The Feasibility, Acceptability, and Efficacy of Delivering Internet-Based Self-Help and Guided Self-Help Interventions for Generalized Anxiety Disorder to Indian University Students: Design of a Randomized Controlled Trial

Abstract

BackgroundGeneralized anxiety disorder (GAD) is one of the most common mental disorders among university students; however, many students go untreated due to treatment costs, stigma concerns, and limited access to trained mental health professionals. These barriers are heightened in universities in India, where there are scant mental health care services and severe stigma surrounding help seeking.ObjectiveTo evaluate the feasibility, acceptability, and efficacy of Internet-based, or “online,” cognitive behavioral therapy (CBT)-based unguided and guided self-help interventions (using the programs GAD Online and Lantern, respectively) to reduce GAD symptoms in students with clinical and subthreshold GAD and, ultimately, reduce the prevalence and incidence of GAD among the student population.MethodsStudents will be recruited via 3 colleges in Hyderabad, India, and referred for a campus-wide online screening. Self-report data will be collected entirely online. A total of 300 qualifying students will be randomized in a 1:1:1 ratio to receive GAD Online, Lantern, or to be in a wait-list control condition, stratified by clinical and subthreshold GAD symptomatology. Students will complete a postintervention assessment after 3 months and a follow-up assessment 6 months later, at which point students in the wait-list control condition will receive one of the programs. The primary outcome is GAD symptom severity at 3 months postintervention. Secondary outcomes include GAD caseness at 9 months, other anxiety and depression symptoms, self-efficacy, and functional measures (eg, sleep, social functioning) at 3 and 9 months, respectively. Primary analyses will be differences between each of the intervention groups and the wait-list control group, analyzed on an intention-to-treat (ITT) basis using mixed-design ANOVA.ResultsThe study commenced in February 2015. The sample was recruited over a 3-week period at each college. The trial is expected to end in December 2015.ConclusionsThis trial will be the first to evaluate the use of Internet-based CBT programs compared with a wait-list control group for the treatment of GAD among students in Indian universities. If effective, these programs have the potential to reduce the mental health care treatment gap by providing readily accessible, private, and cost-effective evidence-based care to students with GAD who do not currently receive the treatment they need.Trial RegistrationClinicalTrials.gov NCT02410265 http://clinicaltrials.gov/ct2/show/NCT02410265 (Archived by WebCite at http://www.webcitation.org/6ddqH6Rbt).

Posttraumatic Stress Disorder and Mobile Health: App Investigation and Scoping Literature Review

“…Despite the availability of these tools, the scoping literature review suggested there was insufficient evidence on the validity of the apps. The literature review highlighted the need for additional studies on app dissemination and adoption [ 6 , 32 , 44 , 45 , 49 , 53 ] and app validation and treatment integration [ 7 , 43 , 44 , 46 - 48 , 52 , 59 ]. This literature also suggests the potential of integrating such PTSD-related apps with new technologies, such as smartwatches, as an adjunct for improving treatment.…”

“…Despite potential security issues and obstacles to apps’ dispersion among users, an abundance of calls for more studies on app dissemination and adoption [ 6 , 32 , 44 , 45 , 47 , 49 , 53 ] and on app validation and treatment integration [ 7 , 43 , 44 , 46 - 48 , 52 , 59 ] indicates the importance of developing apps with optimal usability and improve treatment. Of those apps designed to be used in conjunction with clinical treatment, only two currently incorporate specific treatment-related components (PE Coach and CPT Coach).…”

Development and Pilot Testing of an Internet-Based Self-Help Intervention for Depression for Indian Users

“…Relatively very little is known about how internet-based methods of delivery of psychological interventions may be received and used in non-Western cultures by individuals for whom they are designed [ 26 , 27 , 28 ]. A broad scan of literature indicated that although several papers have been published in the last few years on the scope of digital mental health in India, there is a significant dearth of empirical research on internet-based interventions for mental health in the Indian context [ 29 , 30 , 31 , 32 ].…”

Internet and mobile technologies: addressing the mental health of trauma survivors in less resourced communities

“…To date, text messaging has been used for reminders, information provision, supportive messages, and self-monitoring, and as an extension of traditional care rather than treatments in themselves (Berrouiguet et al 2016 ). It has been used in India as a means of coaching college students as they used an app to manage anxiety (Kanuri et al 2015 ). More work is needed to establish whether and how text messaging might offer opportunities to manage post-traumatic stress reactions and related problems during and after exposure to PTEs.…”