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Internet-based CBT benefits patients in real-world clinics

Image of Andrea N Niles
Andrea Niles

Internet-based cognitive behavioral therapy had large effects for symptom improvement when implemented among patients with social phobia, panic disorder or depression in a real-world clinic, according to a presentation from the Anxiety and Depression Association of America annual conference.

Andrea N. Niles, PhD, postdoctoral research fellow at the San Francisco VA Medical Center and the University of California, San Francisco, presented data from a real-world clinic that administered internet-based cognitive behavioral therapy (iCBT). Although evidence supports iCBT for the treatment of anxiety and depression, its effectiveness in real-world clinics remains largely unknown.

In this study, researchers examined the effects of iCBT on symptom reduction in patients with social phobia, panic disorder or depression receiving treatment between 2014 and 2017 at the Karolinska Institutet. They assigned patients to treatments based on the most severe presenting disorder. Patients received 10 weeks of iCBT with internet-based self-help materials from manualized treatment protocols for each of the three conditions and received weekly email support from a clinician.

Niles and colleagues found that patients receiving iCBT for depression showed significant reductions in depressive symptoms (Cohen’s d = 1.21); the effects were largest for patients without previous therapy (r = 0.21) and for those with more frequent depressive thoughts at baseline (r = 0.2).

Patients who received treatment for social phobia showed significant large effects for decrease in related symptoms (Cohen’s d = 1.17); the effects were largest for patients taking medication (r = 0.18) and those with negative social-related cognitions (r =0 .17), according to the meeting abstract. In addition, patients with panic disorder also demonstrated significant large effects for reduction in symptom severity (Cohen’s d = 1.17); patients with more safety behaviors at baseline saw the best outcomes (r = 0.25).

“We showed that demographics were unrelated to treatment response, but that baseline endorsement of negative cognitions for social anxiety disorder and depression and engagement in more safety behaviors for panic disorder, predicted better treatment response,” Niles told Healio Psychiatry. “These findings indicate that baseline deficits in the mechanisms targeted in CBT predict superior treatment outcomes, providing support for a deficit model (that people with deficits in the mechanism targeted in treatment will benefit more from that treatment).

“These findings add to a growing body of literature supporting use of the internet as an effective modality for administration of CBT,” Niles said. “If the deficit model continues to accumulate empirical support, this framework can be used to guide treatment decision making, with assessment of baseline deficits guiding selection of a treatment that targets those deficits.”– by Savannah Demko

References:

Niles AN, Ljótsson B, et al. Outcomes and predictors of response to iCBT for social phobia, panic disorder and depression: Evidence from a world-world clinic. Presented at: The Anxiety and Depression Association of America 39th Annual Conference; Mar. 28-31, 2019; Chicago.

Disclosures: Niles reports no relevant financial disclosures.

Image of Andrea N Niles
Andrea Niles

Internet-based cognitive behavioral therapy had large effects for symptom improvement when implemented among patients with social phobia, panic disorder or depression in a real-world clinic, according to a presentation from the Anxiety and Depression Association of America annual conference.

Andrea N. Niles, PhD, postdoctoral research fellow at the San Francisco VA Medical Center and the University of California, San Francisco, presented data from a real-world clinic that administered internet-based cognitive behavioral therapy (iCBT). Although evidence supports iCBT for the treatment of anxiety and depression, its effectiveness in real-world clinics remains largely unknown.

In this study, researchers examined the effects of iCBT on symptom reduction in patients with social phobia, panic disorder or depression receiving treatment between 2014 and 2017 at the Karolinska Institutet. They assigned patients to treatments based on the most severe presenting disorder. Patients received 10 weeks of iCBT with internet-based self-help materials from manualized treatment protocols for each of the three conditions and received weekly email support from a clinician.

Niles and colleagues found that patients receiving iCBT for depression showed significant reductions in depressive symptoms (Cohen’s d = 1.21); the effects were largest for patients without previous therapy (r = 0.21) and for those with more frequent depressive thoughts at baseline (r = 0.2).

Patients who received treatment for social phobia showed significant large effects for decrease in related symptoms (Cohen’s d = 1.17); the effects were largest for patients taking medication (r = 0.18) and those with negative social-related cognitions (r =0 .17), according to the meeting abstract. In addition, patients with panic disorder also demonstrated significant large effects for reduction in symptom severity (Cohen’s d = 1.17); patients with more safety behaviors at baseline saw the best outcomes (r = 0.25).

“We showed that demographics were unrelated to treatment response, but that baseline endorsement of negative cognitions for social anxiety disorder and depression and engagement in more safety behaviors for panic disorder, predicted better treatment response,” Niles told Healio Psychiatry. “These findings indicate that baseline deficits in the mechanisms targeted in CBT predict superior treatment outcomes, providing support for a deficit model (that people with deficits in the mechanism targeted in treatment will benefit more from that treatment).

“These findings add to a growing body of literature supporting use of the internet as an effective modality for administration of CBT,” Niles said. “If the deficit model continues to accumulate empirical support, this framework can be used to guide treatment decision making, with assessment of baseline deficits guiding selection of a treatment that targets those deficits.”– by Savannah Demko

References:

Niles AN, Ljótsson B, et al. Outcomes and predictors of response to iCBT for social phobia, panic disorder and depression: Evidence from a world-world clinic. Presented at: The Anxiety and Depression Association of America 39th Annual Conference; Mar. 28-31, 2019; Chicago.

Disclosures: Niles reports no relevant financial disclosures.

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