Skip to main content Accessibility help

A Feasibility Open Trial of a Brief Internet-Delivered Written Exposure Therapy for Worry

  • Margaux Roch-Gagné (a1) and France Talbot (a1)


Background: Cognitive exposure, a treatment of choice for hypothetical fears, involves listening repeatedly to a recorded scenario of one's worst hypothetical fear. A major limitation, however, is that the script cannot be easily modified. Aims: The current study assessed the feasibility of a brief guided internet-based written exposure therapy (iWET) for hypothetical fears, Mind at Peace. Method: Fifty-three adults presenting clinical levels of anxiety (GAD-7 ≥ 8) and worry (PSWQ ≥ 45) were recruited. A single group pre-test/post-test design including a 3-month follow-up was used. Mind at Peace is a 6-week iWET consisting of psychoeducation and five 30-minute weekly writing exposure sessions. Feasibility outcome measures included treatment adherence, attrition, treatment acceptability and preliminary efficacy. Primary outcome measures were the Generalized Anxiety Disorder-7 (GAD-7) and the Penn State Worry Questionnaire (PSWQ). Results: Attrition was higher (57%) and adherence lower (28%) than expected. Intent-to-treat repeated measures ANOVAs revealed significant and large improvements on the GAD-7 (ƞp2 = 0.36) and the PSWQ (ƞp2 = 0.23) with similar findings among study completers. Remission rates were higher on the GAD-7 than on the PSWQ, suggesting that Mind at Peace may primarily target general symptoms of generalized anxiety. Rates of acceptability varied, but nearly all study completers reported that they would recommend this treatment to a friend. Conclusions: This study provided valuable information on Mind at Peace. Methodological changes are proposed to improve its feasibility. A more definitive trial incorporating suggested methodological improvements is recommended.


Corresponding author

Correspondence to: France Talbot, E-mail:


Hide All
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Arlington, VA: American Psychiatric Association.
Andersson, G. and Titov, N. (2014). Advantages and limitations of Internet-based interventions for common mental disorders. World Psychology, 13, 411. doi: 10.1002/wps.20083
Andrews, G., Cuijpers, P., Craske, M. G., McEvoy, P. and Titov, N. (2010). Computer therapy for the anxiety and depressive disorders is effective, acceptable, and practical health care: a meta-analysis. PLoS One, 5, e13196. doi: 10.1371/journal.pone.0013196
Behar, E., Alcaine, O., Zuellig, A. R. and Borkovec, T. D. (2003). Screening for generalized anxiety disorder using the Penn State Worry Questionnaire: a receiver operating characteristic analysis. Journal of Behavior Therapy and Experimental Psychiatry, 34, 2543. doi: 10.1016/S0005-7916(03)00004-1
Blais, M. R., Vallerand, R. J., Pelletier, L. G. and Brière, N. M. (1989). L’Échelle de satisfaction de vie: validation canadienne-française du ‘Satisfaction With Life Scale.’ Canadian Journal of Behavioural Science, 21, 210223.
Carlbring, P., Bohman, S., Brunt, S., Buhrman, M., Westling, B. E., Ekselius, L. and Andersson, G. (2006). Remote treatment of panic disorder: a randomized trial of internet-based cognitive behaviour therapy supplemented with telephone calls. The American Journal of Psychiatry, 163, 21192125.
Dear, B. F., Titov, N., Sunderland, M., McMillan, D., Anderson, T., Lorian, C. and Robinson, E. (2011). Psychometric comparison of the Generalized Anxiety Disorder Scale-7 and the Penn State Worry Questionnaire for measuring response during treatment of generalized anxiety disorder. Cognitive Behaviour Therapy, 40, 216227. doi: 10.1080/16506073.2011.582138
Diener, E., Emmons, R. A., Larsen, R. J. and Griffin, S. (1985). The Satisfaction With Life Scale. Journal of Personality Assessment, 49, 7175.
Donker, T., Griffiths, K. M., Cuijpers, P. and Christensen, H. (2009). Psychoeducation for depression, anxiety and psychological distress: a meta-analysis. BMS Medicine, 7. doi: 10.1186/1741-7015-7-79
Dugas, M. J., Brillon, P., Savard, P., Turcotte, J., Gaudet, A., Ladouceur, R. et al. (2010). A randomized clinical trial of cognitive-behavioural therapy and applied relaxation for adults with generalized anxiety disorder. Behavior Therapy, 41, 4658. doi: 10.1016/j.beth.2008.12.004
Dugas, M. J. and Ladouceur, R. (2000). Treatment of GAD: targeting intolerance of uncertainty in two types of worry. Behavior Modification, 24, 635657.
Dugas, M. J., Ladouceur, R., Léger, E., Freeston, M. H., Langlois, F., Provencher, M. D. and Boisvert, J.-M. (2003). Group cognitive-behavioral therapy for generalized anxiety disorder: treatment outcome and long-term follow-up. Journal of Consulting and Clinical Psychology, 71, 821825. doi: 10.1037/0022-006X.71.4.82
Dugas, M. J. and Robichaud, M. (2007). Cognitive-Behavioral Treatment for Generalized Anxiety Disorder: From Science to Practice (pp. 156157). New York, NY: Routledge.
Eldridge, S. M., Chan, C. L., Campbell, M. J., Bond, C. M., Hopewell, S., Thabane, L. and Lancaster, G. A. (2016). CONSORT 2010 statement: extension to randomised pilot and feasibility trials. Pilot and Feasibility Studies, 2. doi: 10.1186/s40814-016-0105-8
Fracalanza, K., Koerner, N. and Antony, M. (2014). Testing a procedural variant of written imaginal exposure for generalized anxiety disorder. Journal of Anxiety Disorders, 28, 559569. doi: 10.1016/j.janxdis.2014.05.011
Goldman, N., Dugas, M. J., Sexton, K. A. and Gervais, N. J. (2007). The impact of written exposure on worry: a preliminary investigation. Behavior Modification, 31, 512538. doi: 10.1177/0145445506298651
Gosselin, E., Dugas, M. J., Ladouceur, R. and Freeston, M. H. (2001). L’Évaluation des inquiétudes: validation d'une traduction française du Penn State Worry Questionnaire [Assessment of worry: validation of a french translation of the Penn State Worry Questionnaire]. L'Encéphale, 27, 475484.
Hoyer, J., Beesdo, K., Gloster, A. T., Runge, J., Höfler, M. and Becker, E. S. (2009). Worry exposure versus applied relaxation in the treatment of generalized anxiety disorder. Psychotherapy and Psychosomatics, 78, 106115. doi: 10.1159/000201936
Kanevelrsrud, C., Brand, J., Lange, A., Ruwaard, J. and Wagner, B. (2015). Web-based psychotherapy for posttraumatic stress disorder in war-traumatized Arab patients: randomized controlled trial. Journal of Medical Internet Research, 17. doi: 10.2196/jmir.3582
Knaevelsrud, C. and Maercker, A. (2007). Internet-based treatment for PTSD reduces distress and facilitates the development of a strong therapeutic alliance: a randomized controlled clinical trial. BioMed Central Psychiatry, 7. doi: 10.1186/1471-244X-7-13
Kroenke, K., Spitzer, R. L. and Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606613.
Kroenke, K., Spitzer, R. L., Williams, J. B., Monahan, P. O. and Löwe, B. (2007). Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146, 317325.
Ladouceur, R., Dugas, M. J., Freeston, M. H., Léger, E., Gagnon, F. and Thibodeau, N. (2000). Efficacy of a cognitive-behavioral treatment for generalized anxiety disorder: evaluation in a controlled clinical trial. Journal of Consulting and Clinical Psychology, 68, 957964. doi: 10.1037//0022-006X.68.6.957
MAPI Research Institute (2016). MAPI Health Research and Commercialization. Retrieved from:
Meares, K. and Freeston, M. (2015). Overcoming Worry and Generalised Anxiety Disorder: A Self-Help Guide using Cognitive Behavioural Techniques (pp. 106107). London, UK: Robinson.
Meyer, T. J., Miller, M. L., Metzger, R. L. and Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behavior Research Therapy, 28, 487495.
Nordin, S., Carlbring, P., Cuijpers, P. and Andersson, G. (2010). Expanding the limits of bibliotherapy for panic disorder: randomized trial for self-help without support but with a clear deadline. Behavior Therapy, 41, 267276.
Olthuis, J. V., Watt, M. C., Bailey, K., Hayden, J. A. and Stewart, S. H. (2016). Therapist-supported internet cognitive behavioural therapy for anxiety disorders in adults (review). Cochrane Database of Systematic Reviews, 3. doi: 10.1002/14651858.CD011565.pub2
Paxling, B., Almlöv, J., Dahlin, M., Carlbring, P., Breitholtz, E., Eriksson, T. and Andersson, G. (2011). Guided internet-delivered cognitive behavior therapy for generalized anxiety disorder: a randomized controlled trial. Behaviour Therapy, 40, 159173. doi: 10.1080/16506073.2011.576699
Pennebaker, J. W. and Beall, S. K. (1986). Confronting a traumatic event: toward an understanding of inhibition and disease. Journal of Abnormal Psychology, 95, 274281.
Provencher, M. D., Dugas, M. J. and Ladouceur, R. (2004). Efficacy of problem-solving training and cognitive exposure in the treatment of generalized anxiety disorder: a case replication series. Cognitive and Behavioral Practice, 11, 404414.
Ruwaard, J. and Lange, A. (2016). Online structured writing therapy for post-traumatic stress disorder and complicated grief. In Lindefors, N. and Andersson, G. (eds), Guided Internet-Based Treatments in Psychiatry (pp. 121141). Switzerland: Springer International Publishing. doi: 10.1007/978-3-319-06083-5_7
Ruwaard, J., Lange, A., Schrieken, B., Dolan, C. V. and Emmelkamp, P. (2012). The effectiveness of online cognitive behavioral treatment in routine clinical practice. PLoS ONE, 7: e40089. doi: 10.1371/journal.pone.0040089
Sloan, D. M., Lee, D. J., Litwack, S. D., Sawyer, A. T. and Marx, B. P. (2013). Written exposure therapy for veterans diagnosed with PTSD: a pilot study. Journal of Traumatic Stress, 26, 776779. doi: 10.1002/jts.21858
Sloan, D. M., Marx, B. P., Bovin, M. J., Feinstein, B. A. and Gallagher, M. W. (2012). Written exposure as an intervention for PTSD: a randomized clinical trial with motor vehicle accident survivors. Behaviour Research and Therapy, 50, 627635. doi: 10.1016/j.brat.2012.07.001
Sloan, D. M., Marx, B. P. and Greenberg, E. M. (2011). A test of written emotional disclosure as an intervention for posttraumatic stress disorder. Behaviour Research and Therapy, 49, 299304. doi: 10.1016/j.brat.2011.02.001
Spek, V., Cuijpers, P., Nyklicek, I., Riper, H., Keyzer, J. and Pop, V. (2007). Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychological Medicine, 37, 319328. doi: 10.1017/S0033291706008944
Spitzer, R. L., Kroenke, K., Williams, J. B. and Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder. Archives of Internal Medicine, 166, 10921097.
Titov, N., Andersson, G. and Paxling, B. (2016). ICBT in psychiatry: Generalised Anxiety Disorder. In Lindefors, N. and Andersson, G. (eds), Guided Internet-Based Treatments in Psychiatry (pp. 79100). Switzerland: Springer International Publishing. doi: 10.1007/978-3-319-06083-5_5
Titov, N., Andrews, G., Johnston, L., Robinson, E. and Spence, J. (2010). Transdiagnostic internet treatment for anxiety disorders: a randomized controlled trial. Behaviour Research and Therapy, 48, 890899.
Titov, N., Dear, B. F., Johnston, L., Lorian, C., Zou, J., Wootton, B. et al. (2013). Improving adherence and clinical outcomes in self-guided internet treatment for anxiety and depression: randomised controlled trial. PLoS ONE, 8, e62873. doi: 10.1371/journal.pone.0062873
Titov, N., Dear, B. F., Schwencke, G., Andrews, G., Johnston, L., Craske, M. G. and McEvoy, P. (2011). Transdiagnostic internet treatment for anxiety and depression: a randomised controlled trial. Behaviour Research and Therapy, 49, 441452. doi:10.1016/j.brat.2011.03.007
Yardley, L., Spring, B. J., Riper, H., Morrison, L. G., Crane, D. H., Curtis, K. et al. (2016). Understanding and promoting effective engagement with digital behavior change interventions. American Journal of Preventive Medicine, 51, 833842. doi: 10.1016/j.amepre.2016.06.015
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Behavioural and Cognitive Psychotherapy
  • ISSN: 1352-4658
  • EISSN: 1469-1833
  • URL: /core/journals/behavioural-and-cognitive-psychotherapy
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

A Feasibility Open Trial of a Brief Internet-Delivered Written Exposure Therapy for Worry

  • Margaux Roch-Gagné (a1) and France Talbot (a1)
Submit a response


No Comments have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *