The efficacy and pattern of use of a computer-assisted programme for the treatment of anxiety: A naturalistic study using mixed methods in primary care in Spain

• Published in: Journal of affective disorders 2015-04, Vol.175, p.184-191
• Main Authors: Herrera-Mercadal, Paola, Montero-Marin, Jesús, Plaza, Inmaculada, Medrano, Carlos, Andrés, Eva, López-Del-Hoyo, Yolanda, Gili, Margalida, García-Campayo, Javier
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anxiety; Anxiety Disorders - therapy; Barriers; Facilitators; Female; Humans; Male; Middle Aged; Naturalistic study; Patient Compliance; Patient Satisfaction; Primary care; Primary Health Care; Professional-Patient Relations; Psychiatry; Psychotherapy - methods; Spain; Therapy, Computer-Assisted
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2014.12.060

Abstract Background Naturalistic studies to assess the efficacy and pattern of use of computer-delivered psychotherapy programmes in real daily clinical conditions are infrequent. Anxiety disorders are the most common mental disorders, and many of them do not receive adequate management, especially in primary care settings. The objective of this study is to assess the efficacy of an internet-delivered programme for anxiety in primary care. Methods Multicentre, naturalistic study. Patients with generalised anxiety disorder were recruited ( N =229). The generalised anxiety disorder 7-item scale (GAD-7) was the only outcome measured. Qualitative methods were used to analyse patient–therapist interactions. Results Only 13.5% of patients completed the programme. Analysis per intent-to-treat using Last Observation Carried Forward showed a significant GAD-7 decrease post-treatment (−2.17: SD=4.77; p =0.001) (Cohen׳s d =0.43) with a correlation between the number of sessions and decrease in anxiety (Rho=−0.34, p =0.001). The analysis per protocol showed significantly decreased GAD-7 (−4.13; SD=6.82; p =0.002) ( d =0.80). Withdrawal was related to low programme friendliness, lack of a partner, and higher education. Only 17.47% of the patients consulted their therapists. Facilitators were patient demand for information and sufficient time. Barriers were lack of motivation and lack of connection with the programme. Limitations The main limitations of this study included the use of an open trial design, the lack of follow-up, and the inclusion of only one outcome (GAD-7). Conclusions To our knowledge, this is the first study with computer-delivered psychotherapy (CDP) on GAD. CDP for anxiety is efficacious in naturalistic environments. Specific facilitators and barriers should be considered.