Questionnaire–9 Item Scale (PHQ-9). Mean within- and between-groups effect sizes (Cohen's d) across the two measures of GAD were 1.3 and 1.1, respectively. Participants found the treatment programme acceptable and satisfactory. The clinician spent a total mean of 130 min per person over the programme. Conclusions: The Worry programme, the first randomized controlled trial of CaCCBT for GAD, resulted in clinically significant improvements. These results are consistent with literature indicating that Internet-based programmes, when combined with clinical guidance, can significantly reduce the symptoms of common mental disorders.
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In the citing paper
“Previous ICBT studies on GAD indicate that ICBT can be effective.”
From Internet-delivered acceptance-based behavior therapy for generalized anxiety disorder: A pilot study (2016) · cites this paper as Titov et al., 2009
In the citing paper
“a number of studies have investigated the potential for internet-delivered treatments for GAD and they have reported significant post-treatment and follow-up gains [33,48-51] similar to those found in face-to-face treatment studies [52].”
From Low-intensity internet-delivered treatment for generalized anxiety symptoms in routine care: protocol for a randomized controlled trial (2014) · cites this paper as [51]
In the citing paper
“However, only a handful of studies have investigated the efficacy and effectiveness of low-intensity internet-delivered treatments for GAD [33,48-51].”
From Low-intensity internet-delivered treatment for generalized anxiety symptoms in routine care: protocol for a randomized controlled trial (2014) · cites this paper as [51]
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“Four trials with moderate risk of bias were identified [65–68].”
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“The study methods are summarised here and are described in more detail elsewhere (Robinson et al., 2010; Titov et al., 2009).”
MethodInfluentialSelf-citationRobinson, E., Titov, N., Andrews, G., McIntyre, K., Schwencke, G., & Solley, K. (2010) · PLoS ONE · doi:10.1371/journal.pone.0010942 · Cited by 277
“, with encouraging results recently reported from the first iCBT program for treating GAD”
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“, 1990), and has been used in previous ICBT studies on GAD (Titov et al., 2009).”
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“Titov and colleagues 12 conducted an RCT of an online guided self-help intervention for GAD called ‘Worry’ with email guidance.”
InfluentialRozental, A., Boettcher, J., Andersson, G., Schmidt, B., & Carlbring, P. (2015) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2015.1008033 · Cited by 189
“…Dear, & Spence, 2013), irritable bowel syndrome (Ljótsson et al., 2011), social anxiety disorder (Andrews, Davies, & Titov, 2011), tinnitus (Hesser et al., 2012), insomnia (van Straten et al., 2014), generalized anxiety disorder (Titov et al., 2009), andpanic disorder (Carlbring et al., 2006).”
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“To our knowledge there is only 1 effectiveness study on the treatment of generalized anxiety disorder (GAD), which is a test of the ‘Worry’ program from Australia [Titov et al., 2009].”
InfluentialBerger, T., Boettcher, J., & Caspar, F. (2014) · Psychotherapy · doi:10.1037/a0032527 · Cited by 158
Carl, E., Witcraft, S. M., Kauffman, B. Y., Gillespie, E. M., Becker, E. S., Cuijpers, P., Van Ameringen, M., Smits, J. A. J., & Powers, M. B. (2020) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2018.1560358 · Cited by 151
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“In the trial by Titov et al. (2009), the dropout rate was larger (19%; 9/48) at posttreatment but, on the other hand, more participants completed the whole program.”
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“Generalized Anxiety Disorder There are only a few studies of guided iCBT for GAD.”
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“To date email has been used predominately in psychotherapy as a replacement for traditional face to face therapy (e.g., Titov et al., 2009).”
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“Four interventions were delivered in 6 modules of content over 8 to 10 weeks (Newby et al., 2013; Robinson et al., 2010; Titov et al., 2010; Titov et al., 2009).”
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InfluentialTitov, N., Andrews, G., Kemp, A., & Robinson, E. (2010) · PLoS ONE · doi:10.1371/journal.pone.0010885 · Cited by 97
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“[6, 7] Two studies included in the review by Andrews et al (2010) focused on iCBT for GAD specifically.[8, 9] These studies found significant reductions in primary (GAD symptoms) and secondary outcomes (depression symptoms, psychological distress, and disability) for the treatment groups (effect sizes were all moderat…”
ResultSelf-citationComputer-Assisted Cognitive-Behavior Therapy and Mobile Apps for Depression and Anxiety
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“Mean between-group effect size for the GAD measures was d ¼ 1.10 at post-treatment (Titov et al., 2009).”
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“Titov et al. (2009) found that participants receiving therapist-assisted iCBT for anxiety improved significantly relative to control.”
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“The trainer next presents research on therapist-assisted ICBT for depression, anxiety, and panic, describing research showing that clients receiving therapist-assisted ICBT improve to a significantly greater degree than clients on waiting lists (Klein et al, 2006 ; Perini et al, 2009 ; Titov et al, 2009 ), clients in…”
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Treating people you never see: Internet-based treatment of the internalising mental disorders
Andrews, G., & Titov, N. (2010) · Australian Health Review · doi:10.1071/ah09775 · Cited by 23
Self-citationChow, D. Y.-W., Jiang, X., & You, J. H. S. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.05.048 · Cited by 26
Internet-Based Cognitive Behavior Therapy
Andersson, G., Carlbring, P., & Hadjistavropoulos, H. D. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-803457-6.00021-0 · Cited by 26
Mahoney, A., Hobbs, M. J., Newby, J. M., Williams, A. D., & Andrews, G. (2018) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465818000127 · Cited by 22
“This CBT protocol has been validated in two randomized controlled trials (Robinson et al., 2010; Titov et al., 2009), two effectiveness studies (Mewton et al., 2012; Newby et al., 2017) and therapist guides are publicly available (Andrews et al., 2016).”
MethodSelf-citationYu, J. S., Szigethy, E., Wallace, M., Solano, F., & Oser, M. (2018) · Telemedicine and e-Health · doi:10.1089/tmj.2017.0280 · Cited by 15
“Furthermore, participants in studies of Internet-based CBT have typically completed 5 to 6 treatment modules within 8–9 weeks.”
InfluentialAre Trials of Computerized Therapy Generalizable? A Multidimensional Meta-analysis
Wilks, C. R., Zieve, G. G., & Lessing, H. K. (2016) · Telemedicine and e-Health · doi:10.1089/tmj.2015.0129 · Cited by 18
Internet-delivered acceptance-based behavior therapy for generalized anxiety disorder: A pilot study
Dahlin, M., Ryberg, M., Vernmark, K., Annas, N., Carlbring, P., & Andersson, G. (2016) · Internet Interventions · doi:10.1016/j.invent.2016.08.004 · Cited by 17
“The results showed large to moderate between group effect sizes on primary GAD measures as well as secondary outcomes (Titov et al., 2009).”
ResultThe Use of Telepsychology in Clinical Practice: Benefits, Effectiveness, and Issues to Consider
Godine, N., & Barnett, J. E. (2013) · International Journal of Cyber Behavior, Psychology and Learning · doi:10.4018/ijcbpl.2013100105 · Cited by 18
Collins, S., Byrne, M., Hawe, J., & O'Reilly, G. (2018) · British Journal of Clinical Psychology · doi:10.1111/bjc.12165 · Cited by 15
“Although originally used as a screening tool for GAD, the GAD-7 has good sensitivity and specificity as a screen for panic disorder, social anxiety disorder, and post-traumatic stress disorder (Titov et al., 2009).”
MethodRichards, D., Timulak, L., Doherty, G., Sharry, J., McLoughlin, O., Rashleigh, C., Colla, A., & Joyce, C. (2014) · Trials · doi:10.1186/1745-6215-15-145 · Cited by 16
White, K. A. (2020) · Digital Scholarship - UNLV (University of Nevada Reno) · doi:10.34917/3276068 · Cited by 16
Dahlin, M., Johansson, A., Romare, H., Carlbring, P., & Andersson, G. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100531 · Cited by 15
“Several previous studies on internet-based treatments for GAD have used this approach resulting in positive effects (Andersson et al., 2012b; Paxling et al., 2011; Robinson et al., 2010; Titov et al., 2009).”
Zhang, W., Du, Y., Yang, X., Wang, E., Fang, J., Liu, Z., Wu, S., Liu, Q., & Hu, Y. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.832167 · Cited by 21
“(44) Australia GAD/DSM-IV 45 (21/24) no details no details ICBT 6 sessions GAD-7”
BackgroundGuided self-help for generalized anxiety disorder in older adults.
Landreville, P., Gosselin, P., Grenier, S., Hudon, C., & Lorrain, D. (2016) · Aging & Mental Health · doi:10.1080/13607863.2015.1060945 · Cited by 14
“…these results are promising, but they are not clear if GSH is effective for GAD in older adults although there is evidence of the efficacy of CBT-GSH for GAD in younger adults (Paxling et al., 2011; Robinson et al., 2010; Titov, Andrews, Johnston, Robinson, & Spence, 2010; Titov et al., 2009).”
BackgroundPowell, C., Chiu, C.-Y., Sun, X.-Q., & So, S. (2024) · BMC Psychiatry · doi:10.1186/s12888-023-05306-6 · Cited by 13
Mackenzie, A., Harvey, S. B., Mewton, L. R., & Andrews, G. (2014) · The Medical Journal of Australia · doi:10.5694/mja14.00293 · Cited by 14
Self-citationTitov, N., Dear, B. F., Johnston, L., & Terides, M. (2012) · Revista de Psicopatología y Psicología Clínica · doi:10.5944/rppc.vol.17.num.3.2012.11842 · Cited by 13
Self-citationClarke, J., Vatiliotis, V., Verge, C. F., Holmes-Walker, D. J., Campbell, L. V., Wilhelm, K. A., & Proudfoot, J. G. (2015) · JMIR Research Protocols · doi:10.2196/resprot.4032 · Cited by 13
“It is used widely as a screening tool for depression, and is frequently included as outcome measures in studies of online interventions (eg, [36,37]).”
Significant events in an Internet‐delivered (Space from Depression) intervention for depression
Richards, D., Dowling, M., O'Brien, E., Viganò, N., & Timulak, L. (2018) · Counselling and Psychotherapy Research · doi:10.1002/capr.12142 · Cited by 13
“…(Baumeister, Reichler, Munzinger & Lin, 2014; Richards & Richardson, 2012), but the nature, type, duration of any support are still largely unanswered as it seems that a variety of implementations of support can achieve the same outcomes (Richards & Richardson, 2012; Titov et al., 2009, 2010).”
BackgroundFinding Web-Based Anxiety Interventions on the World Wide Web: A Scoping Review
Ashford, M. T., Olander, E. K., & Ayers, S. (2016) · JMIR Mental Health · doi:10.2196/mental.5349 · Cited by 11
“For This Way Up, a program targeted at generalized anxiety disorder, the intervention group participants showed significantly reduced symptoms of panic [81] and anxiety [82] at post-treatment compared to the control group.”
Rajeshkumar, L., Mishkind, M. C., Coleman, J. J., Pahwa, M., LaPreze, D., Solenske, S., & Wright, J. H. (2024) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000815 · Cited by 12
“61 The Worry Program , 64 – 66 a similar form of CCBT from the same group in Australia, is designed to build CBT skills for GAD, including modi fi cation of cognitions about worry and graded exposure.”
Distance Treatment of Obsessive–Compulsive Disorder
Wootton, B. M., & Titov, N. (2010) · Behaviour Change · doi:10.1375/bech.27.2.112 · Cited by 10
Self-citationWeb Based Interventions in Psychiatry: An Overview
Mehta, V. S., & Parakh, M. (2015) · International Journal of Mental Health & Psychiatry · doi:10.4172/2471-4372.1000108 · Cited by 10
“There is now evidence to suggest that Internet delivered CBT works for panic disorder [9,10], social anxiety disorder [11], generalized anxiety disorder [12], post-traumatic stress disorder [13], and specific phobia [8].”
BackgroundComputerised cognitive behavioural therapy: helping Ireland log on
Twomey, C., O'Reilly, G., & Byrne, M. (2013) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2012.5 · Cited by 11
Metadata
- Authors
- Titov, N., Andrews, G., Robinson, E., Schwencke, G., Johnston, L., Solley, K., & Choi, I.
- Affiliations
- UNSW Sydney (AU)
- St Vincent's Hospital Sydney (AU)
- Corresponding author
- Titov, Nickolai
- Venue
- Australian & New Zealand Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2009-01-01
- Volume
- 43
- Issue
- 10
- Pages
- 905-912
- ISSN
- 0004-8674 (ISSN-L)
- 1440-1614
- OpenAlex
- W2102373238
- Semantic Scholar
- 0c00964dd9a9544f82e95160878f9726632ce6dc
- Cited by
- 147
- References
- 53
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 6 · 2023: 5 · 2022: 11 · 2021: 4 · 2020: 10 · 2019: 6 · 2018: 9 · 2017: 6 · 2016: 7 · 2015: 14 · 2014: 12 · 2013: 13 · 2012: 13
- FWCI
- 14.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Australian & New Zealand Journal of Psychiatry (publishedVersion)
- Funders
- Australian Rotary Health
- University of New South Wales
- 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 › Telemedicine and Telehealth Implementation
- Keywords
- generalized anxiety disorder, online therapy, worry, depression, treatment acceptability
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