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A RCT of a Transdiagnostic Internet-Delivered Treatment for Three Anxiety Disorders: Examination of Support Roles and Disorder-Specific Outcomes
Open accessAbstract
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 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
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“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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Cited by
Sorted by citations
The impact of guidance on Internet-based mental health interventions — A systematic review
Baumeister, H., Reichler, L., Munzinger, M., & Lin, J. (2014) · Internet Interventions · doi:10.1016/j.invent.2014.08.003 · Cited by 1,037
“Titov et al. (2010), compared guidance from a qualified clinical psychologist (Johnston et al., 2011) respectively qualified psychiatrist (Titov et al., 2010) with guidance provided by an administration employee without clinical experience.”
BackgroundMethodInfluentialHedman, E., Ljótsson, B., & Lindefors, N. (2012) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1586/erp.12.67 · Cited by 672
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
Psychological treatment of generalized anxiety disorder: A meta-analysis
Cuijpers, P., Sijbrandij, M., Koole, S., Huibers, M., Berking, M., & Andersson, G. (2014) · Clinical Psychology Review · doi:10.1016/j.cpr.2014.01.002 · Cited by 527
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. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011565.pub2 · Cited by 390
Metadata
- Authors
- Johnston, L., Titov, N., Andrews, G., Spence, J., & Dear, B. F.
- Affiliations
- UNSW Sydney (AU)
- Macquarie University (AU)
- Corresponding author
- Johnston, Luke
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2011-11-23
- Volume
- 6
- Issue
- 11
- Pages
- e28079
- ISSN
- 1932-6203 (ISSN-L)
- 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
- 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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