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- Title
Short-term effectiveness of web-based guided self-help for phobic outpatients: randomized controlled trial.
- Authors
Kok, Robin N.; van Straten, Annemieke; Beekman, Aartjan T. F.; Cuijpers, Pim
- Abstract
<bold>Background: </bold>Internet-based guided self-help has been successfully used in the general population, but it is unknown whether this method can be effectively used in outpatient clinics for patients waiting for face-to-face psychotherapy for phobias.<bold>Objective: </bold>The aim was to assess the clinical effectiveness of Phobias Under Control, an Internet-based intervention based on exposure therapy with weekly guidance.<bold>Methods: </bold>We conducted a randomized controlled trial, recruiting 212 outpatients scheduled to receive face-to-face psychotherapy for any type of phobia at an outpatient clinic. Participants suffering from at least 1 DSM-IV or ICD-10 classified phobia (social phobia, agoraphobia with or without panic disorder, and/or specific phobia as ascertained by a telephone interview at baseline) were randomly allocated to either a 5-week Internet-based guided self-help program based on exposure therapy with weekly student support followed by face-to-face psychotherapy (n=105) or a wait-list control group followed by face-to-face psychotherapy (n=107). Primary outcome was the Fear Questionnaire (FQ). Secondary outcomes were the Beck Anxiety Inventory (BAI) and Center of Epidemiological Studies-Depression scale (CES-D). Assessments took place by telephone at baseline (T0) and on the Internet at posttest (T1, self-assessment at 5 weeks after baseline). Missing data at T1 were imputed.<bold>Results: </bold>At posttest, analysis of covariance on the intention-to-treat sample showed significant but small effect sizes between intervention and control groups on the FQ (d=0.35, P=.02), CES-D (d=0.34, P=.03), and a nonsignificant effect size on the BAI (d=0.28. P=.05). Although initial acceptance was good, high nonresponse was observed, with 86 of 212 participants (40.5%) lost to follow-up at T1 and only 14 of 105 (13.3%) intervention participants finishing all 5 weeks.<bold>Conclusions: </bold>Phobias Under Control is modestly effective in lowering phobic and depressive symptoms in a relatively short period and may be clinically beneficial when implemented in routine outpatient practice.<bold>Trial Registration: </bold>Netherlands Trial Register NTR2233; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2233 (Archived by WebCite at http://www.webcitation.org/6O2ioOQSs).
- Subjects
NETHERLANDS; MENTAL depression; THERAPEUTICS; PHOBIAS treatment; OUTPATIENT medical care; BEHAVIOR therapy; HEALTH behavior; INTERNET; PSYCHOLOGICAL tests; QUESTIONNAIRES; SELF-evaluation; HUMAN services programs
- Publication
Journal of Medical Internet Research, 2014, Vol 16, Issue 9, pe226
- ISSN
1439-4456
- Publication type
journal article
- DOI
10.2196/jmir.3429