Abstract
Anxiety disorders are common and disabling. Cognitive behavior therapy is the treatment of choice but is often difficult to obtain. Automated, internet-delivered, cognitive behavior therapy (iCBT) courses may be an answer. There are three recent systematic reviews of randomized controlled trials that show that the benefits are substantial (d = 1.0) and similar to face to face CBT. There are two large effectiveness trials that demonstrate strong effects when iCBT is used in primary care; 60 % of patients who complete the courses no longer meet diagnostic criteria. The courses are suitable for most people with a primary anxiety disorder. Research studies usually exclude people whose anxiety is secondary to schizophrenia, bipolar disorder, or substance abuse or who are actively suicidal. Little additional input from clinicians is required. Patients find the courses very convenient. Clinically, the principal advantage is the fidelity of the treatment. What you prescribe is what the patient sees.
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References
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Kessler RC et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry. 2005;62(6):593–602.
Brown TA et al. Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. J Abnorm Psychol. 2001;110(4):585–99.
Gøtzsche PC. Why I think antidepressants cause more harm than good. Lancet Psychiatry. 2014;1:104–6.
Andersson G. Using the internet to provide cognitive behavior therapy. Behav Res Ther. 2009;47:175–80.
Andrews G et al. Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS One. 2010;5:e13196.
Hedman E, Ljotsson B, Lindefors N. Cognitive behavior therapy via the Internet: a systematic review of applications, clinical efficacy and cost-effectiveness. Expert Rev Pharmacoeconomics Outcomes Res. 2012;12(6):745–64. A systematic review and meta analysis of the broader literature.
Mewton L et al. Current perspectives on Internet-delivered cognitive behavioral therapy for adults with anxiety and related disorders. Psychol Res Behav Manag. 2014;7:37–46. A very up to date systematic review of the field.
Nordgren LB et al. Effectiveness and cost-effectiveness of individually tailored internet-delivered cognitive behavior therapy for anxiety disorders in a primary care population: a randomized controlled trial. Behav Res Ther. 2014;59:1–11.
Titov N et al. Internet treatment for social phobia reduces comorbidity. Aust N Z J Psychiatr. 2009;43(8):754–9.
Berger T, Boettcher J, Caspar F. Internet-based guided self-help for several anxiety disorders: a randomized controlled trial comparing a tailored with a standardized disorder-specific approach. Psychotherapy. 2014;51(2):207–19.
Mewton L, Wong N, Andrews G. The effectiveness of computerised cognitive behavioral therapy for generalised anxiety disorder in clinical practice. Depression Anxiety. 2012;29:843–9.
Newby JM et al. Effectiveness of transdiagnostic Internet cognitive behavioral treatment for mixed anxiety and depression in primary care. J Affect Disord. 2014;165:45–52.
Newby JM et al. Internet cognitive behavioral therapy for mixed anxiety and depression: a randomized controlled trial and evidence of effectiveness in primary care. Psychol Med. 2013;FirstView:1–14.
Bergstrom J et al. An open study of the effectiveness of Internet treatment for panic disorder delivered in a psychiatric setting. Nord J Psychiatry. 2009;63(1):44–50.
Hedman E et al. Effectiveness of Internet-based cognitive behavior therapy for panic disorder in routine psychiatric care. Acta Psychiatr Scand. 2013;128(6):457–67.
Ruwaard J et al. The effectiveness of online cognitive behavioral treatment in routine clinical practice. PLoS One. 2012;7(7):e40089.
Hedman E et al. Clinical and genetic outcome determinants of Internet- and group-based cognitive behavior therapy for social anxiety disorder. Acta Psychiatr Scand. 2012;126(2):126–36.
Hedman E, Andersson G, Ljótsson B, Andersson E, Rück C, et al. Internet-based cognitive behavior therapy vs. cognitive behavioral group therapy for social anxiety disorder: A randomized controlled non-inferiority trial. PLoS One. 2011;6(3):e18001. doi:10.1371/journal.pone.0018001.
Mewton L, Wong N, Andrews G. The effectiveness of internet cognitive behavioral therapy for generalized anxiety disorder in clinical practice. Depression Anxiety. 2012;29(10):843–9.
Titov N, Andrews G, Kemp A, Robinson E. Characteristics of adults with anxiety or depression treated at an internet clinic: comparison with a national survey and an outpatient clinic. PLoS One. 2011;5(5):e10885. doi:10.1371/journal.pone.0010885.
Sheehan D et al. The mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(20):22–33.
First MB et al. Structured clinical interview for DSM-IV axis I disorders (SCID-I). Washington: American Psychiatric Press; 1996.
Williams AD, Andrews G. The effectiveness of internet cognitive behavioral therapy (iCBT) for depression in primary care: a quality assurance study. PLoS One. 2013;8(2):e57447.
Watts S, Newby JM, Mewton L, Andrews G. A clinical audit of changes in suicide ideas with internet treatment for depression. BMJ Open. 2012;2(5). doi:10.1136/bmjopen-2012-001558.
Mewton L, Andrews G. Cognitive behavior therapy via the internet for depression: a useful strategy to reduce suicidal ideation. J Affect Disord. in press.
Rozental A et al. Consensus statement on defining and measuring negative effects of Internet interventions. Internet Interv. 2014;1:12–9. A discussion of the need to track and identify any side effects associated with iCBT.
Spek V et al. Internet-based cognitive behavior therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med. 2007;37(03):319–28.
Andersson G, Carlbring P, Furmark T, on behalf of the S. O. F. I. E. Research Group. Therapist experience and knowledge acquisition in internet-delivered CBT for social anxiety disorder: A randomized controlled trial. PLoS One. 2012;7(5):e37411. doi:10.1371/journal.pone.0037411.
Robinson E et al. Internet treatment for generalized anxiety disorder: a randomized controlled trial comparing clinician vs. technician assistance. PLoS One. 2010;5(6):e10942.
Andrews G, Williams AD. Up-scaling clinician assisted internet cognitive behavioral therapy (iCBT) for depression: A model for dissemination into primary care. Clin Psychol Rev. in press.
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Conflict of Interest
Alishia D. Williams declares that she has no conflict of interest.
Gavin Andrews is the developer of the ThisWayUpClinic suite of courses. They are a not for profit initiative of St Vincent's Hospital Sydney Australia. Dr Andrews has transferred all IP to the hospital.
Jill M. Newby is supported by an Australian National Health and Medical Research Council (NHMRC) Early Career Fellowship (1037787).
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This article does not contain any studies with human or animal subjects performed by any of the authors.
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This article is part of the Topical Collection on Anxiety Disorders
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Andrews, G., Newby, J.M. & Williams, A.D. Internet-Delivered Cognitive Behavior Therapy for Anxiety Disorders Is Here to Stay. Curr Psychiatry Rep 17, 533 (2015). https://doi.org/10.1007/s11920-014-0533-1
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DOI: https://doi.org/10.1007/s11920-014-0533-1