Summary of Research Support for Web-Based CBT

Overview

Controlled studies consistently reveal that Web-Based Cognitive Behavioral Training (WCBT) is an effective solution for several anxiety disorders, depression, and a number of other mental health and adjustment problems. In these studies, users provided with WCBT have had much better outcomes than those in control groups. In fact, WCBT has performed as well as the current therapy of choice, face to face Cognitive Behavioral Therapy (FCBT), in severa0 l (e.g., Furmark et al 2009, Bergstrom et al, 2010).1

WCBT Effectiveness for Anxiety and Depression - General

Numerous studies have supported the effectiveness of WCBT for depression and anxiety. A meta-analysis of 22 randomized controlled trials demonstrated WCBT’s effectiveness for anxiety disorders and depression (Andrews et al, 2010). WCBT has been exceedingly well-received by participants in the studies. Users report that WCBT is as credible as FCBT and they like it much or more than FCBT (Newman et al 1997).

Reviewers of the research report WCBT provides better

• cost-effectiveness,
• standardization/consistency of services,
• accessibility, and
• privacy (eg, Khanna et al 2007)

The National Institute for Health and Clinical Excellence (NICE) in Great Britain has already approved two WCBT packages as effective treatments for anxiety and depression (NICE, 2006). Such an endorsement requires a broad range of (a) effectiveness and (b) cost-benefit data. (Note that much of the recent WCBT research has been conducted in the UK, Scandinavia, and Australia.)

Highlights of WCBT Research for Social Anxiety Disorder

WCBT has effectively reduced problems with Social Anxiety Disorders in numerous studies. Two recent, compelling studies, one in Switzerland and the other in Australia are noted below, due their excellent design and relevance. They suggest the following:

1. WCBT is effective for Social Anxiety Disorder.
2. WCBT is effective even if offered without any therapist support.

Highlights of WCBT Research for Panic

Numerous trials of WCBT have been conducted for addressing Panic Disorder. These studies have, with few exceptions, yielded compelling results. Some have been modestscale trials while others have been randomized controlled trials (RCTs). As the table below displays, WCBT has outperformed control groups. Several studies have found it as effective as FCBT, which is often viewed as the treatment of choice for Panic Disorder, due to its effectiveness that matches or surpasses medications and produces more durable benefits.2

The consistent conclusion of these investigations has been that WCBT is a very promising solution for Panic Disorder, particularly well-suited as the first step in a stepped-care model. See these recent examples of studies from the U.K., Australia, and Sweden, where research activity has been notable:

Highlights of WCBT Research for Depression

WCBT has effectively treated Major Depression in several studies. Randomized controlled trials with large samples have demonstrated impressive effectiveness of WCBT for depression (e.g., Clarke et al 2005). And when compared to treatment-as-usual, WCBT has produced much better outcomes, even for moderate and severe depression, even after 6 months, and even when many of the users had never used computers before (e.g., Proudfoot et al 2004). Cost-effectiveness studies have further identified WCBT as a costeffective treatment for depression, even when the price of the treatment in substantial (~$180/user) and the valuation of change is modest (McCrone et al, 2004).

Because of results like these, a WCBT package for depression was the first approved by the National Institute for Health and Clinical Excellence (NICE) in the UK in 2002.

Notes:

1. Note that, in turn, FCBT has performed comparably to medications, the most common treatments for these disorders.
2. Note that one of the principle researchers in successful Swedish projects, Per Carlbring PhD, is presently consulting on Learn to Live projects.

---

Sources

Andersson,G.,Carlbring, P.,Holmstrom, A., et al (2006). Internet-based self-help with therapist feedback and in-vivo group exposure for social phobia: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 74: 677-686.

Andrews G, Cuijpers P, Craske MG, McEvoy P, Titov N (2010) Computer Therapy for the Anxiety and Depressive Disorders Is Effective, Acceptable and Practical Health Care: A Meta-Analysis. PLoS ONE 5(10): e13196.

Andrews G, Davies M, Titov N. (2011). Effectiveness randomized controlled trial of face to face versus Internet cognitive behaviour therapy for social phobia. Aust N Z J Psychiatry.2011 Apr;45(4):337-40. Epub 2011 Feb 16.

Barlow, D.H. (2002). Anxiety and its Disorders. New York: Guilford Press.

Bergstrom, J. (2005). Internet-based CBT for panic disorder in a psychiatric setting. Presentation at Anxiety Disorders Association of America Annual Conference.

Bergström J, Andersson G, Ljótsson B, Rück C, Andréewitch S, Karlsson A, Carlbring P, Andersson E, Lindefors N (2010). Internet- versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting: a randomised trial. BMC Psychiatry 2010, 10:54

Carlbring, P., Ekselius, L., Anderrson, G. (2003). Treatment of panic disorder via the internet: A randomized trial of CBT vs. applied relaxation. Journal of Behavior Therapy & Experimental Psychiatry, 34: 129-140.

Carlbring P, Gunnarsdottir, M., Hedensjo, L., Anderrson, Ekselius, L., Furmark, T. (2007). Treatment of Social Phobia: Randomized trial of internet delivered cognitve-behavioral therapy with telephone support. British Journal of Psychiatry, 190:123-128.

Carlbring P, Nilsson-Ihrfelt E, Waara J, Kollenstam C, Buhrman M, Kaldo V, Soderberg M, Ekselius L, Andersson G. (2005). Treatment of panic disorder: Live therapy vs. self-help via the Internet. Behav Res Ther,43:1321-33.

Carlbring, P., Westling, B., Ljungstrand et al (2001). Treatment of panic disorder via the internet: A randomized trial of a self-help program. Behavior Therapist, 32: 751-764.

Clarke G, Eubanks D, Reid Ed, Kelleher C, O'Connor E, DeBar LL, Lynch F, Nunley S, Gullion C (2005). Overcoming Depression on the Internet (ODIN) (2): A Randomized Trial of a Self-Help Depression Skills Program With Reminders. J Med Internet Res 2005;7(2):e16

Furmark, T., Carlbring, P., Hedman, E., Sonnenstein, A., Clevberger, P., Bohman, B., et al. (2009). Guided and unguided self-help for social anxiety disorder: randomized controlled trial. British Journal of Psychiatry, 195, 440e447.

Khanna, M, Aschenbrand, S, & Kendall, P (2007). New frontiers: computer technology in the treatment of anxious youth. The Behavior Therapist, 2007, January: 22-25.

Kenwright, M., Liness, S., & Marks, I. (2001). Reducing demands on clinicians by offering computer-aided self-help for phobia/panic: A feasibility study. British Journal of Psychiatry, 179:456-459.

Kiropoulos LA, Klein B, Austin DW, Gilson K, Pier C, Mitchell J, Ciechomski L. (2008). Is internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT? J Anxiety Disord. 2008 Dec;22(8):1273-84. Epub 2008 Jan 18.

Klein, B. (2002). A randomized controlled trial of internet-based therapy for panic disorder. Unpubished doctoral dissertation. University of Ballarat, Australia.

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 2011;13(4):e89

Marks, I., Kenwright, M., McDonough, M., Whittacker, M., & Mataix-Cols, D. (2004). Saving clinician’s time by delegating routine aspects of therapy to a computer: A randomized, controlled trial in phobic/panic disorder. Psychological Medicine, 34: 9-17.

National Institute for Health and Clinical Excellence (NICE). Computerised cognitive behaviour therapy for depression and anxiety. London (UK): National Institute for Health and Clinical Excellence (NICE); 2006 Feb. 38 p. (Technology appraisal; no. 97).

Otto, M.W., Pollack, M.H., & Maki, K.M. (2000). Empirically supported treatments for panic: Costs, benefits, and stepped care. Journal of Consulting & Clinical Psychology, 68: 556-563.

Proudfoot J, Ryden C, Everitt, Shapiro D, Goldberg D, Mann A, Tylee A, Marks I, Gray J (2004). Clinical efficacy of computerised cognitive-behavioural therapy for anxiety and depression in primary care: randomized controlled trial. Br Jou of Psychiatry, 185:46-54.

Richards, J & Alvarenga, M.E. Extension and replications of an internet-based treatment program for panic disorder. Cognitive Behaviour Therapy, 31, 41-47.

Salvador-Cordulla, Segui, P., Fendandez-Cano, P., & Canet, J. (1995). Costs and offset effect in panic disorder. British Journal of Psychiatry, 177 (suppl. 27), 23-28.

Schneider, A., Mataix-Cols, D., Marks, I., Bachofen, M. (2005). Internet-guided self-help with or without exposure therapy for phobic and panic disorders. Psychotherapy and Psychosomatics, 74: 154-164.

Spek V, Cuijpers P, Nyklíèek I, Riper H, Pop V(2006). Internet-based cognitive behavioral therapy for mood and anxiety disorders: A systematic review of randomized controlled trials. The Second Meeting of the International Society for Research on Internet Interventions April 28-29, 2006 Karolinska Institutet, Stockholm, Sweden.