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Efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders: systematic review
Open accessAbstract
Background: Self-help interventions for psychiatric disorders represent an increasingly popular alternative to therapist-administered psychological therapies, offering the potential of increased access to cost-effective treatment. Aims: To determine the efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders. Method: Randomised controlled trials (RCTs) of self-help interventions for anxiety disorders were identified by searching nine online databases. Studies were grouped according to disorder and meta-analyses were conducted where sufficient data were available. Overall meta-analyses of self-help v.waiting list and therapist-administered treatment were also undertaken. Methodological quality was assessed independently by two researchers according to criteria set out by the Cochrane Collaboration. Results: Thirty-one RCTs met inclusion criteria for the review. Results of the overall meta-analysis comparing self-help with waiting list gave a significant effect size of 0.84 in favour of self-help. Comparison of self-help with therapist-administered treatments revealed a significant difference in favour of the latter with an effect size of 0.34. The addition of guidance and the presentation of multimedia or web-based self-help materials improved treatment outcome. Conclusions: Self-help interventions appear to be an effective way of treating individuals diagnosed with social phobia and panic disorder. Further research is required to evaluate the cost-effectiveness and acceptability of these interventions.
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“When using bibliotherapy, providing information all at one time was as effective as pacing [157], and therapist support does not appear to be essential [75,158].”
From Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders (2014) · cites this paper as [75]
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“In addition, the main advantages are its ease of use, low cost, low staffing demands, and greater privacy.26,27”
From Comparative efficacy and acceptability of bibliotherapy for depression and anxiety disorders in children and adolescents: a meta-analysis of randomized clinical trials (2018) · cites this paper as [26]
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“A more recent meta-analysis of self-help interventions for anxiety disorders (Lewis et al., 2012) showed a greater reduction in anxiety symptoms for self-help interventions versus waiting-list conditions (Cohen's d = 0.84).”
From Self-help interventions to reduce self-stigma in people with mental health problems: A systematic literature review (2020) · cites this paper as Lewis et al., 2012
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“However, when self-help interventions were compared with therapist-administered interventions, results revealed a significant difference in treatment efficacy in favour of therapist-guided treatment ( d = 0.34).”
From Self-help interventions to reduce self-stigma in people with mental health problems: A systematic literature review (2020) · cites this paper as Lewis et al., 2012
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“These effects were somewhat smaller than those reported in other recent reviews [17, 19–22] and also smaller than the large effect sizes for Internet-based ACT (0.80 and 0.87) in the study of Fledderus et al. [40] and for Internet-based CBT for anxiety complaints in older adults (1.43) in the study of Dear et al. [26].”
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“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 [75]
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Metadata
- Authors
- Lewis, C., Pearce, J., & Bisson, J. I.
- Affiliations
- Cardiff University (GB)
- Corresponding author
- Lewis, Catrin
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2012-01
- Volume
- 200
- Issue
- 1
- Pages
- 15-21
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2166049192
- Cited by
- 189
- References
- 42
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 10 · 2023: 9 · 2022: 11 · 2021: 16 · 2020: 5 · 2019: 11 · 2018: 20 · 2017: 17 · 2016: 21 · 2015: 20 · 2014: 20 · 2013: 16 · 2012: 3
- FWCI
- 4.29
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- 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 › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- self-help intervention, anxiety disorders, social anxiety disorder, panic disorder, cost-effectiveness, acceptability, waiting list comparison, treatment efficacy
- MeSH terms
- Anxiety Disorders, Cost-Benefit Analysis, Health Services Accessibility, Humans, Mental Health Services, Patient Acceptance of Health Care, Self Care, Waiting Lists, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Databases, Bibliographic, Treatment Outcome
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