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Randomized Controlled Trial
. 2014 Sep 29;16(9):e226.
doi: 10.2196/jmir.3429.

Short-term effectiveness of web-based guided self-help for phobic outpatients: randomized controlled trial

Robin N Kok  1 , Annemieke van Straten, Aartjan T F Beekman, Pim Cuijpers
Affiliations
Randomized Controlled Trial

Short-term effectiveness of web-based guided self-help for phobic outpatients: randomized controlled trial

Robin N Kok et al. J Med Internet Res. .

Abstract

Background: 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.

Objective: The aim was to assess the clinical effectiveness of Phobias Under Control, an Internet-based intervention based on exposure therapy with weekly guidance.

Methods: 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.

Results: 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.

Conclusions: 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.

Trial registration: Netherlands Trial Register NTR2233; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2233 (Archived by WebCite at http://www.webcitation.org/6O2ioOQSs).

Keywords: Internet therapy; Web-based intervention; anxiety disorders; outpatients; phobias; phobic disorders; randomized controlled trial.

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Conflict of interest statement

Conflicts of Interest: AB has received grants for research from Eli Lilly, AstraZeneca, Janssen, and Shire and as a speaker from Lundbeck and Eli Lilly. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Screenshot of Phobias Under Control: fear hierarchy.
Figure 2
Figure 2
Screenshot of Phobias Under Control: intervention content.
Figure 3
Figure 3
Participant flowchart.
Figure 4
Figure 4
Change in scores between baseline and imputed posttest scores.
See this image and copyright information in PMC

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