Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
J Med Internet Res. 2020 Sep 16;22(9):e16450. doi: 10.2196/16450.
Internet interventions have been shown to be effective in treating anxiety disorders. Most interventions to date focus on single disorders and disregard potential comorbidities.
The aim of this mixed-methods study was to investigate feasibility, user experience, and effects of a newly developed individually tailored transdiagnostic guided internet intervention for anxiety disorders.
This study is an uncontrolled, within-group, baseline, postintervention pilot trial with an embedded qualitative and quantitative process and effect evaluation. In total, 49 adults with anxiety disorders (generalized anxiety disorder n=20, social phobia n=19, agoraphobia without panic n=12, panic with agoraphobia n=6, panic without agoraphobia n=4, subclinical depression n=41) received access to the 7-session intervention. We examined motivation and expectations, intervention use, user experience, impact, and modification requests. Qualitative data were assessed using semistructured interviews and analyzed by qualitative content analysis. Quantitative outcomes included symptom severity of anxiety and depression (Hamilton Anxiety Rating Scale [HAM-A], Quick Item Inventory of Depressive Symptomatology clinician rating [QIDS-C]), diagnostic status in clinical interviews (Mini International Neuropsychiatric Interview [MINI]), and web-based self-reports (Generalized Anxiety Disorder-7 [GAD-7], Center for Epidemiological Studies Depression Scale [CES-D], Beck Anxiety Inventory [BAI], Panic and Agoraphobia Scale [PAS], Social Phobia Scale [SPS], Patient Health Questionnaire-9 [PHQ-9]) at baseline and postassessment. Quantitative data was analyzed by comparing within-group means expressed as Cohen d.
Anxiety symptom severity (HAM-A d=1.19) and depressive symptoms (QIDS-C d=0.42) improved significantly, and 54% (21/39) no longer were diagnosed as having any anxiety disorder. The main positive effects were the general improvement of disease burden and attentiveness to feelings and risk situations while the main negative effects experienced were lack of change in disease burden and symptom deterioration. The most prevalent reasons for participation were the advantages of online treatment, symptom burden, and openness toward online treatment. Helpful factors included support, psychoeducation and practicing strategies in daily life; the main hindering factors were too little individualization and being overwhelmed by the content and pace.
The intervention was found to be feasible and results show preliminary data indicating potential efficacy for improving anxiety and depression. The next step should be the evaluation within a randomized controlled trial. Concerning intervention development, it was found that future interventions should emphasize individualization even more in order to further improve the fit to individual characteristics, preferences, and needs.
互联网干预已被证明对治疗焦虑症有效。迄今为止，大多数干预措施都集中在单一疾病上，而忽略了潜在的共病。
本混合方法研究旨在调查新开发的个体化针对性的焦虑障碍互联网干预的可行性、用户体验和效果。
本研究为无对照、组内、基线、干预后试点试验，嵌入了定性和定量的过程和效果评估。共有 49 名患有焦虑症的成年人（广泛性焦虑症 n=20，社交恐惧症 n=19，广场恐惧症无惊恐症 n=12，惊恐症伴广场恐惧症 n=6，惊恐症无广场恐惧症 n=4，亚临床抑郁症 n=41）获得了 7 节干预课程的访问权限。我们调查了动机和期望、干预使用、用户体验、影响和修改请求。定性数据采用半结构化访谈进行评估，并采用定性内容分析进行分析。定量结果包括焦虑和抑郁的症状严重程度（汉密尔顿焦虑量表[HAM-A]，快速项目抑郁症状评定量表[QIDS-C]临床医生评定），临床访谈中的诊断状况（迷你国际神经精神访谈[MINI]）和基于网络的自我报告（广泛性焦虑症-7 项[GAD-7]，流行病学研究抑郁量表[CES-D]，贝克焦虑量表[BAI]，惊恐和广场恐惧症量表[PAS]，社交恐惧症量表[SPS]，患者健康问卷-9[PHQ-9]）在基线和后评估时。定量数据通过比较表示为 Cohen d 的组内均值进行分析。
焦虑症状严重程度（HAM-A d=1.19）和抑郁症状（QIDS-C d=0.42）显著改善，54%（21/39）不再被诊断为患有任何焦虑症。主要的积极影响是疾病负担的普遍改善和对感觉和风险情况的关注，而主要的负面影响是疾病负担没有变化和症状恶化。参与的主要原因是在线治疗的优势、疾病负担和对在线治疗的开放性。有益因素包括支持、心理教育和日常生活中的策略实践；主要的阻碍因素是个性化程度不够，以及内容和节奏过多。
该干预措施被发现是可行的，结果表明初步数据表明改善焦虑和抑郁具有潜在疗效。下一步应该是在随机对照试验中进行评估。关于干预措施的发展，发现未来的干预措施应该更加注重个性化，以进一步提高与个体特征、偏好和需求的匹配度。
