TY  - JOUR
AU  - Ritola, Ville
AU  - Lipsanen, Jari Olavi
AU  - Pihlaja, Satu
AU  - Gummerus, Eero-Matti
AU  - Stenberg, Jan-Henry
AU  - Saarni, Suoma
AU  - Joffe, Grigori
PY  - 2022
DA  - 2022/3/24
TI  - Internet-Delivered Cognitive Behavioral Therapy for Generalized Anxiety Disorder in Nationwide Routine Care: Effectiveness Study
JO  - J Med Internet Res
SP  - e29384
VL  - 24
IS  - 3
KW  - CBT
KW  - iCBT
KW  - cognitive behavioral therapy
KW  - routine care
KW  - generalized anxiety disorder
KW  - internet
KW  - web-based
KW  - digital health
KW  - mental health
AB  - Background: Therapist-supported, internet-delivered cognitive behavioral therapy (iCBT) is efficacious for generalized anxiety disorder (GAD), but few studies are yet to report its effectiveness in routine care. Objective: In this study, we aim to examine whether a new 12-session iCBT program for GAD is effective in nationwide routine care. Methods: We administered a specialized, clinic-delivered, therapist-supported iCBT for GAD in 1099 physician-referred patients. The program was free of charge for patients, and the completion time was not predetermined. We measured symptoms with web-based questionnaires. The primary measure of anxiety was the GAD 7-item scale (GAD-7); secondary measures were, for pathological worry, the Penn State Worry Questionnaire and, for anxiety and impairment, the Overall Anxiety Severity and Impairment Scale. Results: Patients completed a mean 7.8 (SD 4.2; 65.1%) of 12 sessions, and 44.1% (485/1099) of patients completed all sessions. The effect size in the whole sample for GAD-7 was large (Cohen d=0.97, 95% CI 0.88-1.06). For completers, effect sizes were very large (Cohen d=1.34, 95% CI 1.25-1.53 for GAD-7; Cohen d=1.14, 95% CI 1.00-1.27 for Penn State Worry Questionnaire; and Cohen d=1.23, 95% CI 1.09-1.37 for Overall Anxiety Severity and Impairment Scale). Noncompleters also benefited from the treatment. Greater symptomatic GAD-7–measured relief was associated with more completed sessions, older age, and being referred from private or occupational care. Of the 894 patients with a baseline GAD-7 score ≥10, approximately 421 (47.1%) achieved reliable recovery. Conclusions: This nationwide, free-of-charge, therapist-supported HUS Helsinki University Hospital–iCBT for GAD was effective in routine care, but further research must establish effectiveness against other treatments and optimize the design of iCBT for GAD for different patient groups and individual patients. 
SN  - 1438-8871
UR  - https://www.jmir.org/2022/3/e29384
UR  - https://doi.org/10.2196/29384
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35323119
DO  - 10.2196/29384
ID  - info:doi/10.2196/29384
ER  -