J. Med. Internet Res. - Short-term effectiveness of web-based guided self-help for phobic outpatients: randomized controlled trial.


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CKGROUND: 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).

Resumo Limpo

ckground internetbas guid selfhelp success use general popul unknown whether method can effect use outpati clinic patient wait facetofac psychotherapi phobiasobject aim assess clinic effect phobia control internetbas intervent base exposur therapi week guidancemethod conduct random control trial recruit outpati schedul receiv facetofac psychotherapi type phobia outpati clinic particip suffer least dsmiv icd classifi phobia social phobia agoraphobia without panic disord andor specif phobia ascertain telephon interview baselin random alloc either week internetbas guid selfhelp program base exposur therapi week student support follow facetofac psychotherapi n waitlist control group follow facetofac psychotherapi n primari outcom fear questionnair fq secondari outcom beck anxieti inventori bai center epidemiolog studiesdepress scale cesd assess took place telephon baselin t internet posttest t selfassess week baselin miss data t imputedresult posttest analysi covari intentiontotreat sampl show signific small effect size intervent control group fq d p cesd d p nonsignific effect size bai d p although initi accept good high nonrespons observ particip lost followup t intervent particip finish weeksconclus phobia control modest effect lower phobic depress symptom relat short period may clinic benefici implement routin outpati practicetri registr netherland trial regist ntr httpwwwtrialregisternltrialregadminrctviewasptc archiv webcit httpwwwwebcitationorgoiooqss

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