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

Abstract

BackgroundInternet-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).MethodAdults (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).ResultsCAU 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.ConclusionsThe unguided ICBT intervention examined is effective for anxiety disorders when delivered in primary care.

Transdiagnostic psychiatry: a systematic review

“…The transdiagnostic construct was demonstrated across all clinical conditions investigated only in a minority (34%) of studies. It was demonstrated in a median of three conditions and one spectrum.…”

“…A substantial proportion of studies (40%) did not acknowledge an a priori protocol. There were very few studies reporting industry involvement (4%). Transdiagnostic findings were hardly ever externally replicated, with the exception of four studies (4%).…”

“…Most studies (45%) were investigating interventions (of which 50% were controlled, 48% uncontrolled, and 2% unclear). Less than half (46%) of the interventional studies were randomized. All interventional studies focused on neurotic, stress‐related and somatoform disorders or mood (affective) disorders, while other mental disorders were rarely investigated (Table ).…”

“…Only a minority (35%) of studies explicitly acknowledged their primary outcome measure, which may be suggestive of suboptimal study quality. There was also a high variability in the number of primary outcome measures, ranging from one to thirteen (median: two measures) per study.…”

The Use of Technology to Augment Clinical Care in Depression and Anxiety Disorders: An Evidence Map

“…After dual review of titles and abstracts to determine if the citation could meet eligibility criteria, 1,365 RCTs were selected for full-text dual review. Of these, 280 RCTs met the inclusion criteria and are included in the evidence map: Adler et al, 2015;Alavi et al, 2016;Alegria et al, 2014;Allen et al, 2016;Andersson et al, 2005;Andersson, Carlbring, and Furmark, 2012;Andersson et al, 2006;Andersson, Hesser, et al, 2013;Andersson et al, 2009;Andersson, Waara, et al, 2013;Andrews, Davies, and Titov, 2011;Arean et al, 2016;Au, 2015;Bae and Panuncio, 2008;Baikie, Geerligs, and Wilhelm, 2012;Beard and Amir, 2008;Bee et al, 2010;Beevers et al, 2017;Berger, Boettcher, and Caspar, 2014;Berger, Hämmerli, et al, 2011;Berger, Hohl, and Caspar, 2009;Berger et al, 2016;Bergström et al, 2010;Birney et al, 2016;Blackwell et al, 2015;Boeschoten et al, 2016;Boettcher, Aström, et al, 2014;Boettcher, Berger, and Renneberg, 2012;Boettcher, Hasselrot, et al, 2014;Boettcher et al, 2013;Bombardier et al, 2013;Bornas, Tortella-Feliu, and Llabrés, 2006;Botella et al, 2010;Botella et al, 2016;Bouchard et al, 2004;Brabyn et al, 2016;…”