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Self-help interventions for anxiety disorders: An overview


Anxiety disorders are highly prevalent and are associated with a marked impairment in quality of life and a huge economic cost to society. Unfortunately, a considerable number of people who struggle with anxiety do not seek or receive adequate treatment. Self-help interventions have been proposed to constitute a relatively cheap, effective, efficient, and low-threshold intervention for anxiety disorders. This paper offers a critical discussion of their advantages and disadvantages and the evidence for their effectiveness. We conclude that guided self-help can play a major role in mental health care for patients with anxiety disorders. However, several research questions need to be answered before broad-scale dissemination is possible. The Internet will continue to play a prominent role in the further development of this field of research and clinical practice.

References and Recommended Reading

  1. 1.

    Somers JM, Goldner EM, Waraich P, Hsu L: Prevalence and incidence studies of anxiety disorders: a systematic review of the literature. Can J Psychiatry 2006, 51:100–113.

    PubMed  Google Scholar 

  2. 2.

    Bijl RV, Ravelli A, van Zessen G: Prevalence of psychiatric disorder in the general population: results of The Netherlands Mental Health Survey and Incidence Study (NEMESIS). Soc Psychiatry Psychiatr Epidemiol 1998, 33:587–595.

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Mendlowicz MV, Stein MB: Quality of life in individuals with anxiety disorders. Am J Psychiatry 2000, 157:669–682.

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Angermeyer MC, Kilian R, Wilms HU, Wittmund B: Quality of life of spouses of mentally ill people. Int J Soc Psychiatry 2006, 52:278–285.

    PubMed  Article  Google Scholar 

  5. 5.

    DuPont RL, Rice DP, Miller LS, et al.: Economic costs of anxiety disorders. Anxiety 1996, 2:167–172.

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Smit F, Cuijpers P, Oostenbrink J, et al.: Costs of nine common mental disorders: implications for curative and preventive psychiatry. J Ment Health Policy Econ 2006, 9:193–200.

    PubMed  Google Scholar 

  7. 7.

    Bijl RV, Ravelli A: Psychiatric morbidity, service use, and need for care in the general population: results of The Netherlands Mental Health Survey and Incidence Study. Am J Public Health 2000, 90:602–607.

    PubMed  CAS  Google Scholar 

  8. 8.

    Haaga DA: Introduction to the special section on stepped care models in psychotherapy. J Consult Clin Psychol 2000, 68:547–548.

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Andrews G, Issakidis C, Sanderson K, et al.: Utilising survey data to inform public policy: comparison of the cost-effectiveness of treatment of ten mental disorders. Br J Psychiatry 2004, 184:526–533.

    PubMed  Article  Google Scholar 

  10. 10.

    Hirai M, Clum GA: A meta-analytic study of self-help interventions for anxiety problems. Behav Ther 2006, 37:99–111.

    PubMed  Article  Google Scholar 

  11. 11.

    Willemse GR, Smit F, Cuijpers P, Tiemens BG: Minimal-contact psychotherapy for sub-threshold depression in primary care. Randomised trial. Br J Psychiatry 2004, 185:416–421.

    PubMed  Article  Google Scholar 

  12. 12.

    Cuijpers P: Bibliotherapy in unipolar depression: a meta-analysis. J Behav Ther Exp Psychiatry 1997, 28:139–147.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Marrs RW: A meta-analysis of bibliotherapy studies. Am J Community Psychol 1995, 23:843–870.

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Mains JA, Scogin FR: The effectiveness of self-administered treatments: a practice-friendly review of the research. J Clin Psychol 2003, 59:237–246.

    PubMed  Article  Google Scholar 

  15. 15.

    Ostgood-Hynes D, Greist JH, Marks IM, et al.: Self-administered psychotherapy for depression using a telephone-accessed computer system plus booklets: an open US-UK study. J Clin Psychiatry 1998, 59:358–365.

    Google Scholar 

  16. 16.

    Scogin F, Floyd M, Jamison C, et al.: Negative outcomes: what is the evidence on self-administered treatments? J Consult Clin Psychol 1996, 64:1086–1089.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Gould RA, Clum GA: A meta-analysis of self-help treatment approaches. Clin Psychol Rev 1993, 133:169–186.

    Article  Google Scholar 

  18. 18.

    Scogin F, Bynum J, Stephens G, Calhoon S: Efficacy of self-administered treatment programs: meta-analytic review. Prof Psychol Res Pr 1990, 21:42–47.

    Article  Google Scholar 

  19. 19.

    Emmelkamp PM: Behavior therapy with adults. In Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change. Edited by Lambert M. New York: Wiley; 2004:393–446.

    Google Scholar 

  20. 20.

    Gould RA, Safren SA, Washington DO, Otto MW: A meta-analytic review of cognitive-behavioral treatments. In Generalized Anxiety Disorder: Advances in Research and Practice. Edited by Heimberg RG, Turk CL, Mennin DS. New York: Guilford Press; 2004:248–264.

    Google Scholar 

  21. 21.

    Öst LG: Applied relaxation: description of a coping technique and review of controlled studies. Behav Res Ther 1986, 25:397–409.

    Article  Google Scholar 

  22. 22.

    Cotler SB: Sex differences and generalization of anxiety reduction with automated desensitization and minimal therapist interaction. Behav Res Ther 1970, 8:273–285.

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Donner L, Guerney BG, Jr: Automated group desensitization for test anxiety. Behav Res Ther 1969, 7:1–13.

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    van Boeijen CA, van Balkom AJ, van Oppen P, et al.: Efficacy of self-help manuals for anxiety disorders in primary care: a systematic review. Fam Pract 2005, 22:192–196.

    PubMed  Article  Google Scholar 

  25. 25.

    den Boer PC, Wiersma D, Van den Bosch RJ: Why is self-help neglected in the treatment of emotional disorders? A meta-analysis. Psychol Med 2004, 34:959–971.

    Article  Google Scholar 

  26. 26.

    Andersson G, Carlbring P, Holmstrom A, et al.: Internet-based self-help with therapist feedback and in vivo group exposure for social phobia: a randomized controlled trial. J Consult Clin Psychol 2006, 74:677–686.

    PubMed  Article  Google Scholar 

  27. 27.

    Carlbring P, Ekselius L, Andersson G: Treatment of panic disorder via the Internet: a randomized trial of CBT vs. applied relaxation. J Behav Ther Exp Psychiatry 2003, 34:129–140.

    PubMed  Article  Google Scholar 

  28. 28.

    Klein B, Richards JC, Austin DW: Efficacy of Internet therapy for panic disorder. J Behav Ther Exp Psychiatry 2006, 37:213–238.

    PubMed  Article  Google Scholar 

  29. 29.

    Hirai M, Clum GA: An Internet-based self-change program for traumatic event related fear, distress, and maladaptive coping. J Trauma Stress 2005, 18:631–636.

    PubMed  Article  Google Scholar 

  30. 30.

    Carlbring P, Nilsson-Ihrfelt E, Waara J, et al.: Treatment of panic disorder: live therapy vs. self-help via the Internet. Behav Res Ther 2005, 43:1321–1333.

    PubMed  Article  Google Scholar 

  31. 31.

    Lange A, Rietdijk D, Hudcovicova M, et al.: Interapy: a controlled randomized trial of the standardized treatment of posttraumatic stress through the internet. J Consult Clin Psychol 2003, 71:901–909.

    PubMed  Article  Google Scholar 

  32. 32.

    Ritterband LM, Andersson G, Christensen HM, et al.: Directions for the International Society for Research on Internet Interventions (ISRII). J Med Internet Res 2006, 8:e23.

    PubMed  Article  Google Scholar 

  33. 33.

    Spek V, Cuijpers P, Nyklicek I, et al.: Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med 2007, 37:319–328.

    PubMed  Article  Google Scholar 

  34. 34.

    Mataix-Cols D, Marks IM: Self-help with minimal therapist contact for obsessive-compulsive disorder: a review. Eur Psychiatry 2006, 21:75–80.

    PubMed  Article  Google Scholar 

  35. 35.

    van’t Veer-Tazelaar N, van Marwijk H, van Oppen P, et al.: Prevention of anxiety and depression in the age group of 75 years and over: a randomised controlled trial testing the feasibility and effectiveness of a generic stepped care programme among elderly community residents at high risk of developing anxiety and depression versus usual care [ISRCTN26474556]. BMC Public Health 2006, 6:186.

    Article  Google Scholar 

  36. 36.

    Newman MG: Recommendations for a cost-offset model of psychotherapy allocation using generalized anxiety disorder as an example. J Consult Clin Psychol 2000, 68:549–555.

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    Wang PS, Lane M, Olfson M, et al.: Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005, 62:629–640.

    PubMed  Article  Google Scholar 

  38. 38.

    Goldberg D, Huxley P: Common Mental Disorders: A Biosocial Model. London: Tavistock/Routledge; 1992.

    Google Scholar 

  39. 39.

    Andersson G: Internet-based cognitive-behavioral self help for depression. Expert Rev Neurother 2006, 6:1637–1642.

    PubMed  Article  Google Scholar 

  40. 40.

    Andersson G, Bergstrom J, Carlbring P, Lindefors N: The use of the Internet in the treatment of anxiety disorders. Curr Opin Psychiatry 2005, 18:73–77.

    PubMed  Google Scholar 

  41. 41.

    Schneider AJ, Mataix-Cols D, Marks IM, Bachofen M: Internet-guided self-help with or without exposure therapy for phobic and panic disorders. Psychother Psychosom 2005, 74:154–164.

    PubMed  Article  Google Scholar 

  42. 42.

    Kenwright M, Marks IM: Computer-aided self-help for phobia/panic via Internet at home: a pilot study. Br J Psychiatry 2004, 184:448–449.

    PubMed  Article  Google Scholar 

  43. 43.

    Gega L, Norman IJ, Marks IM: Computer-aided vs. tutor-delivered teaching of exposure therapy for phobia/panic: randomized controlled trial with pre-registration nursing students. Int J Nurs Stud 2007, 44:397–405.

    PubMed  Article  CAS  Google Scholar 

  44. 44.

    Rosen GM, Glasgow RE, Barrera M, Jr.: A controlled study to assess the clinical efficacy of totally self-administered systematic desensitization. J Consult Clin Psychol 1976, 44:208–217.

    PubMed  Article  CAS  Google Scholar 

  45. 45.

    Scogin FR, Hanson A, Welsh D: Self-administered treatment in stepped-care models of depression treatment. J Clin Psychol 2003, 59:341–349.

    PubMed  Article  Google Scholar 

  46. 46.

    Sobell MB, Sobell LC: Stepped care as a heuristic approach to the treatment of alcohol problems. J Consult Clin Psychol 2000, 68:573–579.

    PubMed  Article  CAS  Google Scholar 

  47. 47.

    Newman MG, Erickson T, Przeworski A, Dzus E: Self-help and minimal-contact therapies for anxiety disorders: is human contact necessary for therapeutic efficacy? J Clin Psychol 2003, 59:251–274.

    PubMed  Article  Google Scholar 

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Correspondence to Pim Cuijpers PhD.

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Cuijpers, P., Schuurmans, J. Self-help interventions for anxiety disorders: An overview. Curr Psychiatry Rep 9, 284–290 (2007).

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  • Anxiety Disorder