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Effects of a transdiagnostic unguided Internet intervention (‘velibra’) for anxiety disorders in primary care: results of a randomized controlled trial

Published online by Cambridge University Press:  22 September 2016

T. Berger ,
A. Urech ,
T. Krieger ,
T. Stolz ,
A. Schulz ,
A. Vincent ,
C. T. Moser ,
S. Moritz  and
B. Meyer
T. Berger*
Affiliation:
Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
A. Urech
Affiliation:
Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
T. Krieger
Affiliation:
Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
T. Stolz
Affiliation:
Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
A. Schulz
Affiliation:
Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
A. Vincent
Affiliation:
Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
C. T. Moser
Affiliation:
Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
S. Moritz
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
B. Meyer
Affiliation:
Department of Psychology, City University, London, UK Research Department, Gaia AG, Hamburg, Germany
*
*Address for correspondence: T. Berger, Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland. (Email: thomas.berger@ptp.unibe.ch)
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Abstract

Background

Internet-based cognitive–behavioural treatment (ICBT) for anxiety disorders has shown some promise, but no study has yet examined unguided ICBT in primary care. This randomized controlled trial (RCT) investigated whether a transdiagnostic, unguided ICBT programme for anxiety disorders is effective in primary care settings, after a face-to-face consultation with a physician (MD). We hypothesized that care as usual (CAU) plus unguided ICBT would be superior to CAU in reducing anxiety and related symptoms among patients with social anxiety disorder (SAD), panic disorder with or without agoraphobia (PDA) and/or generalized anxiety disorder (GAD).

Method

Adults (n = 139) with at least one of these anxiety disorders, as reported by their MD and confirmed by a structured diagnostic interview, were randomized. Unguided ICBT was provided by a novel transdiagnostic ICBT programme (‘velibra’). Primary outcomes were generic measures, such as anxiety and depression symptom severity, and diagnostic status at post-treatment (9 weeks). Secondary outcomes included anxiety disorder-specific measures, quality of life, treatment adherence, satisfaction, and general psychiatric symptomatology at follow-up (6 months after randomization).

Results

CAU plus unguided ICBT was more effective than CAU at post-treatment, with small to medium between-group effect sizes on primary (Cohen's d = 0.41–0.47) and secondary (Cohen's d = 0.16–0.61) outcomes. Treatment gains were maintained at follow-up. In the treatment group, 28.2% of those with a SAD diagnosis, 38.3% with a PDA diagnosis, and 44.8% with a GAD diagnosis at pretreatment no longer fulfilled diagnostic criteria at post-treatment.

Conclusions

The unguided ICBT intervention examined is effective for anxiety disorders when delivered in primary care.

Keywords

Anxietycognitive-behaviour therapyInternetprimary caretransdiagnostic treatments
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 1 , January 2017 , pp. 67 - 80
Copyright
Copyright © Cambridge University Press 2016 

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