Short-Term Effectiveness of Web-Based Guided Self-Help for Phobic Outpatients: Randomized Controlled Trial

Robin Niels Kok, Annemieke van Straten, Aartjan T F Beekman, Pim Cuijpers

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Background: Internet-based guided self-help has been successfully used in the general population, but it is unknown whether this method can be effectively used in outpatient clinics for patients waiting for face-to-face (FtF) psychotherapy. Objective: To assess the clinical effectiveness of Phobias Under Control, an internet-based intervention based on exposure therapy with weekly guidance. Methods: We conducted a randomised controlled trial, recruiting 212 outpatients who were scheduled to receive FtF psychotherapy for any type of phobia at an outpatient clinic. Participants suffering from at least one DSM-IV or ICD-10 classified phobia (social phobia, agoraphobia with or without panic disorder and/or specific phobia as ascertained by a telephone interview at baseline) were randomly allocated to either a five-week internet-based guided self-help programme based on exposure therapy with weekly student support, followed by FtF psychotherapy (n = 105); or wait-list control group (WLC) followed by FtF psychotherapy (n = 107). Primary outcome was the Fear Questionnaire (FQ). Secondary outcomes were the Beck Anxiety Inventory (BAI) and Centre of Epidemiological Studies – Depression scale (CES-D). Assessments took place by telephone at baseline (T0) and on the Internet at post-test (T1, self-assessment at five weeks after baseline). Missing data at T1 were imputed. Results: At post-test, analysis of covariance on the intention-to-treat sample showed significant but small effect sizes between intervention and control groups on the FQ (d = 0.35, p = .016), CES-D (d = 0.34, p = .026), and a non-significant effect size on the BAI (d = 0.28. p = .053). However, high non-response was observed, with 86 participants (41%) lost to follow-up at T1 and only 14 (13%) participants finishing all five weeks. Conclusions: Trial Registration: Netherlands Trial Register NTR2233 (Archived by WebCite® at http://www.webcitation.org/6O2ioOQSs) Keywords: phobias, phobic disorders, anxiety disorders, web-based intervention, internet therapy, randomised controlled trial, outpatients
OriginalsprogEngelsk
Artikelnummere226
TidsskriftJournal of Medical Internet Research
Vol/bind16
Udgave nummer9
Antal sider16
ISSN1439-4456
DOI
StatusUdgivet - 2014
Udgivet eksterntJa

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