Therapist-Supported Internet Cognitive Behavioural Therapy for Anxiety Disorders in Adults

Summary

A Cochrane review [Abstract] 1 included 38 studies with a total of 3214 subjects. The studies examined social phobia (11 trials), panic disorder with or without agoraphobia (8 trials), generalized anxiety disorder (5 trials), post-traumatic stress disorder (2 trials), obsessive compulsive disorder (2 trials) and specific phobia (2 trials). Eight remaining studies included a range of anxiety disorder diagnoses. Studies investigated a variety of Internet cognitive behavioural therapy (ICBT) protocols. Three primary comparisons were identified, experimental vs. waiting list control, vs. unguided ICBT and vs. face-to-face CBT. Eleven studies (n=866) contributed to a pooled RR of 3.75 (95% CI 2.51 to 5.60) for clinically important improvement in anxiety at post-treatment, favouring therapist-supported ICBT over a waiting list, attention, information, or online discussion group only. Similarly, the standard mean difference (SMD) at post-treatment favoured therapist-supported ICBT for both disorder-specific symptoms (SMD -1.06, 95% CI -1.29 to -0.82; 28 studies, n=2147) and general anxiety symptoms (SMD -0.75, 95% CI -0.98 to -0.52; 19 studies, n=1496). One study (n=54) compared unguided CBT to therapist-supported ICBT for clinically important improvement in anxiety at post-treatment, showing no difference in outcome between treatments. At post-treatment there were no clear differences between unguided CBT and therapist-supported ICBT for disorder-specific anxiety symptoms (SMD -0.22, 95% CI -0.56 to 0.13; 5 studies, n=312) or general anxiety symptoms (SMD 0.28, 95% CI -2.21 to 2.78; 2 studies, n=138).Compared to face-to-face CBT, therapist-supported ICBT showed no significant differences in clinically important improvement in anxiety at post-treatment (RR 1.09, 95% CI 0.89 to 1.34; 4 studies, n=365). There were also no clear post-treatment differences between face-to-face and therapist supported ICBT for disorder-specific anxiety symptoms (SMD 0.06, 95% CI -0.25 to 0.37; 7 studies, n=450) or general anxiety symptoms (SMD 0.17, 95% CI -0.35 to 0.69; 5 studies, n=317).Adverse events were rarely reported.