A RCT of a transdiagnostic internet-delivered treatment for three anxiety disorders: Examination of support roles and disorder-specific outcomes

Johnston, Luke; Titov, Nickolai; Andrews, Gavin; Spence, Jay; Dear, Blake F.

doi:10.1371/journal.pone.0028079

Cited by 150Digital Mental Health InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and Assessments

A RCT of a transdiagnostic internet-delivered treatment for three anxiety disorders: Examination of support roles and disorder-specific outcomes

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Johnston, Luke, Titov, Nickolai, Andrews, Gavin, Spence, Jay, Dear, Blake F.·2011·PLoS ONE

DOI 10.1371/journal.pone.0028079PMC PMC3223218

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Abstract

BACKGROUND: Anxiety disorders share common vulnerabilities and symptoms. Disorder-specific treatment is efficacious, but few access evidence-based care. Administering transdiagnostic cognitive-behavioral therapy via the internet (iCBT) may increase access to evidence-based treatment, with a recent randomized controlled trial (RCT) providing preliminary support for this approach. This study extends those findings and aims to answer three questions: Is a transdiagnostic iCBT program for anxiety disorders efficacious and acceptable? Does it result in change for specific disorders? Can good clinical outcomes be obtained when guidance is provided via a Coach rather than a Clinician? METHOD: RCT (N = 131) comparing three groups: Clinician-supported (CL) vs. Coach-supported (CO) vs. waitlist control (Control). Individuals met DSM-IV criteria for a principal diagnosis of generalized anxiety disorder (GAD), social phobia (SP) or panic disorder with or without agoraphobia (Pan/Ag). Treatment consisted of an 8-lesson/10 week iCBT program with weekly contact from a Clinician or Coach, and follow-up at 3-months post-treatment. RESULTS: Outcomes for the pooled treatment groups (CL+CO) were superior to the Control group on measures of anxiety, depression and disability, were associated with medium to large effect sizes (Cohen's d = .76-1.44) (response rate = 89-100%), and were maintained at follow-up. Significant reductions were found on disorder-specific outcomes for each of the target diagnoses, and were associated with large effect sizes. CO participants achieved similar outcomes to CL participants at post-treatment, yet had significantly lower symptom severity scores on general anxiety, panic-disorder, depression and disability at follow-up (d = .45-.46). Seventy-four percent of CO and 76% of CL participants completed the program. Less than 70 minutes of Clinician or Coach time was required per participant during the program. DISCUSSION: This transdiagnostic iCBT course for anxiety appears to be efficacious, associated with significant change for three target disorders, and is efficacious when guided by either a Clinician or Coach. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12610000242022.

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Previous studies have not found significant differences in acceptability or outcomes when support is offered by graduate student practitioners or registered healthcare professionals.
“Previous studies have not found significant differences in acceptability or outcomes when support is offered by either graduate student practitioners or registered healthcare professionals (e.g. Johnston et al., 2011).”
From Five-year observational study of Internet-delivered cognitive behavioural pain management when offered as routine care by an online therapy clinic (2022) · cites this paper as Johnston et al., 2011
The Results section reports no significant difference in satisfaction ratings between the Coach and Clinician groups, supporting the acceptability part. But it reports significant differences on some outcomes at post-treatment and three-month follow-up. The Methods section also identifies the Coach as a registered psychologist, not a graduate student practitioner; no page numbers are available in our copy. (LLM, conf=0.91)
Experimental — accuracy not yet measured
In RCTs, TD-CBT has been shown to be more effective than waitlist control in group-format and online delivery.
“In randomised controlled trials (RCTs) TD-CBT has been shown to be more effective compared to waitlist control (WLC) in group-format (controlled between-group ES: d = .50)(Erickson, Janeck, & Tallman, 2007) and online delivery (Johnston et al., 2011).”
From Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood (2015) · cites this paper as Johnston et al., 2011

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Self-citation
Internet-based behavioral activation and acceptance-based treatment for depression: A randomized controlled trial
Carlbring, P., Hägglund, M., Luthström, A., Dahlin, M., Kadowaki, Å., Vernmark, K., & Andersson, G. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.12.020 · Cited by 177 · see citing works
Meta-analysis of technology-assisted interventions for social anxiety disorder
Kampmann, I. L., Emmelkamp, P. M. G., & Morina, N. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.06.007 · Cited by 180 · see citing works
Guided Online or Face-to-Face Cognitive Behavioral Treatment for Insomnia: A Randomized Wait-List Controlled Trial
Lancee, J., van Straten, A., Nexhmedin Morina, B., Kaldo, V., & Kamphuis, J. H. (2015) · SLEEP · doi:10.5665/sleep.5344 · Cited by 173 · see citing works
Two decades of digital interventions for anxiety disorders: a systematic review and meta-analysis of treatment effectiveness
Pauley, D., Cuijpers, P., Papola, D., Miguel, C., & Karyotaki, E. (2021) · Psychological Medicine · doi:10.1017/s0033291721001999 · Cited by 170 · see citing works
Psychological and pharmacological treatments for generalized anxiety disorder (GAD): a meta-analysis of randomized controlled trials
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 · 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
“Similarly, the effect sizes for anxiety interventions reported here are consistent with controlled effect sizes reported for standardized CBT for various anxiety disorders (Hedman et al., 2011c; Johnston et al., 2011; Titov, Andrews, Johnston, Robinson, & Spence, 2010).”
Result
Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults
Olthuis, J. V., Watt, M. C., Bailey, K., Hayden, J. A., & Stewart, S. H. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011565 · Cited by 150 · see citing works
Implementation of Telemental Health Services Before COVID-19: Rapid Umbrella Review of Systematic Reviews
Barnett, P., Goulding, L., Casetta, C., Jordan, H., Sheridan-Rains, L., Steare, T., Williams, J., Wood, L., Gaughran, F., & Johnson, S. (2021) · Journal of Medical Internet Research · doi:10.2196/26492 · Cited by 136 · see citing works
Effectiveness of Transdiagnostic Cognitive Behaviour Therapy for Anxiety and Depression in Adults: A Systematic Review and Meta-analysis
Andersen, P., Toner, P., Bland, M., & McMillan, D. (2016) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465816000229 · Cited by 128 · see citing works
The efficacy of internet-delivered treatment for generalized anxiety disorder: A systematic review and meta-analysis
Richards, D., Richardson, T., Timulak, L., & McElvaney, J. (2015) · Internet Interventions · doi:10.1016/j.invent.2015.07.003 · Cited by 111 · see citing works
“Three studies (Andersson et al., 2012; Johnston et al., 2011; Robinson et al., 2010) had two active intervention conditions as they compared different types of internet-delivered therapy.”
BackgroundMethodResultInfluential
Media-delivered cognitive behavioural therapy and behavioural therapy (self-help) for anxiety disorders in adults
Mayo-Wilson, E., & Montgomery, P. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005330.pub4 · Cited by 112 · see citing works
Transdiagnostic versus disorder-specific and clinician-guided versus self-guided internet-delivered treatment for social anxiety disorder and comorbid disorders: a randomized controlled trial
Dear, B. F., Staples, L. G., Terides, M. D., Fogliati, V. J., Sheehan, J., Johnston, L., Kayrouz, R., Dear, R., McEvoy, P. M., & Titov, N. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.05.004 · Cited by 114 · see citing works
Motivational support provided via email improves the effectiveness of internet-delivered self-help treatment for insomnia: A randomized trial
Lancee, J., van den Bout, J., Sorbi, M. J., & van Straten, A. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2013.09.004 · Cited by 104 · see citing works
Internet-Based Therapy for Mild to Moderate Depression in Swedish Primary Care: Short Term Results from the PRIM-NET Randomized Controlled Trial
Kivi, M., Eriksson, M. C. M., Hange, D., Petersson, E.-L., Vernmark, K., Johansson, B., & Björkelund, C. (2014) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2014.921834 · Cited by 92 · see citing works
Treating anxiety and depression in older adults: randomised controlled trial comparing guided <i>V.</i> self-guided internet-delivered cognitive–behavioural therapy
Titov, N., Fogliati, V. J., Staples, L. G., Gandy, M., Johnston, L., Wootton, B., Nielssen, O., & Dear, B. F. (2016) · BJPsych Open · doi:10.1192/bjpo.bp.115.002139 · Cited by 93 · see citing works
Self-citation
Eficacia de la terapia cognitivo conductual transdiagnóstica en el tratamiento de la ansiedad y la depresión en adultos, niños y adolescentes: Un meta-análisis
García-Escalera, J., Chorot, P., Valiente, R. M., Reales, J. M., & Sandín, B. (2017) · Revista de Psicopatología y Psicología Clínica · doi:10.5944/rppc.vol.21.num.3.2016.17811 · Cited by 94 · see citing works
A Stress-Coping Model of Problem Online Video Game Use
Maroney, N., Williams, B. J., Thomas, A. C., Skues, J., & Moulding, R. (2018) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-018-9887-7 · Cited by 100 · see citing works
Effectiveness of transdiagnostic internet cognitive behavioural treatment for mixed anxiety and depression in primary care
Newby, J. M., Mewton, L. R., Williams, A. D., & Andrews, G. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.04.037 · Cited by 91 · see citing works
Self-citation
A systematic review and meta-analysis of transdiagnostic cognitive behavioural therapies for emotional disorders
Schaeuffele, C., Meine, L. E., Schulz, A., Weber, M. C., Moser, A., Paersch, C., Recher, D., Boettcher, J., Renneberg, B., Flückiger, C., et al. (2024) · Nature Human Behaviour · doi:10.1038/s41562-023-01787-3 · Cited by 91 · see citing works
Disorder-specific versus transdiagnostic and clinician-guided versus self-guided internet-delivered treatment for panic disorder and comorbid disorders: a randomized controlled trial
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
Improving Adherence and Clinical Outcomes in Self-Guided Internet Treatment for Anxiety and Depression: A 12-Month Follow-Up of a Randomised Controlled Trial
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
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Benefits of Individualized Feedback in Internet-Based Interventions for Depression: A Randomized Controlled Trial
Zagorscak, P., Heinrich, M., Sommer, D., Wagner, B., & Knaevelsrud, C. (2018) · Psychotherapy and Psychosomatics · doi:10.1159/000481515 · Cited by 77 · see citing works
Transdiagnostic internet-delivered CBT and mindfulness-based treatment for depression and anxiety: A randomised controlled trial
Kladnitski, N., Smith, J., Uppal, S., James, M. A., Allen, A. R., Andrews, G., & Newby, J. M. (2020) · Internet Interventions · doi:10.1016/j.invent.2020.100310 · Cited by 77 · see citing works
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A scoping review of human-support factors in the context of Internet-based psychological interventions (IPIs) for depression and anxiety disorders
Shim, M., Mahaffey, B., Bleidistel, M., & Gonzalez, A. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.09.003 · Cited by 72 · see citing works
Transdiagnostic case conceptualization of emotional problems in youth with ASD: An emotion regulation approach.
Weiss, J. A. (2014) · Clinical Psychology: Science and Practice · doi:10.1111/cpsp.12084 · Cited by 73 · see citing works
Up-scaling clinician assisted internet cognitive behavioural therapy (iCBT) for depression: A model for dissemination into primary care
Andrews, G., & Williams, A. D. (2014) · Clinical Psychology Review · doi:10.1016/j.cpr.2014.05.006 · Cited by 72 · see citing works
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Efficacy of App-Based Cognitive Behavioral Therapy for Body Dysmorphic Disorder with Coach Support: Initial Randomized Controlled Clinical Trial
Wilhelm, S., Weingarden, H. M., Greenberg, J. L., Hoeppner, S. S., Snorrason, Í., Bernstein, E. E., McCoy, T. H., & Harrison, O. (2022) · Psychotherapy and Psychosomatics · doi:10.1159/000524628 · Cited by 72 · see citing works
Digital Technologies in the Treatment of Anxiety: Recent Innovations and Future Directions
Firth, J., Torous, J., Carney, R., Newby, J., Cosco, T. D., Christensen, H., & Sarris, J. (2018) · Current Psychiatry Reports · doi:10.1007/s11920-018-0910-2 · Cited by 70 · see citing works
The efficacy of internet‐based cognitive behavioural therapy for social anxiety disorder: A systematic review and meta‐analysis
Guo, S., Deng, W., Wang, H., Liu, J., Liu, X., Yang, X., He, C., Zhang, Q., Liu, B., Dong, X., et al. (2020) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2528 · Cited by 72 · see citing works
Brief internet-delivered cognitive behavioral therapy for anxiety in older adults: A feasibility trial
Zou, J. B., Dear, B. F., Titov, N., Lorian, C. N., Johnston, L., Spence, J., Knight, R. G., Anderson, T. M., & Sachdev, P. S. (2012) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2012.04.002 · Cited by 71 · see citing works
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Trends in Psychiatry and Psychotherapy
(2020) · Trends in Psychiatry and Psychotherapy · doi:10.47626/2237-6089 · Cited by 70 · see citing works
Internet-Based Interventions for Social Anxiety Disorder - an Overview
Boettcher, J., Carlbring, P., Renneberg, B., & Berger, T. (2013) · Verhaltenstherapie · doi:10.1159/000354747 · Cited by 67 · see citing works
The effectiveness of Internet‐delivered treatment for generalized anxiety disorder: An updated systematic review and meta‐analysis
Eilert, N., Enrique, A., Wogan, R., Mooney, O., Timulak, L., & Richards, D. (2021) · Depression and Anxiety · doi:10.1002/da.23115 · Cited by 60 · see citing works
“D 25.25 (9.7) ‐ ‐ Dahlin et al. (2016) GAD‐7 13.67 (3.9) PHQ‐9 11.29 (4.78) PSWQ 67.17 (6.97) Dear et al. (2015) GAD‐7 12.26 (4.83) PHQ‐9 10.86 (4.37) ‐ ‐ Hirsch et al. (2018) GAD‐7 14.28 (3.32) PHQ‐9 13.14 (4.19) PSWQ 68.29 (6.38) Johansson et al. (2013) GAD‐7 12.67 (3.18) PHQ‐9 13.3 (3.74) ‐ ‐ L. Johnston et al. (20…”
BackgroundInfluential
Current perspectives on Internet delivered cognitive behavioral therapy for adults with anxiety and related disorders
Mewton, L., Smith, J., Rossouw, P., & Andrews, G. (2014) · Psychology Research and Behavior Management · doi:10.2147/prbm.s40879 · Cited by 57 · see citing works
Self-citation
Internet-Delivered Cognitive Behavioral Therapy for Anxiety Disorders in Open Community Versus Clinical Service Recruitment: Meta-Analysis
Romijn, G., Batelaan, N., Kok, R., Koning, J., van Balkom, A., Titov, N., & Riper, H. (2019) · Journal of Medical Internet Research · doi:10.2196/11706 · Cited by 52 · see citing works
Self-citation
The pain course: a randomised controlled trial comparing a remote-delivered chronic pain management program when provided in online and workbook formats
Dear, B. F., Gandy, M., Karin, E., Ricciardi, T., Fogliati, V. J., McDonald, S., Staples, L. G., Perry, K. N., Sharpe, L., Nicholas, M. K., et al. (2017) · Pain · doi:10.1097/j.pain.0000000000000916 · Cited by 57 · see citing works
Self-citation
Dropping out of a transdiagnostic online intervention: A qualitative analysis of client's experiences
Fernández-Álvarez, J., Díaz-García, A., González-Robles, A., Baños, R., García-Palacios, A., & Botella, C. (2017) · Internet Interventions · doi:10.1016/j.invent.2017.09.001 · Cited by 60 · see citing works
A Psychodynamic Perspective on a Systematic Review of Online Psychotherapy for Adults
Machado, D. D. B., Laskoski, P. B., Severo, C. T., Bassols, A. M. S., Sfoggia, A., Kowacs, C., Krieger, D. V., Torres, M. B., Gastaud, M. B., Wellausen, R. S., et al. (2016) · British Journal of Psychotherapy · doi:10.1111/bjp.12204 · Cited by 59 · see citing works
Man vs. machine: A meta-analysis on the added value of human support in text-based internet treatments (“e-therapy”) for mental disorders
Koelen, J. A., Vonk, A., Klein, A. M., de Koning, L., Vonk, P., Vet, S. D., & Wiers, R. W. H. J. (2022) · Clinical Psychology Review · doi:10.1016/j.cpr.2022.102179 · Cited by 56 · see citing works
Human Support in App-Based Cognitive Behavioral Therapies for Emotional Disorders: Scoping Review
Bernstein, E. E., Weingarden, H. M., Wolfe, E. C., Hall, M. D., Snorrason, Í., & Wilhelm, S. (2022) · Journal of Medical Internet Research · doi:10.2196/33307 · Cited by 55 · 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
Internet-assisted cognitive behavioral therapy
Andersson, G., & Carlbring, P. (2017) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2017.08.004 · Cited by 45 · see citing works
Comorbidity and Internet-Delivered Transdiagnostic Cognitive Behavioural Therapy for Anxiety Disorders
Johnston, L., Titov, N., Andrews, G., Dear, B. F., & Spence, J. (2013) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2012.753108 · Cited by 44 · see citing works
Self-citation
Transdiagnostic treatment using a unified protocol: application for patients with a range of comorbid mood and anxiety disorders
Maia, A. C. C. D. O., Braga, A. A., Nunes, C. A., Nardi, A. E., & Silva, A. C. (2013) · Trends in Psychiatry and Psychotherapy · doi:10.1590/s2237-60892013000200007 · Cited by 43 · see citing works
A Pilot Theory–Based Intervention to Improve Resilience, Psychosocial Well-Being, and Quality of Life Among People Living With HIV in Rural China
Yu, N. X., Lau, J. T. F., Mak, W. W. S., Cheng, Y., Lv, Y., & Zhang, J. (2013) · Journal of Sex & Marital Therapy · doi:10.1080/0092623x.2012.668512 · Cited by 42 · see citing works
Audiologist-Supported Internet-Based Cognitive Behavioral Therapy for Tinnitus in the United States: A Pilot Trial
Beukes, E. W., Andersson, G., Fagelson, M., & Manchaiah, V. (2021) · American Journal of Audiology · doi:10.1044/2021_aja-20-00222 · Cited by 34 · see citing works
Exploring the efficacy and acceptability of Internet-delivered cognitive behavioural therapy for young adults with anxiety and depression: An open trial
Johnston, L., Dear, B. F., Gandy, M., Fogliati, V. J., Kayrouz, R., Sheehan, J., Rapee, R. M., & Titov, N. (2014) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867414527524 · Cited by 36 · see citing works
Self-citation
Adaptive Elements in Internet-Delivered Psychological Treatment Systems: Systematic Review
Mukhiya, S. K., Wake, J. D., İnal, Y., Pun, K. I., & Lamo, Y. (2020) · Journal of Medical Internet Research · doi:10.2196/21066 · Cited by 32 · see citing works
A randomized controlled trial of a transdiagnostic Internet intervention for individuals with panic and phobias – one size fits all
Schröder, J., Jelinek, L., & Moritz, S. (2017) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2016.05.002 · Cited by 32 · see citing works
Improvement in quality of life and sexual functioning in a comorbid sample after the unified protocol transdiagnostic group treatment
Maia, A. C. C. D. O., Sanford, J., Boettcher, H. T., Nardi, A. E., & Barlow, D. H. (2017) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2017.05.013 · Cited by 32 · see citing works
Online mindfulness-enhanced cognitive behavioural therapy for anxiety and depression: Outcomes of a pilot trial
Kladnitski, N., Smith, J., Allen, A., Andrews, G., & Newby, J. M. (2018) · Internet Interventions · doi:10.1016/j.invent.2018.06.003 · Cited by 31 · see citing works
“Transdiagnostic iCBT programs have been shown to be effective in the treatment of mixed and comorbid anxiety disorders (Johnston et al., 2011; Titov et al., 2010; Nordgren et al., 2014), as well as anxiety co-morbid with depression (Titov et al.”
BackgroundSelf-citation
TRANSDIAGNOSTIC INTERNET TREATMENT FOR ANXIETY AND DEPRESSION
Titov, N., Dear, B. F., Johnston, L., & Terides, M. D. (2012) · Revista de Psicopatología y Psicología Clínica · Cited by 31 · see citing works
Self-citation
Online physical activity interventions for mental disorders: A systematic review
Rosenbaum, S., Newby, J. M., Steel, Z., Andrews, G., & Ward, P. B. (2015) · Internet Interventions · doi:10.1016/j.invent.2015.04.001 · Cited by 29 · see citing works
Self-citation
Comorbidity and diagnosis distribution in transdiagnostic treatments for emotional disorders: A systematic review of randomized controlled trials
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
A feasibility open trial of internet-delivered cognitive-behavioural therapy (iCBT) among consumers of a non-governmental mental health organisation with anxiety
Kirkpatrick, T., Manoukian, L., Dear, B. F., Johnston, L., & Titov, N. (2013) · PeerJ · doi:10.7717/peerj.210 · Cited by 29 · see citing works
Reducing the burden of dizziness in middle-aged and older people: A multifactorial, tailored, single-blind randomized controlled trial
Menant, J. C., Migliaccio, A. A., Sturnieks, D. L., Hicks, C., Lo, J. C. M., Ratanapongleka, M., Turner, J., Delbaere, K., Titov, N., Meinrath, D., et al. (2018) · PLoS Medicine · doi:10.1371/journal.pmed.1002620 · Cited by 28 · see citing works
Self-citation
Is online treatment adherence affected by presentation and therapist support? A randomized controlled trial
Alfonsson, S., Olsson, E. M. G., Linderman, S., Winnerhed, S., & Hursti, T. J. (2016) · Computers in Human Behavior · doi:10.1016/j.chb.2016.01.035 · Cited by 25 · see citing works
Internet-Based Cognitive Behavior Therapy
Andersson, G., Carlbring, P., & Hadjistavropoulos, H. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-803457-6.00021-0 · Cited by 24 · see citing works
Are 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 · see citing works
An Evaluation of the Effectiveness of a Transdiagnostic Bibliotherapy Program for Anxiety and Related Disorders: Results From Two Studies Using a Benchmarking Approach
Wootton, B. M., Steinman, S. A., Czerniawski, A., Norris, K., Baptie, C., Diefenbach, G., & Tolin, D. F. (2018) · Cognitive Therapy and Research · doi:10.1007/s10608-018-9921-x · Cited by 19 · see citing works
“While there is currently significant data on the effectiveness of transdiagnostic ICBT for the treatment of anxiety disorders (Dear et al. 2016, 2015; Johnston et al. 2011; Titov et al. 2010), there are currently no studies to date looking at the effectiveness and acceptability of a more pragmatic approach in the trea…”
Background
Effectiveness, acceptability and feasibility of an Internet-delivered cognitive behavioral pain management program in a routine online therapy clinic in Canada
Hadjistavropoulos, H. D., Schneider, L. H., Hadjistavropoulos, T., Titov, N., & Dear, B. F. (2018) · Canadian Journal of Pain · doi:10.1080/24740527.2018.1442675 · Cited by 18 · see citing works
Self-citation
Dissemination of an Online Theory-Based Intervention to Improve Gluten-Free Diet Adherence in Coeliac Disease: the Relationship Between Acceptability, Effectiveness, and Attrition
Sainsbury, K., Mullan, B. A., & Sharpe, L. (2014) · International Journal of Behavioral Medicine · doi:10.1007/s12529-014-9416-4 · Cited by 17 · see citing works
Five-year observational study of Internet-delivered cognitive behavioural pain management when offered as routine care by an online therapy clinic
Hadjistavropoulos, H. D., Peynenburg, V., Thiessen, D., Schneider, L. H., Nugent, M., Wilhelms, A., Karin, E., Titov, N., & Dear, B. F. (2022) · European Journal of Pain · doi:10.1002/ejp.1866 · Cited by 16 · see citing works
Self-citation
Implementing referral to an electronic alcohol brief advice website in primary healthcare: results from the ODHIN implementation trial
Bendtsen, P., Müssener, U., Karlsson, N. E., López‐Pelayo, H., Vieira, J. A. P., Colom, J., Gual, A., Reynolds, J., Wallace, P., Segura, L., et al. (2016) · BMJ Open · doi:10.1136/bmjopen-2015-010271 · Cited by 16 · see citing works
Widening Access to Treatment for Alcohol Misuse: Description and Formative Evaluation of an Innovative Web-Based Service in One Primary Care Trust
Murray, E., Linke, S., Harwood, E., Conroy, S., Stevenson, F. A., & Godfrey, C. (2012) · Alcohol and Alcoholism · doi:10.1093/alcalc/ags096 · Cited by 16 · see citing works
Worry-specific versus self-tailored internet-based treatments for generalized anxiety disorder, with scheduled support or support on demand: A pilot factorial design trial
Dahlin, M., Johansson, A., Romare, H., Carlbring, P., & Andersson, G. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100531 · Cited by 15 · see citing works
The impact of technology systems and level of support in digital mental health interventions: a secondary meta-analysis
Sasseville, M., LeBlanc, A., Tchuente, J., Boucher, M., Dugas, M., Mbemba, G. I. C., Barony, R., Chouinard, M., Beaulieu, M., Beaudet, N., et al. (2023) · Systematic Reviews · doi:10.1186/s13643-023-02241-1 · Cited by 16 · see citing works
A randomized clinical trial of behavioral activation and exposure-based therapy for adults with generalized anxiety disorder
Berg, H. E., Akeman, E., McDermott, T. J., Cosgrove, K. T., Kirlić, N., Clausen, A. N., Cannon, M., Yeh, H., White, E. J., Thompson, W. K., et al. (2023) · Journal of Mood and Anxiety Disorders · doi:10.1016/j.xjmad.2023.100004 · Cited by 14 · see citing works
Transdiagnostic internet treatment for anxiety and depression = Tratamiento transdiagnóstico por internet de la ansiedad y la depresión
Titov, 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 · see citing works
Self-citation
Efficacy of an Internet- and Mobile-Based Intervention for Subclinical Anxiety and Depression (ICare Prevent) with Two Guidance Formats: Results from a Three-Armed Randomized Controlled Trial
Zarski, A.-C., Weisel, K. K., Berger, T., Krieger, T., Schaub, M. P., Berking, M., Görlich, D., Jacobi, C., & Ebert, D. D. (2024) · Psychotherapy and Psychosomatics · doi:10.1159/000536149 · Cited by 13 · see citing works
Internet-Based Cognitive Behavior Therapy for Social Anxiety Disorder
Hedman‐Lagerlöf, E., Botella, C., & Berger, T. (2016) · Springer eBooks · doi:10.1007/978-3-319-06083-5_4 · Cited by 12 · see citing works
A pilot evaluation of the AfterDeployment.org online posttraumatic stress workshop for military service members and veterans.
Bush, N. E., Prins, A., Laraway, S., O'Brien, K., Ruzek, J. I., & Ciulla, R. (2013) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/a0032179 · Cited by 11 · see citing works
Individually tailored internet-based cognitive behavioural therapy for anxiety disorders
Nordgren, L. B. (2013) · Linköping University Electronic Press eBooks · doi:10.3384/diss.diva-100969 · Cited by 11 · see citing works
Technology-based cognitive behavioral therapy interventions
Newby, J. M., Upton, E., Mason, E., & Black, M. (2024) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2024.02.004 · Cited by 11 · see citing works
Internet‐Delivered Treatments for Social Anxiety Disorder
Andersson, G., Carlbring, P., & Furmark, T. (2014) · Wiley eBooks · doi:10.1002/9781118653920.ch26 · Cited by 10 · see citing works
Web-Based Interventions to Help Australian Adults Address Depression, Anxiety, Suicidal Ideation, and General Mental Well-being: Scoping Review
Skaczkowski, G., van der Kruk, S., Loxton, S., Hughes-Barton, D., Howell, C., Turnbull, D., Jensen, N., Smout, M., & Gunn, K. (2022) · JMIR Mental Health · doi:10.2196/31018 · Cited by 9 · see citing works
“A rapid review of the evidence for each of these programs’ evaluations is provided in Multimedia Appendix 4 [10,12,17,42-151].”
Background
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
Efficacy of internet-delivered universal and tailored transdiagnostic interventions for anxiety and depression: A systematic review and meta-analysis of randomized controlled trials
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Transdiagnostic, internet-delivered cognitive behavior therapy for depression and anxiety: Exploring impact on health anxiety
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Self-citation

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
Self-citation
Development and evaluation of a transdiagnostic internet-delivered cognitive behavioural therapy program for three anxiety disorders
Johnston, L. J. (2022) · UNSWorks (University of New South Wales, Sydney, Australia) · doi:10.26190/unsworks/15695
Self-citation
Transdiagnostic internet treatment for anxiety and depression: a randomised controlled trial
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Anxiety unplugged: Effectiveness of an unguided, transdiagnostic, web-based intervention for anxiety disorders—A randomized controlled trial
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Self-citation

Authors: Johnston, L., Titov, N., Andrews, G., Spence, J., & Dear, B. F.
Affiliations: UNSW Sydney (AU)
Macquarie University (AU)
Corresponding author: Johnston, Luke
ORCID: Titov, Nickolai
Andrews, Gavin
Dear, Blake F.
Venue: PLoS ONE
Publisher: Public Library of Science (PLoS)
Published: 2011-11-23
Volume: 6
Issue: 11
Pages: e28079
ISSN: 1932-6203 (ISSN-L)
DOI: 10.1371/journal.pone.0028079
PMC: PMC3223218
OpenAlex: W2006280171
Cited by: 150
References: 62
Citations by year: 2026: 2 · 2025: 6 · 2024: 10 · 2023: 11 · 2022: 9 · 2021: 9 · 2020: 12 · 2019: 6 · 2018: 11 · 2017: 7 · 2016: 15 · 2015: 13 · 2014: 18 · 2013: 15 · 2012: 6
FWCI: 16.59
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (unspecified)
Locations: PLoS ONE (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
RePEc: Research Papers in Economics (submittedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Figshare (submittedVersion, cc-by)
Funders: New South Wales Institute of Psychiatry
Australian Rotary Health
University of New South Wales
Medical Research Council
National Health and Medical Research Council
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 › Psychological Treatments and Assessments
Keywords: transdiagnostic cognitive behavioral therapy, internet-delivered treatment, anxiety disorders, generalized anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, treatment acceptability, treatment efficacy, depression, disability
MeSH terms: Adult, Anxiety Disorders, Demography, Female, Humans, Male, Patient Compliance, Social Support, Comorbidity, Cognitive Behavioral Therapy, Case-Control Studies, Treatment Outcome, Internet

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A RCT of a transdiagnostic internet-delivered treatment for three anxiety disorders: Examination of support roles and disorder-specific outcomes

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