Tailored internet-administered treatment of anxiety disorders for primary care patients: study protocol for a randomised controlled trial

BackgroundInternet-administered cognitive behavioural therapy (ICBT) has been found to be effective for a range of anxiety disorders. However, most studies have focused on one specific primary diagnosis and co-morbidity has not been considered. In primary care settings, patients with anxiety often suffer from more than one psychiatric condition, making it difficult to disseminate ICBT for specific conditions. The aim of this study will be to investigate if ICBT tailored according to symptom profile can be a feasible treatment for primary care patients with anxiety disorders. It is a randomised controlled trial aimed to evaluate the treatment against an active control group.MethodsParticipants with anxiety disorders and co-morbid conditions (N = 128), will be recruited from a primary care population. The Clinical Outcome in Routine Evaluation (CORE-OM) will serve as the primary outcome measure. Secondary measures include self-reported depression, anxiety, quality of life and loss of production and the use of health care. All assessments will be collected via the Internet and measure points will be baseline, post treatment and 12 months post treatment.DiscussionThis trial will add to the body of knowledge on the effectiveness of ICBT for anxiety disorders in primary care. The trial will also add knowledge on the long term effects of ICBT when delivered for regular clinic patientsTrial RegistrationClinicalTrials.gov: NCT01390168

[1]  M. Åsberg,et al.  A New Depression Scale Designed to be Sensitive to Change , 1979, British Journal of Psychiatry.

[2]  W. M. Patterson,et al.  Evaluation of suicidal patients: the SAD PERSONS scale. , 1983, Psychosomatics.

[3]  R. Snaith,et al.  Grade Scores of the Montgomery—Åsberg Depression and the Clinical Anxiety Scales , 1986, British Journal of Psychiatry.

[4]  A. Beck,et al.  An inventory for measuring clinical anxiety: psychometric properties. , 1988, Journal of consulting and clinical psychology.

[5]  A. Lindbeck,et al.  The Swedish Experience , 1990 .

[6]  John E. Cornell,et al.  Clinical Validation of the Quality of Life Inventory: A Measure of Life Satisfaction for Use in Treatment Planning and Outcome Assessment , 1992 .

[7]  P. Svanborg,et al.  A new self‐rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale , 1994, Acta psychiatrica Scandinavica.

[8]  P. Svanborg,et al.  Determinants of self‐rating and expert rating concordance in psychiatric out‐patients, using the affective subscales of the CPRS , 1996, Acta psychiatrica Scandinavica.

[9]  M. First,et al.  Structured clinical interview for DSM-IV axis I disorders : SCID-I: clinical version : administration booklet , 1996 .

[10]  P. Lewinsohn,et al.  Comparability of telephone and face-to-face interviews in assessing axis I and II disorders. , 1997, The American journal of psychiatry.

[11]  S. Hollon,et al.  Defining empirically supported therapies. , 1998, Journal of consulting and clinical psychology.

[12]  M. Barkham,et al.  Service profiling and Outcomes benchmarking using the CORE-OM: toward practice-based evidence in the psychological therapies : Patient-Focused Research , 2001 .

[13]  L. Roijen,et al.  Manual Trimbos/iMTA Questionnaire for Costs Associated with Psychiatric Illness , 2002 .

[14]  F. Mazzi,et al.  Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project , 2004, Acta psychiatrica Scandinavica. Supplementum.

[15]  R. Kessler,et al.  12‐Month comorbidity patterns and associated factors in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project , 2004, Acta psychiatrica Scandinavica. Supplementum.

[16]  J. Lépine,et al.  The European Study of the Epidemiology of Mental Disorders (ESEMeD) project: an epidemiological basis for informing mental health policies in Europe , 2004, Acta psychiatrica Scandinavica. Supplementum.

[17]  H. Wittchen,et al.  Size and burden of mental disorders in Europe—a critical review and appraisal of 27 studies , 2005, European Neuropsychopharmacology.

[18]  A. Vickers.  Analysis of variance is easily misapplied in the analysis of randomized trials: a critique and discussion of alternative statistical approaches. , 2005, Psychosomatic medicine.

[19]  Heleen Riper,et al.  Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis , 2006, Psychological Medicine.

[20]  G. Andersson,et al.  Internet-based self-help with therapist feedback and in vivo group exposure for social phobia: a randomized controlled trial. , 2006, Journal of consulting and clinical psychology.

[21]  P. Cuijpers,et al.  Costs of nine common mental disorders: implications for curative and preventive psychiatry. , 2006, The journal of mental health policy and economics.

[22]  Per Carlbring,et al.  Remote treatment of panic disorder: a randomized trial of internet-based cognitive behavior therapy supplemented with telephone calls. , 2006, The American journal of psychiatry.

[23]  G. Andersson,et al.  Internet-delivered treatments with or without therapist input: does the therapist factor have implications for efficacy and cost? , 2007, Expert review of pharmacoeconomics & outcomes research.

[24]  Per Carlbring,et al.  Internet vs. paper and pencil administration of questionnaires commonly used in panic/agoraphobia research , 2007, Comput. Hum. Behav..

[25]  G. Andersson,et al.  Development of a New Approach to Guided Self-Help via the Internet: The Swedish Experience , 2008 .

[26]  N. Titov,et al.  Internet Treatment for Social Phobia Reduces Comorbidity , 2009, The Australian and New Zealand journal of psychiatry.

[27]  G. Andersson.  Using the Internet to provide cognitive behaviour therapy. , 2009, Behaviour research and therapy.

[28]  G. Andersson,et al.  Therapist Factors in Internet-Delivered Cognitive Behavioural Therapy for Major Depressive Disorder , 2009, Cognitive behaviour therapy.

[29]  Gerhard Andersson,et al.  Computer‐Aided Psychotherapy for Anxiety Disorders: A Meta‐Analytic Review , 2009, Cognitive behaviour therapy.

[30]  G. Andersson,et al.  Long-term outcome of Internet-delivered cognitive-behavioural therapy for social phobia: a 30-month follow-up. , 2009, Behaviour research and therapy.

[31]  M. Reger,et al.  A meta-analysis of the effects of internet- and computer-based cognitive-behavioral treatments for anxiety. , 2009, Journal of clinical psychology.

[32]  Per Carlbring,et al.  Internet administered guided self-help versus individualized e-mail therapy: A randomized trial of two versions of CBT for major depression. , 2010, Behaviour research and therapy.

[33]  J. Aubry,et al.  Self- and clinician-rated Montgomery-Asberg Depression Rating Scale: evaluation in clinical practice. , 2010, Journal of affective disorders.

[34]  Per Carlbring,et al.  Internet administration of self-report measures commonly used in research on social anxiety disorder: A psychometric evaluation , 2010, Comput. Hum. Behav..

[35]  Michelle G. Craske,et al.  Computer Therapy for the Anxiety and Depressive Disorders Is Effective, Acceptable and Practical Health Care: A Meta-Analysis , 2010, PloS one.

[36]  P. Morris,et al.  The clinical effectiveness of CBT-based guided self-help interventions for anxiety and depressive disorders: a systematic review , 2011, Psychological Medicine.

[37]  G. Andersson,et al.  Guided Internet-Delivered Cognitive Behavior Therapy for Generalized Anxiety Disorder: A Randomized Controlled Trial , 2011, Cognitive behaviour therapy.

[38]  G. Andersson,et al.  Individually-tailored, Internet-based treatment for anxiety disorders: A randomized controlled trial. , 2011, Behaviour research and therapy.

[39]  J. Os,et al.  The size and burden of mental disorders and other disorders of the brain in Europe 2010 , 2011, European Neuropsychopharmacology.

[40]  Janet B W Williams,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .