Skip to main content

ICBT in Psychiatry: Generalised Anxiety Disorder

  • Chapter
  • First Online:
Guided Internet-Based Treatments in Psychiatry

Abstract

Generalised anxiety disorder (GAD) is a common anxiety disorder characterised by excessive and uncontrollable worry. It is a chronic disorder associated with considerable disability. Historically, GAD has been considered one of the least successfully treated anxiety disorders. In recent years, more than ten published studies have described outcomes of Internet-delivered cognitive behavioural therapy (ICBT) for GAD. These include research trials and reports of use in clinics. The results of research trials consistently reveal that large effect sizes are obtained during therapist-guided ICBT, with gains sustained up to 2 years post-treatment. Reports of use of ICBT for GAD from clinics are also highly promising and indicate that those who complete the interventions obtain outcomes similar to those reported in clinical trials. To date, most reports from clinics using ICBT for GAD have been limited to analyses of outcomes from those who have completed the ICBT intervention. This limits the conclusions that can be drawn about the effectiveness of existing ICBT interventions for GAD at this time. It is expected, however, that future reports will confirm the potential of ICBT interventions for treating GAD.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • American Psychiatric Association (2000) Diagnostic criteria from DSM-IV-TR. American Psychiatric Association, Washington, D.C

    Google Scholar 

  • Andersson G, Titov N (2014) Advantages and limitations of Internet-based interventions for common mental disorders. World Psychiatry 13:4–11

    Article  PubMed  PubMed Central  Google Scholar 

  • Andersson G, Paxling B, Roch-Norlund P, Ostman G, Norgren A, Almlov J, Georen L, Breitholtz E, Dahlin M, Cuijpers P, Carlbring P, Silverberg F (2012) Internet-based psychodynamic versus cognitive behavioral guided self-help for generalized anxiety disorder: a randomized controlled trial. Psychother Psychosom 81:344–355

    Article  PubMed  Google Scholar 

  • Beck AT (1991) Cognitive therapy. A 30-year retrospective. Am Psychol 46:368–375

    Article  CAS  PubMed  Google Scholar 

  • Beck A, Emery G, Greenberg R (1985) Anxiety disorders and phobias: a cognitive approach. Basic, New York

    Google Scholar 

  • Beck AT, Epstein N, Brown G, Steer RA (1988) An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 56:893

    Article  CAS  PubMed  Google Scholar 

  • Borkovec T, Costello E (1993) Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. J Consult Clin Psychol 61:611

    Article  CAS  PubMed  Google Scholar 

  • Borkovec TD, Wilkinson L, Folensbee R, Lerman C (1983) Stimulus control applications to the treatment of worry. Behav Res Ther 21:247–251

    Article  CAS  PubMed  Google Scholar 

  • Borkovec TD, Alcaine O, Behar E (2004) Avoidance theory of worry and generalized anxiety disorder. In: Heimberg RG, Turk CL, Mennin DS (Eds) Generalized anxiety disorder: advances in research and practice. The Guildford Press, New York.

    Google Scholar 

  • Bowman D, Scogin F, Floyd M, Patton E, Gist L (1997) Efficacy of self-examination therapy in the treatment of generalized anxiety disorder. J Couns Psychol 44:267

    Article  Google Scholar 

  • Breitholtz E, Westling BE, Ost LG (1998) Cognitions in generalized anxiety disorder and panic disorder patients. J Anxiety Disord 12:567–577

    Article  CAS  PubMed  Google Scholar 

  • Brown TA, Antony MM, Barlow DH (1992) Psychometric properties of the Penn State Worry Questionnaire in a clinical anxiety disorders sample. Behav Res Ther 30:33–37

    Article  CAS  PubMed  Google Scholar 

  • Brown TA, Barlow DH, Liebowitz MR (1994) The empirical basis of generalized anxiety disorder. Am J Psychiatry 151(9):1272–1280

    Article  CAS  PubMed  Google Scholar 

  • Carlbring P, Maurin L, Torngren C, Linna E, Eriksson T, Sparthan E, Straat M, Marquez Von Hage C, Bergman-Nordgren L, Andersson G (2011) Individually-tailored, internet-based treatment for anxiety disorders: a randomized controlled trial. Behav Res Ther 49:18–24

    Article  PubMed  Google Scholar 

  • Constans JI, Barbee JG, Townsend MH, Leffler H (2002) Stability of worry content in GAD patients: a descriptive study. J Anxiety Disord 16:311–319

    Article  PubMed  Google Scholar 

  • Cuijpers P, Sijbrandij M, Koole S, Huibers M, Berking M, Andersson G (2014) Psychological treatment of generalized anxiety disorder: a meta-analysis. Clin Psychol Rev 34:130–140

    Article  PubMed  Google Scholar 

  • Dear BF, Titov N, Schwencke G, Andrews G, Johnston L, Craske MG, Mcevoy P (2011a) An open trial of a brief transdiagnostic internet treatment for anxiety and depression. Behav Res Ther 49:830–837

    Article  PubMed  Google Scholar 

  • Dear BF, Titov N, Sunderland M, Mcmillan D, Anderson T, Lorian C, Robinson E (2011b) Psychometric comparison of the generalized anxiety disorder scale-7 and the Penn State Worry Questionnaire for measuring response during treatment of generalised anxiety disorder. Cogn Behav Ther 40:216–227

    Article  PubMed  Google Scholar 

  • Draper M, Rees CS, Nathan PR (2008) Internet-based self-management of generalised anxiety disorder: a preliminary study. Behav Chang 25:229–244

    Article  Google Scholar 

  • Dugas MJ, Freeston MH, Ladouceur R (1997) Intolerance of uncertainty and problem orientation in worry. Cogn Ther Res 21:593–606

    Article  Google Scholar 

  • Dugas MJ, Gagnon F, Ladouceur R, Freeston MH (1998) Generalized anxiety disorder: a preliminary test of a conceptual model. Behav Res Ther 36:215–226

    Article  CAS  PubMed  Google Scholar 

  • Dugas MJ, Ladouceur R, Leger E, Freeston MH, Langlois F, Provencher MD, BOISVERT JM (2003) Group cognitive-behavioral therapy for generalized anxiety disorder: treatment outcome and long-term follow-up. J Consult Clin Psychol 71:821–825

    Article  PubMed  Google Scholar 

  • Frisch MB, Cornell J, Villanueva M, Retzlaff PJ (1992) Clinical validation of the Quality of Life Inventory. A measure of life satisfaction for use in treatment planning and outcome assessment. Psychol Assess 4:92

    Article  Google Scholar 

  • Gale C, Davidson O (2007) Generalised anxiety disorder. BMJ 334:579–581

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hidalgo RB, Tupler LA, Davidson JR (2007) An effect-size analysis of pharmacologic treatments for generalized anxiety disorder. J Psychopharmacol 21:864–872

    Article  CAS  PubMed  Google Scholar 

  • Hoffman DL, Dukes EM, Wittchen HU (2008) Human and economic burden of generalized anxiety disorder. Depress Anxiety 25:72–90

    Article  PubMed  Google Scholar 

  • Johansson O, Michel T, Andersson G, Paxling B (2015) Experiences of non-adherence to internet-delivered cognitive behavior therapy: a qualitative study. Internet Interventions 2:137–142

    Article  Google Scholar 

  • Johnston L, Titov N, Andrews G, Spence J, Dear BF (2011) A RCT of a transdiagnostic internet-delivered treatment for three anxiety disorders: examination of support roles and disorder-specific outcomes. PLoS One 6:e28079

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kessler RC, Greenberg PE (2002) The economic burden of anxiety and stress disorders. Neuropsychopharmacology 67:982–992

    Google Scholar 

  • Kessler RC, Wittchen H-U (2002) Patterns and correlates of generalized anxiety disorder in community samples. J Clin Psychiatry 63:4–10

    Article  PubMed  Google Scholar 

  • Kessler RC, Angermeyer M, Anthony JC, De Graaf R, Demyttenaere K, Gasquet I, De Girolamo G, Gluzman S, Gureje O, Haro JM (2007) Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry 6:168

    PubMed  PubMed Central  Google Scholar 

  • Kessler RC, Berglund PA, Chiu WaiTat, Demler O, Glantz M, Lane MA, Jin R, Merikangas KR, Nock M, Olfson M, Pincus HA, Walters EE, Wang PS, Wells KB (2008) The National Comorbidity Survey Replication (NCS-R): cornerstone in improving mental health and Mental Health Care in the United States. The WHO world mental health surveys: global perspectives on the epidemiology of mental disorders 165–210

    Google Scholar 

  • Kirkpatrick T, Manoukian L, Dear BF, Johnston L, Titov N (2013) A feasibility open trial of internet-delivered cognitive-behavioural therapy (ICBT) among consumers of a non-governmental mental health organisation with anxiety. PeerJ 1:e210

    Google Scholar 

  • Klein B, Meyer D, Austin DW, Kyrios M (2011) Anxiety online—a virtual clinic: preliminary outcomes following completion of five fully automated treatment programs for anxiety disorders and symptoms. J Med Internet Res 13:e89

    Article  PubMed  PubMed Central  Google Scholar 

  • Konnopka A, Leichsenring F, Leibing E, König H-H (2009) Cost-of-illness studies and cost-effectiveness analyses in anxiety disorders: a systematic review. J Affect Disord 114:14–31

    Article  PubMed  Google Scholar 

  • Leichsenring F, Salzer S, Jaeger U, Kächele H, Kreische R, Leweke F, Rüger U, Winkelbach C, Leibing E (2009) Short-term psychodynamic psychotherapy and cognitive-behavioral therapy in generalized anxiety disorder: a randomized, controlled trial. Am J Psychiatry 166:875–881

    Article  PubMed  Google Scholar 

  • Levy Berg A, Sandell R, Sandahl C (2009) Affect-focused body psychotherapy in patients with generalized anxiety disorder: Evaluation of an integrative method. J Psychother Integr 19:67

    Article  Google Scholar 

  • Meyer TJ, Miller ML, Metzger RL, Borkovec TD (1990) Development and validation of the penn state worry questionnaire. Behav Res Ther 28:487–495

    Article  CAS  PubMed  Google Scholar 

  • Mewton L, Wong N, Andrews G (2012) The effectiveness of internet cognitive behavioural therapy for generalized anxiety disorder in clinical practice. Depression and Anxiety 29(10):843–849

    Google Scholar 

  • Newby JM, Mackenzie A, Williams AD, Mcintyre K, Watts S, Wong N, ANDREWS G (2013) Internet cognitive behavioural therapy for mixed anxiety and depression: a randomized controlled trial and evidence of effectiveness in primary care. Psychol Med 43:2635–2648

    Article  CAS  PubMed  Google Scholar 

  • Nice 2007 Management of anxiety (panic disorder, with or without agoraphobia, and generalized anxiety disorder) in adults in primary, secondary, and community care. In: Health (ed) Clinical Guideline 22 (amended)

    Google Scholar 

  • Nice 2011 Generalised Anxiety Disorder and Panic Disorder (With Or Without Agoraphobia) in Adults: Management in Primary, Secondary and Community Care. NICE clinical guideline 113. Available at www.nice.org.uk/CG113 [NICE guideline].

  • Nordgren LB, Hedman E, Etienne J, Bodin J, Kadowaki Å, Eriksson S, Lindkvist E, Andersson G, Carlbring P (2014) 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 Therapy 59:1–11

    Article  Google Scholar 

  • Noyes R, Holt CS, Woodman CL (1996) Natural course of anxiety disorders. In: Mavissakalian M, Prien R (eds) Long-term treatments of anxiety disorders. American Psychiatric Press, Washington, DC

    Google Scholar 

  • Olfson M, Gameroff MJ (2007) Generalized anxiety disorder, somatic pain and health care costs. Gen Hosp Psychiatry 29:310–316

    Article  PubMed  Google Scholar 

  • Paxling B, Almlov J, Dahlin M, Carlbring P, Breitholtz E, Eriksson T, Andersson G (2011) Guided internet-delivered cognitive behavior therapy for generalized anxiety disorder: a randomized controlled trial. Cogn Behav Ther 40:159–173

    Article  PubMed  Google Scholar 

  • Rapee RM, Bryant RA (2009) Stress and psychosocial factors in onset of fear circuitry disorders. In: Andrews G, Charney D, Sirovatka P, Regier D (eds) Stress-induced and fear circuitry disorders: advancing the research agenda for DSM-V. American Psychiatric Publishing, In, Arlington

    Google Scholar 

  • Ravindran LN, Stein MB (2009) Anxiety disorders: somatic treatment. In: Sadock BJ, Sadock VA (eds) Kaplan and Sadock comprehensive textbook of psychiatry. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  • Robinson E, Titov N, Andrews G, Mcintyre K, Schwencke G, Solley K (2010) Internet treatment for generalized anxiety disorder: a randomized controlled trial comparing clinician vs technician assistance. PLoS One 5:e10942

    Article  PubMed  PubMed Central  Google Scholar 

  • Roemer L, Orsillo SM (2002) Expanding our conceptualization of and treatment for generalized anxiety disorder: Integrating mindfulness/acceptance‐based approaches with existing cognitive‐behavioral models. Clin Psychol 9:54–68

    Google Scholar 

  • Smit F, Cuijpers P, Oostenbrink J, Batelaan N, De Graaf R, Beekman A (2006) Costs of nine common mental disorders: implications for curative and preventive psychiatry. J Ment Health Policy Econ 9:193–200

    PubMed  Google Scholar 

  • Spitzer RL, Kroenke K, Williams JB, Löwe B (2006) A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 166:1092–1097

    Article  PubMed  Google Scholar 

  • Stanley MA, Beck JG, Glassco JD (1996) Treatment of generalized anxiety in older adults: a preliminary comparison of cognitive-behavioral and supportive approaches. Behav Ther 27:565–581

    Article  Google Scholar 

  • Stein DJ (2006) Evidence-based treatment of anxiety disorders. Int J Psychiatry Clin Pract 10:16–21

    Article  CAS  PubMed  Google Scholar 

  • Svanborg P, Åsberg M (1994) A new self‐rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale. Acta Psychiatr Scand 89:21–28

    Article  CAS  PubMed  Google Scholar 

  • Titov N, Andrews G, Robinson E, Schwencke G, Johnston L, Solley K, Choi I (2009a) Clinician-assisted Internet-based treatment is effective for generalized anxiety disorder: randomized controlled trial. Aust N Z J Psychiatry 43:905–912

    Article  Google Scholar 

  • Titov N, Gibson M, Andrews G, Mcevoy P (2009b) Internet treatment for social phobia reduces comorbidity. Aust N Z J Psychiatry 43:754–759

    Article  PubMed  Google Scholar 

  • Titov N, Andrews G, Johnston L, Robinson E, Spence J (2010) Transdiagnostic Internet treatment for anxiety disorders: A randomized controlled trial, Behaviour Research and Therapy 48:890–899. doi:10.1016/j.brat.2010.05.014

    Google Scholar 

  • Titov N, Dear BF, Schwencke G, Andrews G, Johnston L, Craske MG, Mcevoy P (2011) Transdiagnostic internet treatment for anxiety and depression: a randomised controlled trial. Behav Res Ther 49:441–452

    Article  PubMed  Google Scholar 

  • Titov N, Dear B, Johnston L, Terides M (2012) Transdiagnostic internet treatment for anxiety and depression. Revista de Psicopatologia y Psicologia Clinica (RPPC) 17:237–260

    Article  Google Scholar 

  • Titov N, Dear BF, Johnston L, Lorian C, Zou J, Wootton B, Spence J, Mcevoy PM, Rapee RM (2013) Improving adherence and clinical outcomes in self-guided internet treatment for anxiety and depression: randomised controlled trial. PLoS One 8:e62873

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Titov N, Dear BF, Johnston L, Mcevoy PM, Wootton B, Terides MD, Gandy M, Fogliati V, Kayrouz R, Rapee RM (2014) Improving adherence and clinical outcomes in self-guided internet treatment for anxiety and depression: a 12-month follow-up of a randomised controlled trial. PLoS One 9:e89591

    Article  PubMed  PubMed Central  Google Scholar 

  • Titov N, Dear BF, Staples LG, Bennett-Levy J, Klein B, Rapee RM, Shann C, Richards D, Andersson G, Ritterband L, Purtell C, Bezuidenhout G, Johnston L, Nielssen O (2015) MindSpot Clinic: an accessible, efficient and effective online treatment service for anxiety and depression. Psychiatr Serv 66(10):1043–1050

    Article  PubMed  Google Scholar 

  • Treanor M, Erisman SM, Salters‐Pedneault K, Roemer L, Orsillo SM (2011) Acceptance‐based behavioral therapy for GAD: effects on outcomes from three theoretical models. Depress Anxiety 28:127–136

    Article  PubMed  Google Scholar 

  • Tyrer P, Baldwin D (2006) Generalised anxiety disorder. Lancet 368:2156–2166

    Article  PubMed  Google Scholar 

  • Wells A (1995) Meta-cognition and worry: a cognitive model of generalized anxiety disorder. Behav Cogn Psychother 23:301–320

    Article  CAS  Google Scholar 

  • Wells A, Carter K (1999) Preliminary tests of a cognitive model of generalized anxiety disorder. Behav Res Ther 37:585–594

    Article  CAS  PubMed  Google Scholar 

  • Wells A, King P (2006) Metacognitive therapy for generalized anxiety disorder: an open trial. J Behav Ther Exp Psychiatry 37:206–212

    Article  PubMed  Google Scholar 

  • Wittchen HU (2002) Generalized anxiety disorder: prevalence, burden, and cost to society. Depress Anxiety 16:162–171

    Article  PubMed  Google Scholar 

  • World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 1992

    Google Scholar 

  • Yonkers KA, Bruce SE, Dyck IR, Keller MB (2003) Chronicity, relapse, and illness—course of panic disorder, social phobia, and generalized anxiety disorder: findings in men and women from 8 years of follow‐up. Depress Anxiety 17:173–179

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nickolai Titov .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Titov, N., Andersson, G., Paxling, B. (2016). ICBT in Psychiatry: Generalised Anxiety Disorder. In: Lindefors, N., Andersson, G. (eds) Guided Internet-Based Treatments in Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-319-06083-5_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-06083-5_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-06082-8

  • Online ISBN: 978-3-319-06083-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics